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Fig. 4 —Anismus defined as incomplete evacuation after 30 sec or nonrelaxing musculus puborectalis during evacuation in 72-year-old man. Rectum below main rectal fold should empty in less than 30 sec; retention proximally was not significant. We defined complete obliteration of puborectalis impression (P) as total relaxation of puborectalis muscle during attempted evacuation; incomplete obliteration was defined as paradoxical contraction of or inability to relax puborectalis muscle during attempted evacuation, leading to poor rectal emptying. (Reprinted with permission from [16])