Anterior Perineal Techniques 
Anterior approaches to the pelvic floor and anal sphincters have been developed, but remain less well-known than posterior techniques. This is surprising when one considers that it is the anterior wall of the rectum that is exposed when the pelvic floor gives way. Rectal prolapse manifests itself by an initial anterior invagination and descent of the rectal wall; mucosal prolapse is most often apparent on the anterior aspect of the lower rectum: childbirth trauma to the recto-vaginal septum and perineal body occurs in the anterior quadrant; solitary rectal ulcer and the mucosal lesions of anal abuse (sexual or otherwise) preferentially occur on the anterior aspects of the rectal lumen. The mechanical effects of stretching, tearing and compression are found most often (and to their greatest extents) on the tissues in front of the rectum and anal canal, and the anal sphincter muscles are shorter and less well-defined anteriorly than they are laterally and posterioly (especially in female subjects).
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