High and low take-off external prolapse phenotypes can be characterised preoperatively on defaecation proctography

In this first formalised description and definition of take-off in the literature, we have shown that defaecating proctogram can satisfactorily identify, discriminate between and characterise two distinct external prolapse phenotypes. We propose two distinct causal pathways to external rectal prolapse, connective tissue failure and levator ani factors. Take-off should be a consideration as a prognostic in clinical practice and research trials.