Summary Defects in the anatomic relationship between the vagina and rectum may produce or aggravate symptoms that are attributed to anorectal disease. The anus and rectum may play only a secondary role when perineal relaxation is also present. The most common perineal deformity requiring repair is rectocele which can be demonstrated readily during routine digital examination of the rectum. Twenty patients with perineal relaxation combined with anorectal disease were operated upon for both conditions. Six had undergone seven anorectal operations that proved inadequate because associated perineal relaxation was not corrected. All are well 7 months to 4 years later. Plastic perineal repair should be combined with an appropriate anorectal operation when perineal relaxation and anorectal disease are associated.