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A 65-year-old female, gravida 4, para 4, presents with a worsening bulge in her vagina. She describes a dragging sensation in the vagina that is worse at the end of the day. She has increased the fiber in her diet to help with constipation. Despite this, over the past three months, she has had increased straining with bowel movements. Now, she must digitally place pressure on the bulge in the vagina to evacuate the rectum.