Pulsion enterocele has a well-deserved reputation as a difficult surgical problem; the multiplicity of suggested solution attests to this. Until the functional anatomy of the pelvic floor is better understood, particularly the specific anatomic defects involved, planning of a rational surgical attack will remain elusive. Both the pelvic cellular tissues and the levator ani complex are involved in the genesis of the condition, and both require correction during any surgical procedure. The supporting effect of the levator complex and the positioning effect of the cellular tissues must be restored.