Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic symptoms of obstructed defecation, including sensation of incomplete evacuation, excessive straining, and frequent digital manipulation to facilitate stool passage. Symptoms are exacerbated by prolonged sitting and physical activity. No history of rectal bleeding or weight loss.
Clinical Examination Findings
Physical examination reveals perineal descent during straining (perineal paradox). Digital rectal examination (DRE) demonstrates reduced resting anal sphincter tone and paradoxical contraction of the puborectalis muscle during simulated defecation. Anoscopy confirms mucosal prolapse and redundant rectal mucosa.
Treatment Protocol
Management plan includes pelvic floor physical therapy (biofeedback) to retrain defecation dynamics, dietary modification with high-fiber intake, and stool softeners. Surgical intervention (e.g., ventral rectopexy) is reserved for refractory cases with significant anatomical prolapse.