Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic constipation and symptoms of obstructed defecation. Reports sensation of incomplete evacuation, excessive straining, and frequent need for digital assistance. No history of rectal bleeding or weight loss. Symptoms refractory to high-fiber diet and osmotic laxatives.
Clinical Examination Findings
Abdominal exam: Soft, non-tender, non-distended. Digital Rectal Exam (DRE): Increased resting anal sphincter tone. Paradoxical contraction of the puborectalis muscle noted upon attempted defecation (straining maneuver). Rectal vault empty of stool. No masses or fissures identified.
Treatment Protocol
Initiate pelvic floor physical therapy with biofeedback training to restore coordinated defecation. Recommend pelvic floor muscle relaxation exercises. Consider short-term use of stool softeners to reduce straining. Follow-up in 6-8 weeks to assess progress in dyssynergic patterns.