Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic constipation and symptoms of obstructed defecation. Reports sensation of incomplete evacuation, prolonged straining, and frequent use of digital maneuvers to assist stool passage. Anorectal manometry and/or balloon expulsion test confirm Type II Pelvic Floor Dyssynergia characterized by inadequate propulsive force during attempted defecation despite appropriate relaxation of the pelvic floor musculature.
Clinical Examination Findings
Physical examination reveals normal anal tone at rest. Digital rectal examination (DRE) demonstrates paradoxical contraction or failure to generate adequate intra-abdominal pressure during simulated defecation. Perineal descent is noted to be within normal limits, but the patient exhibits a lack of effective propulsive force. No evidence of rectocele, rectal prolapse, or significant hemorrhoidal disease noted.
Treatment Protocol
Recommended treatment plan: Biofeedback therapy (anorectal manometry-assisted) to retrain pelvic floor coordination and improve abdominal wall recruitment. Implementation of a high-fiber diet and adequate fluid intake. Optimization of bowel habits (e.g., using a footstool to improve anorectal angle). Consider pelvic floor physical therapy for strengthening and coordination exercises.