Physical Examination

Enterocele may occur in association with rectocele and may be difficult to differentiate on physical examination. Rectovaginal examination may demonstrate the rectocele as distinct from the bulging sac that arises from a point higher in the vagina, often near the apex. Visual inspection of the posterior vaginal wall may reveal a transverse furrow between the two hernias, and usually,loops of small bowel can be palpated through the vaginal wall overlying the enterocele. Occasionally, peristalsis of small bowel loops filling the enterocele sac may be seen during the examination.

Physical examination should begin with the patient in lithotomy position, as for a routine pelvic examination. Pelvic organ prolapse defects can be identified best by using a Sims speculum or the split blade of a Graves speculum. After the resting examination, the patient is instructed to strain forcefully or cough vigorously. During this maneuver, descent of the vagina is observed systemat ically and staged according to the pelvic organ prolapse quantification system that has been adopted by the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons.6 When the physical findings cannot be adequately evaluated in the supine position, the woman is reexamined in the standing position. The patient should be asked if the prolapse exhibited during the examination is consistent with the maximal prolapse she typically experiences.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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