Physical Examination

Pelvic Examination

Normal external genitalia. Urethra, bladder, and vagina were normal. First degree cervical prolapse with good vaginal vault support.

Second degree midline cystocele associated with second degree enterocele and third degree rectocele. Vaginal caliber was normal to slightly enlarged.

Bimanual examination was normal with no uterine enlargement and no adnexal masses. There was mild attenuation of the perineal body.

Reflexes and sensation were normal suggesting neuromuscular integrity. Total vaginal length was 9.2 cm.

Rectal Examination

Thin rectovaginal septum with a probable anteriorly based anal sphincter defect. Decreased resting pressures and no squeeze pressures were identified. Sensation to sharp stimuli in the perianal area was normal.

Constipation Prescription

Constipation Prescription

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