A careful digital rectal examination, including assessment of pelvic floor motion during simulated evacuation, is preferable to a cursory examination without these maneuvers and should be performed prior to referral for anorectal manometry A normal exam, however, does not exclude defecatory disorders.
In addition to colonic transit testing, after ruling out a defecatory disorder, other recommended tests to assess for medical causes of constipation include a complete red blood count.
In this phase, the patients were assessed in the same way that in the baseline period (self-monitoring of each defecatory episode and four sessions of psychophysiological valuation).
This interesting discovery may be a result of the generalization effects of behavioural treatment and of the defecatory process normalization as a result of proper practice.
Patients with mild constipation and defecatory
complaints may benefit from the addition of a probiotic preparation.
Pelvic support defects may contribute to pelvic organ prolapse, urinary and anal incontinence, sexual, voiding, and defecatory
There have been no recurrences of prolapse or any evidence of urinary, defecatory
or coital dysfunctions in sexually-active patients during mean follow-up period (12 months).
Problems may present as genital bleeding, unusual vaginal discharge, pain or pressure, and/or defecatory
complaints, or may only be identified on routine vaginal examination (Sarma et al.
In a study of > 1000 patients with primary constipation, normal-transit constipation was most prevalent (59%), followed by defecatory
disorders (25%), slow-transit (13%), and a combination of defecatory
disorders and slow-transit (3%).
A systematic review by Rao et al concluded that evidence to support the use of Diagnostic findings in patients with defecatory disorders blood tests, radiography, or endoscopy in the routine workup of patients with constipation without alarm features is lacking.
TABLE 3 Diagnostic findings in patients with defecatory disorders History Prolonged strain to expel stool Unusual postures on the toilet to facilitate stool expulsion Support of the perineum, digitation of rectum, or posterior vaginal pressure to facilitate rectal emptying Inability to expel enema fluid Constipation after subtotal colectomy for constipation Rectal examination (with patient in left lateral position) Inspection Anus pulled forward while the patient is bearing down Anal verge descends <1.
dysfunction, characterized by incomplete evacuation and digital manipulation, was associated with worsening posterior compartment POP.