A 65-year-old man presented to the office complaining of chronic constipation. The patient has bowel movement that occurs every 4 days, the stool is hard. The patient has difficulty defecation, with incomplete evacuation. The patient uses his fingers to induce defecation. Medical history is significant for multiple sclerosis, for which he takes interferon therapy. Vital signs are unremarkable. On examination, the patient has a distended, non-tender abdomen. This patient's presentation is due to inadequate relaxation of which of the following muscles?

Question

Quizplus · Accepted Answer

Eductional Objective: Dyssynergia results from the inadequate relaxation of the internal and external sphincter and the puborectalis. Dyssynergia leads to chronic constipation. Dyssynergia is common in elderly patients, Parkinson's disease patients, patients with multiple sclerosis, and trauma.

A 65-Year-Old Man Presented to the Office Complaining of Chronic