facilitate a bowel movement by applying digital pressure along the posterior vaginal wall when defecating to prevent the rectocele from protruding.

PHYSICAL EXAMINATION. Upon inspection, the bulging of the bladder and/or rectum may be visualized when the patient is asked to bear down. This bulge may also be palpated. In addition, inspect the patient for hemorrhoids and assess sphincter tone. Levator ani muscles are tested by inserting two fingers in the vagina and asking the patient to tighten or close the introitus.

PSYCHOSOCIAL. Assess feelings regarding stress incontinence and the patient's knowledge of the problem. Explore the effects on the patient's social life, ability to travel, ability to meet occupational demands, and sexual function.

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