 Hemorrhoids o Anal maneuver

 Fissures o Perineal maneuver

 Fistula  Barrier sensation
 Anal incontinence  Anal sensitivity
o Passive  Urge
o Active  Incomplete exoneration
o Gas  Laxatives
o Stools  Anormal soiling:
 Soiling o mucus,
 Constipation o blood
 How much stools by week  Associated pain:
 Stools texture: o lumbar,
o normal, o abdominal,
o liquid, o coccyx
o hard,  Intestinal disease:
o fragmented o hemorrhagic colic,
 Pushing during exoneration o Crohn disease,
 Straining o Other:
o Vaginal maneuver

Sexology:
 Vaginism
 Anorgasmia
 Anaphrodisia
 Frigidity
 Vulvodynia

Clinic assessment
 Pelvis:
o anteversion, o ptosis,
o retroversion ante-pulsion, o tonic,
o retropulsion, o scars with adherences,
o lateral deviation o diastasis,
 Rachis: o eventration/hernia,
o scoliotic deformation, o bloat
o curve increased  Breathing:
 Diaphragm: o abdo+costo+diafragm,
o flexible, o paradoxical,
o tense o pushed
 Abdomen:

Pelvic static disorders

 Vaginal gap
 Vaginal noise
 prolapsus
 discomfort
  pain

Vulvar-perineal inspection
 Trophicity:  good,  bad  Descending perineum
 Ano-vulvar length:  <2.5,  >2.5 cm  Descended perineum
 Nucleus fibrosis:  convex,  concave.  Prolapsus:
 Episiotomy scar: o cystocele grade…,
o normal, o Rectocele grade…,
o tensed, o Hysterocele grade…,
o inflammed, o colpocele ant grade…,
o infected, o colpocele post grade…
o fibrosis  Cough Automatism
 Vulva:  Vaginal tonicity normal, hypertonic, hypotonic
o closed,  Levator muscle diastasis
o open:  grade 1 (22-25mm),  grade 2  Pain
(25-30mm),  grade 3 (>33mm)  Synkinesis
 Infibulation  Perineal asynchronism

TESTING

Contraction quality maintain How much C R L

without
tiredness

0 Nothing 0 0

1 few 1s 1

2 Ok without resistance <5s 2

3 Ok without resistance >5s 3

4 Ok with light resistance >5s 5

5 Ok with strong >5s >5

resistance