A 74-Year-Old Man Comes to the Office Due to Chronic

A 74-year-old man comes to the office due to chronic constipation.  Bowel movements occur once every 3 days and are hard and pellet-like.  The patient frequently strains when he tries to defecate and never feels completely evacuated.  The constipation is occasionally so severe that he uses his fingers to remove stool from the anorectal vault.  Medical history is significant for Parkinson disease, for which he takes carbidopa-levodopa.  Vital signs are unremarkable.  A resting tremor is present on physical examination.  The abdomen is distended but nontender to palpation.  This patient's condition is most likely due to inadequate relaxation of which of the following muscles during defecation?

A) Bulbospongiosus
B) Obturator
C) Piriformis
D) Puborectalis
E) Rectus abdominis

Correct Answer:

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