A 28-year-old woman, gravida 1 para 1, is seen in the clinic a | Uworld | Step 1

A 28-year-old woman, gravida 1 para 1, is seen in the clinic a week after spontaneous vaginal delivery. The delivery was performed under epidural analgesia and complicated by a prolonged second stage of labor. Since delivery, the patient has had frequent episodes of fecal incontinence, as well as mild perinea! pain that is relieved by ibuprofen and opioid analgesics. She reports no other medical conditions, and her pregnancy was otherwise uncomplicated. On examination, a healing perinea! laceration shows no signs of infection. Digital anorectal examination reveals decreased anal sphincter tone and loss of the anal wink reflex. Bilateral lower extremity reflexes are 2+ with normal tone.