A 65 yearsold female patient c/o constipation for last two decades, straining during defecation, require laxative every day  still no satisfication needs finger evacuation. no h/o hypothyroidism, Serum Ca. level within normal limits, no h/o taking anti hyper tensive , anti depresent or anti pshycotic tretment .

What would be the diagnosis and the treatment medical or surgical.