Authors: Annette C Dobben Maaike P Terra Marije Deutekom Michael F Gerhards A Bart Bijnen Richelle J F FeltBersma Lucas W M Janssen Patrick M M Bossuyt Jaap Stoker
Publish Date: 2006/11/10
Volume: 22, Issue: 7, Pages: 783-790
Abstract
Anal inspection and digital rectal examination are routinely performed in fecal incontinent patients but it is not clear to what extent they contribute to the diagnostic workup We examined if and how findings of anal inspection and rectal examination are associated with anorectal function tests and endoanal ultrasonographyAbsent decreased and normal resting and squeeze pressures at rectal examination correlated to some extent with mean ±SD manometric findings mean resting pressure 413 ±20 438 ±20 and 616 ±23 Hg p0001 incremental squeeze pressure 206 ±20 384 ±31 and 624 ±34 Hg p0001 External anal sphincter defects at rectal examination were confirmed with endoanal ultrasonography for defects 90 degrees in 36 37/103 for defects between 90150 degrees in 61 20/33 for defects between 150270 degrees in 100 6/6 Patients with anal scar tissue at anal inspection had lower incremental squeeze pressures p=004 patients with a gaping anus had lower resting pressures p=0013 at anorectal manometry All other findings were not related to any anorectal function test or endoanal ultrasonographyAnal inspection and digital rectal examination can give accurate information about internal and external anal sphincter function but are inaccurate for determining external anal sphincter defects 90 degrees Therefore a sufficient diagnostic workup should comprise at least rectal examination anal inspection and endoanal ultrasonography
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