Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • obstetric trauma
  • presence of other risk factors
  • patulous anus
  • weak squeeze pressure

Other diagnostic factors

  • constipation
  • urinary incontinence
  • urgency
  • passive leakage
  • faecal seepage
  • perineal scarring
  • perianal fistulae
  • rectal mass
  • rectal prolapse
  • abnormal perianal sensation

Risk factors

  • female sex
  • older age
  • nursing home resident
  • forceps delivery
  • baby >4 kg or delayed second stage of labour
  • occipitoposterior presentation
  • iatrogenic sphincter injury
  • multiple sclerosis/stroke/pudendal neuropathy/spinal injury
  • infectious diarrhoea or inflammatory bowel disease
  • constipation/impaction
  • rectal prolapse
  • 3rd degree haemorrhoids
  • congenital abnormalities of the anorectum
  • dementia/learning difficulties
  • pelvic radiotherapy
  • diabetes mellitus
  • episiotomy
  • central neurological disease

Diagnostic investigations

1st investigations to order

  • examination plus sigmoidoscopy
Full details

Investigations to consider

  • anorectal manometry
  • endoanal ultrasound
  • endoanal MRI
  • pudendal motor nerve latency test
  • electromyography
  • proctography
  • stool culture
  • rectal biopsy
  • FBC
  • CRP
Full details

Emerging tests

  • transvaginal/transperineal ultrasound
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Surgeon

Department of Surgery

Sheffield Teaching Hospitals

Sheffield

UK

Disclosures

SB is an author of a reference cited in this monograph.

Peer reviewers VIEW ALL

Consultant Colorectal/General Surgeon

Leicester Royal Infirmary

Leicester

UK

Disclosures

AM declares that he has no competing interests.

Chief of Staff

Chairman

Department of Colorectal Surgery

Cleveland Clinic

Weston

FL

Disclosures

SW was a member of the Scientific advisory board, has received honoraria, and is a consultant for GlaxoSmithKline.

Assistant Professor of Surgery

Children's Hospital of Pittsburgh

Pittsburgh

PA

Disclosures

DH declares that he has no competing interests.

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