Last reviewed: 4 Jul 2021
Last updated: 27 Nov 2018

Summary

Definition

History and exam

Key diagnostic factors

  • obstetric trauma
  • patulous anus
  • weak squeeze pressure

Other diagnostic factors

  • constipation
  • urinary incontinence
  • urgency
  • passive leakage
  • fecal 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 labor
  • occipitoposterior presentation
  • iatrogenic sphincter injury
  • multiple sclerosis/stroke/pudendal neuropathy/spinal injury
  • infectious diarrhea or inflammatory bowel disease
  • constipation/impaction
  • rectal prolapse
  • 3rd degree hemorrhoids
  • congenital abnormalities of the anorectum
  • dementia/learning difficulties
  • pelvic radiation therapy
  • diabetes mellitus
  • episiotomy
  • central neurological disease

Diagnostic investigations

Investigations to consider

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

Emerging tests

  • transvaginal/transperineal ultrasound

Treatment algorithm

Contributors

Authors

Steven Brown, MBChB, BmedSci, FRCS, MD

Consultant Surgeon

Department of Surgery

Sheffield Teaching Hospitals

Sheffield

UK

Disclosures

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

Peer reviewers

Andrew Miller, MD

Consultant Colorectal/General Surgeon

Leicester Royal Infirmary

Leicester

UK

Disclosures

AM declares that he has no competing interests.

Steven Wexner, MD, FACS, FRCS, FRCS Ed, FASCRS, FAC

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.

David Hackam, MD, PhD

Assistant Professor of Surgery

Children's Hospital of Pittsburgh

Pittsburgh

PA

Disclosures

DH declares that he has no competing interests.

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