Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 7/2007

01-07-2007 | Original Article

Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence

Authors: Annette C. Dobben, Maaike P. Terra, Marije Deutekom, Michael F. Gerhards, A. Bart Bijnen, Richelle J. F. Felt-Bersma, Lucas W. M. Janssen, Patrick M. M. Bossuyt, Jaap Stoker

Published in: International Journal of Colorectal Disease | Issue 7/2007

Login to get access

Abstract

Background

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 work-up. We examined if and how findings of anal inspection and rectal examination are associated with anorectal function tests and endoanal ultrasonography.

Methods

A cohort of fecal incontinent patients (n=312, 90% females; mean age 59) prospectively underwent anal inspection and rectal examination. Findings were compared with results of anorectal function tests and endoanal ultrasonography.

Results

Absent, decreased and normal resting and squeeze pressures at rectal examination correlated to some extent with mean (±SD) manometric findings: mean resting pressure 41.3 (±20), 43.8 (±20) and 61.6 (±23) Hg (p<0.001); incremental squeeze pressure 20.6 (±20), 38.4 (±31) and 62.4 (±34) Hg (p<0.001). External anal sphincter defects at rectal examination were confirmed with endoanal ultrasonography for defects <90 degrees in 36% (37/103); for defects between 90-150 degrees in 61% (20/33); for defects between 150-270 degrees in 100% (6/6). Patients with anal scar tissue at anal inspection had lower incremental squeeze pressures (p=0.04); patients with a gaping anus had lower resting pressures (p=0.013) at anorectal manometry. All other findings were not related to any anorectal function test or endoanal ultrasonography.

Conclusions

Anal 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 work-up should comprise at least rectal examination, anal inspection and endoanal ultrasonography.
Literature
1.
Osterberg A, Edebol Eeg-Olofsson K, Graf W (2000) Results of surgical treatment for faecal incontinence. Br J Surg 87:1546–1552PubMedCrossRef
2.
Bharucha AE, Fletcher JG, Harper CM, Hough D, Daube JR, Stevens C, Seide B et al (2005) Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut 54:546–555PubMedCrossRef
3.
Madoff RD, Parker SC, Varma MG, Lowry AC (2004) Faecal incontinence in adults. Lancet 364:621–632PubMedCrossRef
4.
Mavrantonis C, Wexner SD (1998) A clinical approach to fecal incontinence (review; 127 refs). J Clin Gastroenterol 27:108–121PubMedCrossRef
5.
Prather CM (2004) Physiologic variables that predict the outcome of treatment for fecal incontinence. Gastroenterology 126:S135–S140PubMedCrossRef
6.
Chiarioni G, Scattolini C, Bonfante F, Vantini I (1993) Liquid stool incontinence with severe urgency: anorectal function and effective biofeedback treatment. Gut 34:1576–1580PubMed
7.
MacMillan A (2004) Prevalence of fecal incontinence in community-dwelling adults: a systematic review of the literature. Dis Colon Rectum 47:1341–1349PubMedCrossRef
8.
Rudolph W, Galandiuk S (2002) A practical guide to the diagnosis and management of fecal incontinence. Mayo Clin Proc 77:271–275PubMedCrossRef
9.
Kouraklis G, Andromanakos N (2004) Evaluating patients with anorectal incontinence. Surg Today 34:304–312PubMedCrossRef
10.
11.
Bharucha AE (2004) Outcome measures for fecal incontinence: anorectal structure and function. Gastroenterology 126:S90–S98PubMedCrossRef
12.
Soffer EE, Hull T (2000) Fecal incontinence: a practical approach to evaluation and treatment. Am J Gastroenterol 95:1873–1880PubMedCrossRef
13.
Rao SS (2004) Diagnosis and management of fecal incontinence. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol 99:1585–1604PubMedCrossRef
14.
Diamant NE, Kamm MA, Wald A, Whitehead WE (1999) AGA technical review on anorectal testing techniques. Gastroenterology 116:735–760PubMedCrossRef
15.
Rao SS, Patel RS (1997) How useful are manometric tests of anorectal function in the management of defecation disorders? Am J Gastroenterol 92:469–475PubMed
16.
Liberman H, Faria J, Ternent CA, Blatchford GJ, Christensen MA, Thorson AG (2001) A prospective evaluation of the value of anorectal physiology in the management of fecal incontinence. Dis Colon Rectum 44:1567–1574PubMedCrossRef
17.
Salvioli B, Bharucha AE, Rath-Harvey D, Pemberton JH, Phillips SF (2001) Rectal compliance, capacity, and rectoanal sensation in fecal incontinence. Am J Gastroenterol 96:2158–2168PubMedCrossRef
18.
Dobben AC, Terra MP, Deutekom M, Bossuyt PM, Felt-Bersma RJ, Stoker J (2005) Diagnostic work up of faecal incontinence in daily clinical practice in the Netherlands. Neth J Med 63:265–269PubMed
19.
Nielsen MB, Hauge C, Rasmussen OO, Pedersen JF, Christiansen J (1992) Anal endosonographic findings in the follow-up of primarily sutured sphincteric ruptures. Br J Surg 79:104–106PubMedCrossRef
20.
Sultan AH, Kamm MA, Talbot IC, Nicholls RJ, Bartram CI (1994) Anal endosonography for identifying external sphincter defects confirmed histologically. Br J Surg 81:463–465PubMedCrossRef
21.
Romano G, Rotondano G, Esposito P, Pellecchia L, Novi A (1996) External anal sphincter defects: correlation between pre- operative anal endosonography and intraoperative findings. Br J Radiol 69:6–9PubMedCrossRef
22.
Keating JP, Stewart PJ, Eyers AA, Warner D, Bokey EL (1997) Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum 40:896–901PubMedCrossRef
23.
Hallan RI, Marzouk DEMM, Waldron DJ, Womack NR, Williams NS (1989) Comparison of digital and manometric assessment of anal sphincter function. Br J Surg 76:973–975PubMedCrossRef
24.
Eckardt VF, Kanzler G (1993) How reliable is digital examination for the evaluation of anal sphincter tone? Int J Colorectal Dis 8:95–97PubMedCrossRef
25.
Hill J, Corson RJ, Brandon H, Redford J, Faragher EB, Kiff ES (1994) History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum 37:473–477PubMedCrossRef
26.
Wexner SD, Jorge JM (1994) Colorectal physiological tests: use or abuse of technology? Eur J Surg 160:167–174PubMed
27.
Buch E, Alos R, Solana A, Roig JV, Fernandez C, Diaz F (1998) Can digital examination substitute anorectal manometry for the evaluation of anal canal pressures? Rev Esp Enferm Dig 90:90–93
28.
Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG (1988) Investigation of anorectal function. Br J Surg 75:53–55PubMedCrossRef
29.
Fink RL, Roberts LJ, Scott M (1992) The role of manometry, electromyography and radiology in the assessment of faecal incontinence. Aust N Z J Surg 62:951–958PubMed
30.
Cook TA, Mortensen NJM (1998) Management of faecal incontinence following obstetric injury. Br J Surg 85:293–299PubMedCrossRef
31.
Herbst F, Teleky B (1994) Alteration of maximum anal resting pressure by digital rectal examination prior to manometry: analysis of agreement between repeat measurements. Int J Colorectal Dis 9:207–210PubMedCrossRef
32.
Kaushal JN, Goldner F (1991) Validation of the digital rectal examination as an estimate of anal sphincter squeeze pressure. Am J Gastroenterol 86:886–887PubMed
33.
Terra MP, Dobben AC, Berghmans B, Deutekom M, Baeten CG, Janssen LW, Boeckxstaens GE et al (2006) Electrical stimulation and pelvic floor muscle training with biofeedback in patients with fecal incontinence: a cohort study of 281 patients. Dis Colon Rectum 49:1149–1159PubMedCrossRef
34.
Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44:77–80PubMedCrossRef
35.
Bartram CI, DeLancy JOL (eds) (2003) Imaging pelvic floor disorders. Springer, Berlin Heidelberg New York
36.
Altman DG (1999) Practical statistics for medical research. CRC Press LLC, Boca Raton, Florida
37.
Felt-Bersma RJ, Poen AC, Cuesta MA, Meuwissen SG (1997) Anal sensitivity test: what does it measure and do we need it? Cause or derivative of anorectal complaints. Dis Colon Rectum 40:811–816PubMedCrossRef
38.
Rao SS (1997) Manometric evaluation of defecation disorders: part II. Fecal incontinence. Gastroenterologist 5:99–111PubMed
39.
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef
40.
Azpiroz F, Enck P, Whitehead WE (2002) Anorectal functional testing: review of collective experience. Am J Gastroenterol 97:232–240PubMed
41.
Felt-Bersma RJF, Klinkenberg-Knol EC, Meuwissen SGM (1990) Anorectal function investigations in incontinent and continent patients—differences and discriminatory value. Dis Colon Rectum 33:479–486PubMedCrossRef
42.
Felt-Bersma RJ, van Baren R, Koorevaar M, Strijers RL, Cuesta MA (1995) Unsuspected sphincter defects shown by anal endosonography after anorectal surgery. A prospective study. Dis Colon Rectum 38:249–253PubMedCrossRef
Metadata
Title
Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence
Authors
Annette C. Dobben
Maaike P. Terra
Marije Deutekom
Michael F. Gerhards
A. Bart Bijnen
Richelle J. F. Felt-Bersma
Lucas W. M. Janssen
Patrick M. M. Bossuyt
Jaap Stoker
Publication date
01-07-2007
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 7/2007
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-006-0217-3

Other articles of this Issue 7/2007

International Journal of Colorectal Disease 7/2007 Go to the issue

Letter to the Editor

Treatment of anastomotic-vaginal fistula complicating colorectal resection using Permacol interposition in lieu of omentum

Original Article

Peritoneal instillation of taurolidine or polihexanide modulates intestinal microcirculation in experimental endotoxemia

Letter to the Editor

Urgent colectomy and caesarean section of a pregnant familial adenomatous polyposis: a case report

Original Article

Polymorphisms in methylenetetrahydrofolate reductase gene (MTHFR) and the age of onset of sporadic colorectal adenocarcinoma

Letter to the Editor

Carcinoma colon associated with tuberculosis: an unusual presentation

Review

Spontaneous regression of colorectal cancer: a review of cases from 1900 to 2005