Incontinence with Anorectal Sphincteric Abnormalities

The remaining ambulatory elderly patients with fecal incontinence will exhibit one or a combination of abnormalities of continence mechanisms. Most can be ascertained when a directed physical examination is performed by a skilled and experienced examiner [14, 18]. For example, the tone of the internal anal sphincter and the contractile strength of the external anal sphincter can be assessed by digital examination of the anal canal at rest (largely reflecting internal anal sphincter function) and when the patient tightens the anal canal (external anal sphincter function). Deeper insertion of the finger allows assessment of puborectalis muscle contraction strength. Having the patient bear down, especially in a squatting or dorsal lithotomy position, allows optimal assessment for rectal prolapse or excessive descent of the perineum, suggesting weakness of the pelvic floor muscles. Only impaired rectal sensation cannot be assessed by conventional physical examination; however, this rarely occurs in the absence of other evidence of a neurologic disorder involving the spinal cord or central nervous system. In general, sacral denervation is suggested by a patulous ("gaping") anal sphincter observed when the examining finger is removed, perianal anesthesia or hypoesthesia, and absence of anal sphincter contractions ("anal wink") with mild stroking of the perianal skin.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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