Colorectal Physical Evaluation

A detailed physical examination is conducted on all patients. Careful abdominal examination, looking for any evidence of tenderness, masses, incisions, or hernias is an important initial component. Anorectal examination is first conducted in the prone jackknife position. A proper light source is essential. Initial inspection of the perianal skin can reveal any dermatologic conditions such as excoriation or dermatitis. Previous scars from either episiotomy or anorectal surgery are identified. The anus is assessed, and it is noted if the anus is closed or patulous in the resting state. Assessment of sensation is the next step in the examination. Any loss of either sharp or dull sensation is noted in the perianal area. The presence or absence of the anal wink reflex is also ascertained. Absence of the anal wink may signify pudendal neuropathy.

Digital rectal examination allows gross estimations of the patient's resting anal tone and voluntary squeeze pressure. It is, however, important to exclude accessory muscle contraction when assessing squeeze pressure. Bidigital anovaginal examination is used to estimate perineal bulk and grossly identify sphincter defects. It is with this technique that the rectovaginal septum is also evaluated for any defects or masses. When evaluating any patient for pelvic floor pathology, it is important to conduct a portion of the examination with the patient straining or performing a Valsalva maneuver. This will help to identify increased per-ineal descent, or the presence of a rectocele, cystocele, or perineal hernia. Frequently, it will also be necessary to repeat this portion of the examination, with the patient in the squatting position or sitting on the toilet. Although the prone jackknife position allows for excellent visualization of the anal canal, pelvic organ prolapse can be underestimated with this technique.

After a careful history and physical examination, the physician is able to diagnose most posterior compartment pelvic floor disorders. Focused anorectal physiologic evaluation and radiographic studies are then obtained to complete the evaluation and determine a treatment plan.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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