From the Guidelines
The most helpful physical exam technique for evaluating fecal incontinence in an 80-year-old female is a rectal examination. This examination allows direct assessment of anal sphincter tone, which is crucial in determining the cause of fecal incontinence, as noted in the 2023 study by 1. During the rectal exam, the clinician can evaluate both resting tone (primarily from the internal anal sphincter) and squeeze pressure (from the external anal sphincter), providing immediate information about neuromuscular function of these structures. The exam also allows assessment for rectal masses, impaction, or prolapse that might contribute to the incontinence.
Some key points to consider during the rectal examination include:
- Evaluating the resting tone of the sphincter segment and its augmentation by a squeezing effort, as described in the 2013 study by 1
- Observing the descent of the perineum during simulated evacuation and the elevation during a squeeze aimed at retention
- Testing the anocutaneous reflex to assess for any neurological deficits
- Checking for perineal descent and any evidence of fecal soiling
In elderly women, weakened pelvic floor muscles due to aging, previous childbirth trauma, or neurological conditions are common causes of fecal incontinence, and these can be initially evaluated during the rectal examination. While other examinations like vaginal speculum exam may provide complementary information about pelvic organ prolapse, the rectal examination remains the cornerstone of the initial physical assessment for fecal incontinence, as supported by the most recent evidence from 1.
From the Research
Evaluation of Fecal Incontinence
The most helpful physical exam technique in evaluating an 80-year-old female presenting with fecal incontinence would be:
- Rectal examination, as it can provide accurate information about internal and external anal sphincter function 2
- This examination can help identify defects in the anal sphincter and assess the patient's anal resting and squeeze pressures 2, 3
Comparison with Other Exam Techniques
Other exam techniques, such as:
- Vaginal Speculum Exam, may not be directly relevant to evaluating fecal incontinence
- Palpation of the lower abdomen, may not provide specific information about anal sphincter function
- Auscultation of abdominal vascular bruits, is not typically used to evaluate fecal incontinence 4, 5
Importance of Rectal Examination
Rectal examination is a key component in the evaluation of fecal incontinence, as it can: