Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification.
- Proctoscopy (examination of the anal canal and lower rectum) – if necessary, mucosal prolapse, prolapsing (prolapsing) hemorrhoids.
- Dynamic proctoscopy (attempted defecation/attempted defecation) – to rule out rectoanal prolapse (prolapse).
- Ileocolonoscopy (endoscopic examination of the colon (large intestine, caecum (appendix: is the blind-ending initial part of the colon) and terminal ileum (last part of the scrotum)) with step biopsies (sampling)/stool microbiology – in case of inflammation or true diarrhea/diarrhea (precautionary recommendations should be followed!).
- Anal endosonography (endoscopic ultrasound (EUS); ultrasound examination performed from the inside, i.e., the ultrasound probe is brought into direct contact with the internal surface (in this case: rectum) by means of an endoscope (optical instrument)). – To assess the morphological integrity of the sphincter apparatus (sphincter apparatus) [gold standard].
- Defecography (radiological representation of the dynamic defecation process / defecation)/dynamic pelvic floor magnetic resonance imaging (MRI); emptying process and anatomy are well representable – on suspicion of anorectal prolapse, intussusception (invagination of a part of the intestine in the aborally following intestinal section), celes (“bulges”), spastic pelvic floor.
- MRI sellink/contrast enema/CT colography – for suspected enterocele (protrusion (prolapse) of a portion of the intestine), cul-de-sac syndrome.
- Anorectal manometry – measurement of pressure characteristics of the continence organ under static and dynamic conditions. Among other things, it is measured or determined:
- Sphincter rest pressure
- Level and holding time of the pinch pressure
- Rectal compliance
- Defecation (bowel movements) and pain
- Cough reflex
- Paradoxical pressing
Note: There is no direct correlation between clinical symptoms, fecal continence performance, and manometric measurements.
- Neurophysiological studies such as electromyography (EMG) of the sphincter ani externus muscle.
- Anal canal surface EMG – to differentiate paradoxical pressing.
- If necessary, neurophysiological diagnostics: conduction velocity of the pudenal nerve by surface electrode or needle electromyography of the external anal sphincter (EAS) and puborectalis muscle – for suspected denervation damage (damage caused by interruption of nerve pathways), neuropathy (diseases of the peripheral nerves), myopathy (diseases of the musculature).
