A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye).
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Anal region/anal canal [scars?, mariscae?, prolapsing hemorrhoids?, anal prolapse?, pelvic floor subsidence?; sphincter tone (sphincter tone) normal or gaping anal sphincter (anal sphincter)?; perianal sensitivity intact and anal reflex triggerable?; ampulla with stool as if walled out and overstretched?; fecal stones palpable obstructing the anal canal?; can the patient “pinch” his sphincter muscles?]
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?)
- Check the anocutaneous reflex: if after stroking with a cotton swab over the perianal skin (“around the anus”) the reflex is absent, this gives an indication of neurogenic incontinence (fecal incontinence due to disturbance of the nervous control between the brain and spinal cord)
- Digital rectal examination (DRU): examination of the rectum (rectum) in relation to sphincter function (sphincter function):
- At rest and under pinch the sphincter ani internus muscle.
- When actively pinching, the puborectal sling, the sphincter ani externus muscle, as well as the pelvic floor and anal canal length.
Furthermore, the examination of the adjacent organs with the finger by palpation [anorectal diseases such as tumors, anal or rectal prolapse (prolapse of the rectum) or rectoceles / protrusion of the anterior wall of the rectum into the vagina)].
- Inspection (viewing).
- Cancer screening
- Neurological examination – if a neurological cause is suspected.
- Health check
