We begin our evaluation with a medical consultation and review of your medical history to try to establish the most likely cause of fecal incontinence.  During this evaluation we have you complete a fecal incontinence and quality of life questionnaire which helps us better understand the nature and severity of your symptoms.  We ask about certain factors in

Physical examination — A brief physical examination usually entails evaluation of the perianal area, testing for anal reflexes, and a digital rectal exam.  This exam is performed in a private area and takes just a few minutes.

Diagnostic tests — Although your medical history and results of a physical examination may suggest certain causes of fecal incontinence, we may schedule you to undergo additional tests to help pinpointing the cause and ensuring the correct treatment.  Some of the testes we may want to obtain include the following:

Direct examination — Colonoscopy (examination of the entire colon), or anoscopy (examination of the anal canal) may be recommended. These examinations can help identify inflammation, tumors, and other disorders that can cause fecal incontinence.

Anal Physiology Testing – This includes a series of three tests all performed in our pelvic health center office in a clean and relaxing atmosphere.  These tests do not require any special preparation and are not invasive or painful.  They help us determine a more precise and scientific understanding of how your rectal and anal muscles and nerves are functioning and if any damage is present.  The three tests include:

Anorectal manometry — Anorectal manometry measures the internal pressure in different areas of the lower digestive tract under different conditions. This test can identify several of the different causes of incontinence and may be especially useful in revealing poor tone of the anal sphincters. Manometry can also be used to determine if rectal sensation and rectal reflexes are impaired.            

Electromyography — During electromyography, a tiny recording pad (similar to those used during EKGs) is used to check for neurologic or muscular causes of poor anal sphincter functionNerve conduction tests — The pudendal nerve carries the signals to the external anal sphincter that trigger contraction. Tests of nerve conduction speed may reveal nerve damage.

Ultrasound — An ultrasound examination of the rectum can reveal abnormalities of the anal sphincters, the rectal wall, and the pelvic muscles that help maintain continence. This test is the safest and most reliable test for identifying structural abnormalities of both anal sphincters. It is a quick and painless exam.

Stool tests — Evaluation of a stool specimen may reveal a cause of fecal incontinence in people who have diarrhea.