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Assessment of the Rectum and Anus01:25

Assessment of the Rectum and Anus

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Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
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Rectal temperature measurement is considered the most precise method for assessing core body temperature and typically registers higher than oral temperature. For adults, the rectal thermometer should be inserted 1 to 1.5 inches into the rectum to obtain the most accurate reading.
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Response to the article 'Role of Ultrasound in the Evaluation of Women with Obstetric Sphincter Injuries: Narrative Review'.

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Updated: Apr 11, 2026

Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
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Can we define a cut-off for external anal sphincter defect angle?

H P Dietz1, K L Shek2, J Descallar3,4

  • 1Sydney Urodynamic Centres, Sydney, NSW, Australia.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|April 9, 2026
PubMed
Summary

A 30° defect angle in the external anal sphincter (EAS) on tomographic exoanal imaging is a valid indicator of significant anal incontinence in women. This finding validates the current diagnostic criterion for EAS defects.

Keywords:
birth traumaexoanal ultrasoundexternal anal sphincterobstetric anal sphincter injurysphincter tears

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Area of Science:

  • Urogynecology
  • Medical Imaging
  • Obstetrics

Background:

  • Obstetric anal sphincter injury is a leading cause of anal incontinence in young women.
  • Current diagnosis of external anal sphincter (EAS) defects relies on a 30° gap on endoanal ultrasound.
  • Validation of this criterion using exoanal imaging is needed.

Purpose of the Study:

  • To validate the 30° cut-off for defining significant external anal sphincter (EAS) defects on tomographic exoanal imaging.
  • To assess the association between EAS defect angle and anal incontinence severity.

Main Methods:

  • Retrospective analysis of 850 premenopausal women undergoing 4D transperineal exoanal ultrasound.
  • Evaluation of EAS defects using tomographic ultrasound imaging (TUI).
  • Correlation of EAS defect angle with incontinence scores (St Mark's, VAS) and ROC-curve analysis.

Main Results:

  • External anal sphincter (EAS) defects were identified in 13% of women.
  • Average EAS defect angle strongly correlated with anal incontinence severity (P < 0.001).
  • Receiver-operating-characteristics (ROC) analysis supported a 30° cut-off for significant EAS defects.

Conclusions:

  • A 30° EAS defect angle on tomographic exoanal imaging is a valid diagnostic criterion.
  • This criterion is significantly associated with anal incontinence in premenopausal women.
  • The findings support the use of this cut-off for diagnosing significant anal sphincter defects.