Skip to main content

Patient Evaluation

  • Chapter
  • First Online:
Fundamentals of Anorectal Surgery

Abstract

Throughout medicine and surgery, a comprehensive evaluation of patients with anorectal complaints requires a detailed history, a thorough physical examination, and the addition of directed diagnostic studies. Such a systematic approach will optimize the opportunity for an accurate diagnosis and the development of an effective management plan. In addition, an orderly approach facilitates a comfortable experience for the patient by simultaneously instilling confidence and minimizing embarrassment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Roberts PL. Patient evaluation. In: Beck DE, editor. Fundamentals of anorectal surgery. 2nd ed. London: WB Saunders; 1992. p. 25–36.

    Google Scholar 

  2. Barleben A, Mills S. Anorectal anatomy and physiology. Surg Clin North Am. 2010;90(1):1–15.

    Article  PubMed  Google Scholar 

  3. Grigorescu BA, Lazarou G, Olson TR, Downie SA, Powers K, Greston WM, et al. Innervation of the levator ani muscles: description of the nerve branches to the pubococcygeus, iliococcygeus, and puborectalis muscles. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):107–16.

    Article  PubMed  Google Scholar 

  4. Habr-Gama JMNJA. Anatomy and embryology. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 1–22.

    Google Scholar 

  5. Network NCC. Anal carcinoma. In:NCCN guidelines: anal carcinoma [Internet]; 2016.

    Google Scholar 

  6. Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011;24(1):14–21.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Singer M. Hemorrhoids. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 175–202.

    Chapter  Google Scholar 

  8. Michael RB, Keighley NSW, Church JM, Pahlman L, Scholefield JH, Scott NA. Running a colorectal surgery service. In: Keighley MR, editor. Surgery of the anus, rectum and colon. 3rd ed. Philadelphia: Elsevier; 2008. p. 47–67.

    Google Scholar 

  9. Ternent CA, Bastawrous AL, Morin NA, Ellis CN, Hyman NH, Buie WD, et al. Practice parameters for the evaluation and management of constipation. Dis Colon Rectum. 2007;50(12):2013–22.

    Article  PubMed  Google Scholar 

  10. Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol. 2005;100(Suppl 1):S5–S21.

    Article  PubMed  Google Scholar 

  11. Whitehead WE, Palsson OS, Feld AD, Levy RL, VON Korff M, Turner MJ, et al. Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome. Aliment Pharmacol Ther. 2006;24(1):137–46.

    Article  CAS  PubMed  Google Scholar 

  12. Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920–4.

    Article  CAS  PubMed  Google Scholar 

  13. Johannsson HO, Graf W, Påhlman L. Bowel habits in hemorrhoid patients and normal subjects. Am J Gastroenterol. 2005;100(2):401–6.

    Article  PubMed  Google Scholar 

  14. Walter S, Hallböök O, Gotthard R, Bergmark M, Sjödahl R. A population-based study on bowel habits in a Swedish community: prevalence of faecal incontinence and constipation. Scand J Gastroenterol. 2002;37(8):911–6.

    Article  CAS  PubMed  Google Scholar 

  15. Osterberg A, Graf W, Karlbom U, Påhlman L. Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation. Scand J Gastroenterol. 1996;31(6):575–80.

    Article  CAS  PubMed  Google Scholar 

  16. Park IU, Ogilvie JW, Anderson KE, Li ZZ, Darrah L, Madoff R, et al. Anal human papillomavirus infection and abnormal anal cytology in women with genital neoplasia. Gynecol Oncol. 2009;114(3):399–403.

    Article  PubMed  Google Scholar 

  17. Park IU, Introcaso C, Dunne EF. Human papillomavirus and genital warts: a review of the evidence for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61(Suppl 8):S849–55.

    Article  PubMed  Google Scholar 

  18. Welton ML, Sharkey FE, Kahlenberg MS. The etiology and epidemiology of anal cancer. Surg Oncol Clin N Am. 2004;13(2):263–75.

    Article  PubMed  Google Scholar 

  19. Frisch M, Glimelius B, van den Brule AJ, Wohlfahrt J, Meijer CJ, Walboomers JM, et al. Sexually transmitted infection as a cause of anal cancer. N Engl J Med. 1997;337(19):1350–8.

    Article  CAS  PubMed  Google Scholar 

  20. Daling JR, Weiss NS, Hislop TG, Maden C, Coates RJ, Sherman KJ, et al. Sexual practices, sexually transmitted diseases, and the incidence of anal cancer. N Engl J Med. 1987;317(16):973–7.

    Article  CAS  PubMed  Google Scholar 

  21. Palefsky JM, Holly EA, Ralston ML, Jay N, Berry JM, Darragh TM. High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men. AIDS. 1998;12(5):495–503.

    Article  CAS  PubMed  Google Scholar 

  22. Imhoff LR, Liwanag L, Varma M. Exacerbation of symptom severity of pelvic floor disorders in women who report a history of sexual abuse. Arch Surg. 2012;147(12):1123–9.

    Article  PubMed  Google Scholar 

  23. Leserman J, Drossman DA. Relationship of abuse history to functional gastrointestinal disorders and symptoms: some possible mediating mechanisms. Trauma Violence Abuse. 2007;8(3):331–43.

    Article  PubMed  Google Scholar 

  24. Leroi AM, Berkelmans I, Denis P, Hémond M, Devroede G. Anismus as a marker of sexual abuse. Consequences of abuse on anorectal motility. Dig Dis Sci. 1995;40(7):1411–6.

    Article  CAS  PubMed  Google Scholar 

  25. Drossman DA, Leserman J, Nachman G, Li ZM, Gluck H, Toomey TC, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113(11):828–33.

    Article  CAS  PubMed  Google Scholar 

  26. Townsend MK, Matthews CA, Whitehead WE, Grodstein F. Risk factors for fecal incontinence in older women. Am J Gastroenterol. 2013;108(1):113–9.

    Article  PubMed  Google Scholar 

  27. Wald A. Clinical practice. Fecal incontinence in adults. N Engl J Med. 2007;356(16):1648–55.

    Article  CAS  PubMed  Google Scholar 

  28. Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015;58(7):623–36.

    Article  PubMed  Google Scholar 

  29. Madoff RD, Parker SC, Varma MG, Lowry AC. Faecal incontinence in adults. Lancet. 2004;364(9434):621–32.

    Article  PubMed  Google Scholar 

  30. Ditah I, Devaki P, Luma HN, Ditah C, Njei B, Jaiyeoba C, et al. Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005-2010. Clin Gastroenterol Hepatol. 2014;12(4):636–643.e1–2.

    Article  PubMed  Google Scholar 

  31. Nordgren S, Fasth S, Hultén L. Anal fistulas in Crohn’s disease: incidence and outcome of surgical treatment. Int J Color Dis. 1992;7(4):214–8.

    Article  CAS  Google Scholar 

  32. Bernard S, Ouellet MP, Moffet H, Roy JS, Dumoulin C. Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review. J Cancer Surviv. 2016;10:351–62.

    Article  PubMed  Google Scholar 

  33. Smith LE. Ambulatory surgery for anorectal diseases: an update. South Med J. 1986;79(2):163–6.

    Article  CAS  PubMed  Google Scholar 

  34. Lam TY, Lam SC, Kwok SP. Feasibility case-controlled study of day-case haemorrhoidectomy. ANZ J Surg. 2001;71(11):652–4.

    Article  CAS  PubMed  Google Scholar 

  35. Li S, Coloma M, White PF, Watcha MF, Chiu JW, Li H, et al. Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology. 2000;93(5):1225–30.

    Article  CAS  PubMed  Google Scholar 

  36. Rafferty JF. Preoperative management. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 125–36.

    Chapter  Google Scholar 

  37. Ternent CA, Fleming F, Welton ML, Buie WD, Steele S, Rafferty J, et al. Clinical practice guideline for ambulatory anorectal surgery. Dis Colon Rectum. 2015;58(10):915–22.

    Article  PubMed  Google Scholar 

  38. Kaplan EB, Sheiner LB, Boeckmann AJ, Roizen MF, Beal SL, Cohen SN, et al. The usefulness of preoperative laboratory screening. JAMA. 1985;253(24):3576–81.

    Article  CAS  PubMed  Google Scholar 

  39. Turnbull JM, Buck C. The value of preoperative screening investigations in otherwise healthy individuals. Arch Intern Med. 1987;147(6):1101–5.

    Article  CAS  PubMed  Google Scholar 

  40. Suchman AL, Mushlin AI. How well does the activated partial thromboplastin time predict postoperative hemorrhage? JAMA. 1986;256(6):750–3.

    Article  CAS  PubMed  Google Scholar 

  41. Freeman WK, Gibbons RJ, Shub C. Preoperative assessment of cardiac patients undergoing noncardiac surgical procedures. Mayo Clin Proc. 1989;64(9):1105–17.

    Article  CAS  PubMed  Google Scholar 

  42. Fijten GH, Starmans R, Muris JW, Schouten HJ, Blijham GH, Knottnerus JA. Predictive value of signs and symptoms for colorectal cancer in patients with rectal bleeding in general practice. Fam Pract. 1995;12(3):279–86.

    Article  CAS  PubMed  Google Scholar 

  43. Ellis BG, Thompson MR. Factors identifying higher risk rectal bleeding in general practice. Br J Gen Pract. 2005;55(521):949–55.

    PubMed  PubMed Central  Google Scholar 

  44. Beck DE. Benign and malignant rectal, anal, and perineal problems. In: Ashley SW, editor. ACS surgery. Seventh ed. Toronto: Decker; 2014.

    Google Scholar 

  45. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL, et al. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. 2011;54(9):1059–64.

    Article  PubMed  Google Scholar 

  46. Rocco Ricciardi SLD, Madoff RD. Anal fissure. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 203–18.

    Chapter  Google Scholar 

  47. Vasilevsky C-A. Anorectal abscess and fistula. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 219–44.

    Chapter  Google Scholar 

  48. Thacker JKM. Diagnosis of colon, rectal, and anal disease. In: Yeo CJ, editor. Shackelford’s surgery of the alimentary tract. Seventh ed. Philadelphia: Elsevier; 2013. p. 1740–55.

    Google Scholar 

  49. Billingham RP, Isler JT, Kimmins MH, Nelson JM, Schweitzer J, Murphy MM. The diagnosis and management of common anorectal disorders. Curr Probl Surg. 2004;41(7):586–645.

    Article  PubMed  Google Scholar 

  50. Buchmann P, Keighley MR, Allan RN, Thompson H, Alexander-Williams J. Natural history of perianal Crohn’s disease. Ten year follow-up: a plea for conservatism. Am J Surg. 1980;140(5):642–4.

    Article  CAS  PubMed  Google Scholar 

  51. Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD, Surgeons SPTFotASoCaR. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54(12):1465–74.

    Article  PubMed  Google Scholar 

  52. Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006;130(5):1510–8.

    Article  PubMed  Google Scholar 

  53. Caplan RM. The irritant role of feces in the genesis of perianal itch. Gastroenterology. 1966;50(1):19–23.

    CAS  PubMed  Google Scholar 

  54. Allan A, Ambrose NS, Silverman S, Keighley MR. Physiological study of pruritus ani. Br J Surg. 1987;74(7):576–9.

    Article  CAS  PubMed  Google Scholar 

  55. Ansari P. Pruritus ani. Clin Colon Rectal Surg. 2016;29(1):38–42.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Daniel GL, Longo WE, Vernava AM. Pruritus ani. Causes and concerns. Dis Colon Rectum. 1994;37(7):670–4.

    Article  CAS  PubMed  Google Scholar 

  57. Marfing TE, Abel ME, Gallagher DM. Perianal Bowen’s disease and associated malignancies. Results of a survey. Dis Colon Rectum. 1987;30(10):782–5.

    Article  CAS  PubMed  Google Scholar 

  58. Marchesa P, Fazio VW, Oliart S, Goldblum JR, Lavery IC. Perianal Bowen’s disease: a clinicopathologic study of 47 patients. Dis Colon Rectum. 1997;40(11):1286–93.

    Article  CAS  PubMed  Google Scholar 

  59. Kumar AARR. Diagnostic evaluations. In: Bailey HR, editor. Colorectal surgery. Philadelphia: Saunders; 2013. p. 17–40.

    Google Scholar 

  60. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97.

    Article  CAS  PubMed  Google Scholar 

  61. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999;42(12):1525–32.

    Article  CAS  PubMed  Google Scholar 

  62. Gee AS, Durdey P. Urge incontinence of faeces is a marker of severe external anal sphincter dysfunction. Br J Surg. 1995;82(9):1179–82.

    Article  CAS  PubMed  Google Scholar 

  63. Markland AD, Goode PS, Burgio KL, Redden DT, Richter HE, Sawyer P, et al. Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study. J Am Geriatr Soc. 2010;58(7):1341–6.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Johnson JK, Lindow SW, Duthie GS. The prevalence of occult obstetric anal sphincter injury following childbirth—literature review. J Matern Fetal Neonatal Med. 2007;20(7):547–54.

    Article  CAS  PubMed  Google Scholar 

  65. Qureshi MS, Rao MM, Sasapu KK, Casey J, Qureshi MU, Sadat U, et al. Male faecal incontinence presents as two separate entities with implications for management. Int J Color Dis. 2011;26(12):1589–94.

    Article  Google Scholar 

  66. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480–91.

    Article  PubMed  Google Scholar 

  67. Beck DE, Allen NL. Rectocele. Clin Colon Rectal Surg. 2010;23(2):90–8.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Krevsky B, Malmud LS, D'Ercole F, Maurer AH, Fisher RS. Colonic transit scintigraphy. A physiologic approach to the quantitative measurement of colonic transit in humans. Gastroenterology. 1986;91(5):1102–12.

    Article  CAS  PubMed  Google Scholar 

  69. Preston DM, Lennard-Jones JE. Severe chronic constipation of young women: ‘idiopathic slow transit constipation’. Gut. 1986;27(1):41–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Walsh PV, Peebles-Brown DA, Watkinson G. Colectomy for slow transit constipation. Ann R Coll Surg Engl. 1987;69(2):71–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum. 1996;39(6):681–5.

    Article  CAS  PubMed  Google Scholar 

  72. Simon T. Minor office procedures. Clin Colon Rectal Surg. 2005;18(4):255–60.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Sahai A, Kodner IJ. Premalignant neoplasms and squamous cell carcinoma of the anal margin. Clin Colon Rectal Surg. 2006;19(2):88–93.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Keating JP, Stewart PJ, Eyers AA, Warner D, Bokey EL. Are special investigations of value in the management of patients with fecal incontinence? Dis Colon Rectum. 1997;40(8):896–901.

    Article  CAS  PubMed  Google Scholar 

  75. Hallan RI, Marzouk DE, Waldron DJ, Womack NR, Williams NS. Comparison of digital and manometric assessment of anal sphincter function. Br J Surg. 1989;76(9):973–5.

    Article  CAS  PubMed  Google Scholar 

  76. Times ML, Reickert CA. Functional anorectal disorders. Clin Colon Rectal Surg. 2005;18(2):109–15.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Hill J, Corson RJ, Brandon H, Redford J, Faragher EB, Kiff ES. History and examination in the assessment of patients with idiopathic fecal incontinence. Dis Colon Rectum. 1994;37(5):473–7.

    Article  CAS  PubMed  Google Scholar 

  78. Dobben AC, Terra MP, Deutekom M, Gerhards MF, Bijnen AB, Felt-Bersma RJ, et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Color Dis. 2007;22(7):783–90.

    Article  Google Scholar 

  79. Henderson PK, Cash BD. Common anorectal conditions: evaluation and treatment. Curr Gastroenterol Rep. 2014;16(10):408.

    Article  PubMed  Google Scholar 

  80. Kelly SM, Sanowski RA, Foutch PG, Bellapravalu S, Haynes WC. A prospective comparison of anoscopy and fiberendoscopy in detecting anal lesions. J Clin Gastroenterol. 1986;8(6):658–60.

    Article  CAS  PubMed  Google Scholar 

  81. Gilbertsen VA. Proctosigmoidoscopy and polypectomy in reducing the incidence of rectal cancer. Cancer. 1974;34(3):suppl:936–9.

    Article  CAS  Google Scholar 

  82. Nelson RL, Abcarian H, Prasad ML. Iatrogenic perforation of the colon and rectum. Dis Colon Rectum. 1982;25(4):305–8.

    Article  CAS  PubMed  Google Scholar 

  83. Whitlow CB. Endoscopy. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 63–75.

    Chapter  Google Scholar 

  84. Schoellhammer HF, Gregorian AC, Sarkisyan GG, Petrie BA. How important is rigid proctosigmoidoscopy in localizing rectal cancer? Am J Surg. 2008;196(6):904–8. discussion 8.

    Article  PubMed  Google Scholar 

  85. Nivatvongs S, Fryd DS. How far does the proctosigmoidoscope reach? A prospective study of 1000 patients. N Engl J Med. 1980;303(7):380–2.

    Article  CAS  PubMed  Google Scholar 

  86. Takahashi T, Zarate X, Velasco L, Mass W, Garcia-Osogobio S, Jimenez R, et al. Rigid rectosigmoidoscopy: still a well-tolerated diagnostic tool. Rev Investig Clin. 2003;55(6):616–20.

    Google Scholar 

  87. Marks G, Boggs HW, Castro AF, Gathright JB, Ray JE, Salvati E. Sigmoidoscopic examinations with rigid and flexible fiberoptic sigmoidoscopes in the surgeon’s office: a comparative prospective study of effectiveness in 1,012 cases. Dis Colon Rectum. 1979;22(3):162–8.

    Article  CAS  PubMed  Google Scholar 

  88. Winnan G, Berci G, Panish J, Talbot TM, Overholt BF, McCallum RW. Superiority of the flexible to the rigid sigmoidoscope in routine proctosigmoidoscopy. N Engl J Med. 1980;302(18):1011–2.

    Article  CAS  PubMed  Google Scholar 

  89. Lehman GA, Buchner DM, Lappas JC. Anatomical extent of fiberoptic sigmoidoscopy. Gastroen-terology. 1983;84(4):803–8.

    CAS  Google Scholar 

  90. Ott DJ, Wu WC, Gelfand DW. Extent of colonic visualization with the fiberoptic sigmoidoscope. J Clin Gastroenterol. 1982;4(4):337–41.

    Article  CAS  PubMed  Google Scholar 

  91. Lohsiriwat V, Sujarittanakarn S, Akaraviputh T, Lertakyamanee N, Lohsiriwat D, Kachinthorn U. What are the risk factors of colonoscopic perforation? BMC Gastroenterol. 2009;9:71.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Deen KI, Kumar D, Williams JG, Olliff J, Keighley MR. Anal sphincter defects. Correlation between endoanal ultrasound and surgery. Ann Surg. 1993;218(2):201–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  93. Wong DGKWD. Endoluminal ultrasound. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 107–23.

    Google Scholar 

  94. Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics. 2000;20(2):399–418.

    Article  CAS  PubMed  Google Scholar 

  95. Horton KM, Abrams RA, Fishman EK. Spiral CT of colon cancer: imaging features and role in management. Radiographics. 2000;20(2):419–30.

    Article  CAS  PubMed  Google Scholar 

  96. Hulnick DH, Megibow AJ, Balthazar EJ, Naidich DP, Bosniak MA. Computed tomography in the evaluation of diverticulitis. Radiology. 1984;152(2):491–5.

    Article  CAS  PubMed  Google Scholar 

  97. Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology. 2004;233(3):674–81.

    Article  PubMed  Google Scholar 

  98. Maruyama R, Noguchi T, Takano M, Takagi K, Morita N, Kikuchi R, et al. Usefulness of magnetic resonance imaging for diagnosing deep anorectal abscesses. Dis Colon Rectum. 2000;43(10 Suppl):S2–5.

    Article  CAS  PubMed  Google Scholar 

  99. National Accreditation Program for Rectal Cancer, American College of Surgeons. https://www.facs.org/quality-programs/cancer/naprc.

  100. Baker ME, Einstein DM, Veniero JC. Computed tomography enterography and magnetic resonance enterography: the future of small bowel imaging. Clin Colon Rectal Surg. 2008;21(3):193–212.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Berman L, Israel GM, McCarthy SM, Weinreb JC, Longo WE. Utility of magnetic resonance imaging in anorectal disease. World J Gastroenterol. 2007;13(23):3153–8.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Leigh RJ, Turnberg LA. Faecal incontinence: the unvoiced symptom. Lancet. 1982;1(8285):1349–51.

    Article  CAS  PubMed  Google Scholar 

  103. Jorge JM, Wexner SD. Anatomy and physiology of the rectum and anus. Eur J Surg. 1997;163(10):723–31.

    CAS  PubMed  Google Scholar 

  104. Mellgren AF. Physiologic testing. In: Beck DE, editor. The ASCRS textbook of colon and rectal surgery. 2nd ed. New York: Springer; 2011. p. 49–61.

    Chapter  Google Scholar 

  105. Bharucha AE. Outcome measures for fecal incontinence: anorectal structure and function. Gastroenterology. 2004;126(1 Suppl 1):S90–8.

    Article  PubMed  Google Scholar 

  106. Bharucha AE. Pro: anorectal testing is useful in fecal incontinence. Am J Gastroenterol. 2006;101(12):2679–81.

    Article  PubMed  Google Scholar 

  107. Deutekom M, Dobben AC, Terra MP, Engel AF, Stoker J, Bossuyt PM, et al. Clinical presentation of fecal incontinence and anorectal function: what is the relationship? Am J Gastroenterol. 2007;102(2):351–61.

    Article  PubMed  Google Scholar 

  108. Lam TJ, Kuik DJ, Felt-Bersma RJ. Anorectal function evaluation and predictive factors for faecal incontinence in 600 patients. Color Dis. 2012;14(2):214–23.

    Article  CAS  Google Scholar 

  109. Snooks SJ, Henry MM, Swash M. Anorectal incontinence and rectal prolapse: differential assessment of the innervation to puborectalis and external anal sphincter muscles. Gut. 1985;26(5):470–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Kiff ES, Swash M. Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. J Neurol Neurosurg Psychiatry. 1984;47(8):820–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Henry MM, Parks AG, Swash M. The pelvic floor musculature in the descending perineum syndrome. Br J Surg. 1982;69(8):470–2.

    Article  CAS  PubMed  Google Scholar 

  112. Mahieu P, Pringot J, Bodart P. Defecography: I. Description of a new procedure and results in normal patients. Gastrointest Radiol. 1984;9(3):247–51.

    Article  CAS  PubMed  Google Scholar 

  113. Hetzer FH, Andreisek G, Tsagari C, Sahrbacher U, Weishaupt D. MR defecography in patients with fecal incontinence: imaging findings and their effect on surgical management. Radiology. 2006;240(2):449–57.

    Article  PubMed  Google Scholar 

  114. Southwell BR, Clarke MC, Sutcliffe J, Hutson JM. Colonic transit studies: normal values for adults and children with comparison of radiological and scintigraphic methods. Pediatr Surg Int. 2009;25(7):559–72.

    Article  PubMed  Google Scholar 

  115. Lin HC, Prather C, Fisher RS, Meyer JH, Summers RW, Pimentel M, et al. Measurement of gastrointestinal transit. Dig Dis Sci. 2005;50(6):989–1004.

    Article  PubMed  Google Scholar 

  116. Pomerri F, Frigo AC, Grigoletto F, Dodi G, Muzzio PC. Error count of radiopaque markers in colonic segmental transit time study. AJR Am J Roentgenol. 2007;189(2):W56–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This chapter was written by Patricia L. Roberts, MD in the previous edition of this textbook. The authors would like to acknowledge W. Brian Sweeney, MD for providing photographs and Paul Trombley for creating the medical illustrations.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Justin A. Maykel .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Suwanabol, P.A., Maykel, J.A. (2019). Patient Evaluation. In: Beck, D., Steele, S., Wexner, S. (eds) Fundamentals of Anorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-65966-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65966-4_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65965-7

  • Online ISBN: 978-3-319-65966-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics