Diagnosis
Your doctor will first assess your condition with a physical exam. Tell your doctor about your diet and any medications you are taking, including antacids, laxatives, and herbal supplements. Your doctor will also perform:
A digital rectal exam. Your doctor inserts a gloved and lubricated finger into the rectum. This exam evaluates the strength of the anal muscles and checks for any abnormalities.
More tests may be ordered, including:
Blood tests.
Stool culture: A laboratory examines a small sample of fecal material for signs of infection.
Abdominal x-ray. Your doctor may use x-ray to confirm the presence of impacted hard stool.
Anal manometry. This test assesses pressures in the anal canal and rectum and the strength of the anal muscles.
Endoanal ultrasound. This test inserts an ultrasound probe into the anus and rectum to produce images. This test helps evaluate for tears in the anal muscles.
Barium enema. This fluoroscopy exam fills the colon and rectum with a liquid contrast material. This allows your doctor to view how the colon and rectum look and operate in real time.
Proctosigmoidoscopy. Your doctor inserts a thin, lighted instrument called a sigmoidoscope into the colon. The doctor will examine the rectum and lower colon for inflammation, tumors, or scar tissue that may be causing your condition.
Colonoscopy. This test uses a thin, lighted instrument called a colonoscope to examine the rectum and the entire colon. The test helps your doctor find areas of inflammation, bleeding, ulcers, tumors, and polyps.
Electromyography (EMG). This tests uses a needle electrode to assess the health of the anal sphincter, pelvic floor muscles, and nerve cells that control them. The doctor inserts the electrode directly into the muscle to record the amount of electrical activity.
Magnetic resonance imaging (MRI) defecography. MRI produces detailed images and information about how the pelvic floor and rectum look and operate during a bowel movement. During this exam, the doctor images the various stages of defecation (i.e. at rest, straining, squeezing, defecation). This allows the radiologist to check how well your pelvic muscles work during a bowel movement. It also helps evaluate the anatomy and function of the pelvic floor muscles.
Defecography. During this test, you will have your rectum filled with a semi-solid paste similar in consistency to soft stool. Your radiologist may also insert contrast into the vagina (if applicable). You will sit on a specially designed toilet while x-ray images are obtained. Your radiologist will image the defecation process at rest, during straining, during squeezing, and when you attempt to have a bowel movement. This helps the radiologist doctor evaluate what happens when you attempt to have a bowel movement.
Balloon capacity test. During this test, your doctor will place a lubricated balloon-tipped catheter into the rectum. The balloon slowly fills with warm water as the doctor measures and records volume and pressure. This test assesses the function of the rectum and its ability to expand and contract.
Balloon evacuation study. During this test, your doctor will place a lubricated balloon-tipped catheter into the rectum and fill it with water. The doctor asks you to push the balloon out of the rectum. This helps assess your ability to have a bowel movement.
