Like any other anal or rectal condition, physicians evaluate incontinence initially by inspecting the anal area, feeling inside the anus with a gloved finger (digital rectal exam), and looking inside the anal canal with a small short scope ("anoscope"). If there has been damage to the sphincter muscle, there may be a visible defect or scarring in the anal canal. Also, the digital rectal exam may reveal a weakness of the sphincter muscle. Nerve damage might be identified with the "wink" test, in which the doctor touches the anus to see if the sphincter contracts normally. The next test is often a sigmoidoscopy. A doctor inserts a thin, flexible tube (fitted with a light and video camera) into the rectum to look for inflammation, tumors or other problems. Your doctor may also suggest a barium enema x-ray or colonoscopy to look for problems in the colon further upstream.
Further diagnostic tests may include anal manometry, electromyography ("EMG"), and anal ultrasound. Anal manometry, measures the strength of the anal sphincter muscle. EMG measures the function of the nerves that go to the sphincter muscle. Anal ultrasound can give a picture of the structure of the muscle (to see if there are any tears or defects in muscle).
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