What tests might I need?

In most cases a doctor or nurse will be able to get important clues as to where the problem lies just by talking to you. He or she will probably ask you in some detail about your bowel function. Some of the questions that are likely are shown in the Table.

If you feel embarrassed in talking about your bowels try not to be doctors and nurses do this all day long! You may find it helpful to write down the answers to these questions to take with you so that you do not forget anything important. You may also like to keep a bowel diary for a week before your appointment.

When did it start?
How often do you open your bowels?
Do you have to rush to the toilet?
Do you always get to the toilet in time?
Do you have to strain to empty your bowels?
Is it painful to empty your bowels?
Are your stools hard, soft but formed, or loose (runny)?
Do you ever see any blood when you open your bowels?
Do you have difficulty wiping clean after opening your bowels?
Do you get leakage of stool from the anus after you have opened your bowels?
Do you ever lose stool when you walk, run, or in bed at night?
Do you need to wear a pad?
If you are losing stool how often, how much, what is the consistency (lumps or liquid)?
Are you taking any medicines or tablets?
You will also be asked some general questions about your health, past operations, childbirth and your diet and fluid intake.

Table: Questions you may be asked

In some instances it will be best for you to see a specialist doctor with an interest in faecal incontinence (such as a colo-rectal surgeon or a gastroenterologist) or a specialist nurse (Such as a Continence Adviser or Colorectal Nurse Specialist). The doctor or nurse will usually need to examine your sphincter muscles with a finger. This causes slight discomfort, but is not painful and only lasts a few seconds.

In many cases two tests are necessary to define the exact nature of the problem. Neither of these tests is painful, and you should try not to feel embarrassed as the person doing the tests probably does them all day every day!

Anorectal physiological studies which test the nerves and muscles around the anus. A small tube or balloon is used to measure the muscle pressures in the anus when you are at rest and when you squeeze (Manometry). Other small instruments are used to check that you can feel things properly and that the nerves around the anus are giving you the right messages and how fast your nerves can transmit messages. These tests take about 30 minutes and are done as an outpatient.

Anal ultrasound a small ultrasound probe is used to let your doctor see the two sphincter muscles and if there is any damage. A thin probe is placed just inside the anus and ultrasound pictures are taken. Normally the muscle rings can be seen (Figure 1) and any damage is identified (Figure 2). This test is important in letting you and your doctor know if there is a break in the muscles that an operation could fix. This test takes 5-10 minutes as an outpatient.

Both anno-rectal physiological studies and anal ultrasound are available only in specialist centers, so you may need to travel further than your local hospital for them.