1.Specialist examination (1)Visual examination Visual examination may not have positive signs, but may also be accompanied by symptoms of anal diseases such as external hemorrhoids. (2)Rectal diagnosis
In patients with anterior rectal protrusion, the weak area of the rounded anterior rectal wall protruding into the vagina can be palpated during rectal palpation, which is more obvious when forceful defecation, and the fingertip feels that the intestinal wall tension is reduced, and the intestinal wall recovers slowly or cannot recover at the end of palpation. In patients with intra-rectal mucosal prolapse in the squatting or lateral position, the mucous membrane in the rectal cavity is folded and accumulated, soft and smooth, moving up and down, with the feeling of congestion, and there is a circular groove between the prolapsed part and the intestinal wall. In patients with perineal descent syndrome, the dilatation force of the anal canal is reduced during the resting period, and when the patient is asked to perform random contractions, the contraction force of the anal canal is significantly reduced. Patients with pelvic floor failure syndrome have high anal canal tone and require force to pass through the anal canal. The anal canal is long and the puborectalis muscle is hypertrophic and spastic. The anal canal is contracted instead of relaxed during mock defecation, which is often called “paradoxical contraction”. (3) Sigmoidoscopy or anorectoscopy
In patients with combined rectal mucosal prolapse and perineal descent syndrome, a submucosal accumulation of rectum can be seen with slight abdominal pressure, which seems to protrude into the opening of the mirror barrel like a bottle stopper. A circular or cervical mucosal infold at the junction of the rectum and anus is seen. Proctoscopy can be seen in the rectal mucosa too much, forceful defecation action can be seen embedded in the mirror cavity or appear below the tooth line, patients can be seen mucosal edema, brittle, congestion, or ulcers, polyps and other lesions. 2.Colonic transmission test A test to determine the function of the colon. Subjects from 3 days before the test, laxatives and other drugs that affect intestinal function are prohibited. On the day of the test, 20 capsules containing an opaque marker are taken at breakfast, and then one abdominal plain film is taken every 24 hours until the marker is 80% or more expelled. The maximum number of abdominal films should not exceed 5, and the number of films should be reduced in unmarried women. In patients with mixed constipation, less than 80% of the markers are excreted within 72 hours, and the abdominal plain film shows that the markers are retained in both the colon and rectum. 3, fecal imaging Fecal imaging is a combination of dynamic and static observation of the rectal part of the anal canal during “defecation” by injecting contrast into the patient’s rectum. Patients with mixed constipation have a positive fecal imaging test. 4.Balloon force-out test is a relatively simple test to determine whether the constipation is an outlet obstruction. First, the balloon is placed in the rectal jugular of the subject, filled with 50ml of warm water (39℃), and then the subject is allowed to take the habitual defecation position (sitting or squatting) and told to expel the balloon as soon as possible. Patients with mixed constipation could not expel the balloon within 5 minutes. 5.Anal canal rectal pressure measurement By measuring the anal canal rectal pressure, measuring the anal canal resting pressure, maximum squeezing pressure, rectal perception threshold, maximum rectal tolerance and other indicators, we can understand the change of anal canal rectal pressure during defecation. Patients with mixed constipation show paradoxical contraction of the external anal sphincter during forceful defecation. 6, pelvic floor electromyography examination By recording the bioelectric activity of neuromuscular, to determine the functional activity and morphological changes of neuromuscular. In patients with mixed constipation, abnormal electrical activity is obvious during defecation movements, and there are paradoxical contractions of the puborectalis muscle during forceful defecation, which hinders fecal discharge. In combination with puborectal hypertrophy, muscle activity is reduced during random contractions and voltage is decreased, indicating myogenic damage.