Your GP will begin by asking you about the pattern of your symptoms and other related issues, such as your diet.
You may find this embarrassing, but it is important to answer as honestly and fully as you can because this will help to ensure that you receive the most suitable treatment.
It is likely that your GP will carry out a physical examination. First they will look at your anus and the surrounding area to check for any damage. Your GP will then perform a rectal examination, where they gently insert their finger into your bottom.
Carrying out a rectal examination allows the GP to check whether constipation is causing your symptoms, and checks if there are tumours in your rectum. Your GP may ask you to squeeze your rectum around their finger to assess how well the muscles in your rectum and bowels are working.
Depending on the results of your examination, your GP may refer you for further testing.
Further testing
Endoscopy
During an endoscopy, the inside of your rectum (and in some cases your lower bowel) is examined internally using a long, thin flexible tube with a light and video camera at the end. Images can be taken of the inside of your body and sent to an external monitor.
The endoscope is inserted into your bottom to check whether there is any obstruction, damage or inflammation in your rectum.
Although an endoscopy is not painful, it can feel uncomfortable, so you may be given a sedative to relax you.
Anal manometry
Anal manometry helps to diagnose bowel-related problems by assessing:
- how well your sphincter muscles (above and below the rectum) are working
- how well the muscles of your rectum are working
- whether the nerves in your rectum are working properly
Anal manometry uses a device that looks like a small thermometer with a balloon attached to the end. The device is inserted into your rectum and the balloon is inflated. This may feel unusual, but is not uncomfortable or painful.
A machine is attached to the device, which measures pressure readings taken from the balloon.
During the test you will be asked to squeeze, relax and push your rectum muscles at certain times. You may also be asked to push the balloon out of your rectum in the same way that you push out a stool. The information is sent to the pressure-measuring machine, and gives an idea of how well your muscles are working.
The balloon can also be inflated to different sizes to determine when your rectum feels full. If the balloon is inflated to a relatively large size but you do not feel any sensation of fullness, it may mean there are problems with the nerves in your rectum.
Ultrasound
An ultrasound scanner can be used to build up a detailed picture of the inside of your rectum. Ultrasound scans are particularly useful in detecting underlying damage to the sphincter muscles.
Defecography
Defecography is a test used to study exactly how you are passing stools. It can also be useful in detecting any signs of obstruction, such as faecal impaction, that have not been discovered during a rectal examination.
The test involves you drinking a slightly radioactive but harmless liquid called barium. Barium is used because it shows up on X-rays. After you have drunk the barium, you will be asked to pass a stool in the usual way while X-rays are taken.
Anal electromyography
Anal electromyography is a test that checks for any damage to the nerves running from your rectum to your brain.
During anal electromyography, a small set of electrodes are inserted in the muscles around your anus. A small electrical current is then sent through the electrodes into the muscles and associated nerves.
The electrodes are connected to a computer, which tracks how the electrical signals are transmitted through your muscles and nerves. Any delay in the transmission of the electrical signal can be used to pinpoint where nerve damage has occurred.
