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Anal IncontinenceFrom: Garry E. Siegel, M.D. (garrys@mindspring.com)Wed Jun 4 10:42:23 1997
Please give opinions about the following patients: 36 YO P 1102 with no gyn history presents, referred from a GI doc (she is an existing patient that I delivered twice) for a 2 to 4 month history of anal incontinece of normal stool. Her two deliveries were spontaneous, with 2nd degree tears, repaired--easy deliveries. Her youngest is 4.5 years old. On exam, she has a normal vaginal exam, no cystocele, a small rectocele (not out of line with a para 2), a slightly short perineal body. Neurologically, she has good vaginal tone when I ask her to squeeze, and I feel the levators on a two finger vag exam. Upon digital rectal exam, I can palpate what I believe is an intact sphincter, and when she squeezes, she has little tighterning around my finger. She has normal perineal pinprick, but I could not elicit an anal wink. Her BE and sigmoidoscopy were normal; she did have a nasty fall from a horse at age 17. She is going to see the colorectal surgeon. I'm thinking this is neurologic, not anatomic. I'm also wondering about multiple sclerosis. Any thoughts would be appreciated. Garry
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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