Absence of the anal wink
in a younger patient is likely associated with nerve damage; in an older patient, it may simply indicate muscle weakness.
A physical examination should follow the history and should include a neurological exam, including testing for the presence or absence of the "anal wink
." The absence of this reflex indicates neural damage.
These include abdominal distension; a tight, empty rectum with palpable feces; a gush of liquid stool and air from the rectum after a finger is inserted; occult blood in the stool; weak lower extremities; an absent anal wink
; a patulous anus; flat buttocks; and a pilonidal dimple.
The physical exam should include mental and functional status, genital and rectal exam, and a neurologic exam of sacral root integrity (e.g., anal wink
, bulbocavernosus reflex).
When he touches the perineum, he looks for an "anal wink
" in response: a tensing of the anus that indicates intact reflexes.
The presence of an anal wink
and bulbocavemosus reflex suggests an intact S2 through S4 reflex arc.
Examiners would tell a child to bend over, and if their scrutiny was greeted by an "anal wink
"--i.e., contraction of the sphincter--they would pronounce the child abused.
The "anal wink
," described by Arnold-Long ("Fecal Incontinence"), is a:
The physical exam should include mental and functional status, a genital and rectal exam, and a neurologic exam of sacral root integrity (such as anal wink
or bulbocavernosus reflex).
Look for signs of a possible neuromuscular disorder, such as an absent anal wink
or a dimple covered by a tuft of hair.