1. Examining for rectal prolapse Most NOT evident in lying position as rest Ask patient to bear down – most still not evident Need to examine after straining on the toilet for 1-2 minutes – lean forward – observe from behind – estimate in centimetres - ? full thickness circumferential, or partial mucosal only?

4. Ano-rectal digital examination Resting tone (low = IAS problem) Squeeze pressure (low = EAS problem) Co-ordination Pubo-rectalis (pelvic floor function) Sensation (? Neurological dysfunction) Assessment stops here for MOST patients

5. Abdominal transit study Patient takes 20 radio-opaque markers on 3 consecutive days Attends for plain abdominal X-ray on day 6 80% of markers should have been passed Can distinguish slow whole gut transit from rectal outlet delay

13. Assessment Most can be done by a nurse Takes time (we allow 1 hour in my clinic) Remember how embarrassed most patients will be Many patients have more than one cause (especially older people) If you find the cause, you often know how to treat

14. Website: www.bowelcontrol.org.uk