Encopresis physical examination

• The impacted bowels may be felt through the tummy, but is often not felt even in severe constipation.

• The back should be inspected and ankle jerk reflexes tested to rule out spina-bifida.

• A rectal examination should not be performed, especially not in young girls. The children are already traumatized enough in this area, and this would be one more emotional trauma. It also provides no useful information, as the rectum might be empty at the moment of examination.
• Close inspection of the anus and perianal area: Anal fissures (anal tears) will support the diagnosis. There may also be signs of inflammation like Thrush (Candidiasis) or Streptococcal infection.

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