(03) 9848 4262

youssif@bigpond.net.au

(03) 9848 4262

youssif@bigpond.net.au

Fertility IVF Specialist

Anal Sphincetr Damage and Foecal Incontinence


Diagnosis

  • Physical exam
  • Visual inspection of anus.
  • A probe may be used to examine this area for nerve damage.
  • ¬∑Normally touching anus causes anal sphincter to contract and the anus to pucker.

Surgery

  • Foecal incontinence may require surgery to correct
  • Rectal prolapse or
  • Sphincter damage caused by childbirth. Sphincteroplasty. This procedure repairs a damaged or weakened anal sphincter that occurred during childbirth. The injured area of muscle and edges are freed from the surrounding tissue. The muscle edges are stitched back together in an overlapping fashion, strengthening the muscle and tightening the sphincter.
  • The Blue part is the internal anal sphincter. The red is the Pudendal nerve S 2.3.4. The yellow is the external anal sphincter deep, superficial and subcutaneous parts.

Anal sphincters and nerve supply

Drawing by Dr Serag Youssif

1) Characteristic facial features

  • Flattened midface
  • Thin upper lip
  • Indistinct/absent philtrum
  • Short eye slits


2) Growth retardation

  • Lower birth weight
  • Disproportional weight not due to nutrition, height
  • Weight below the 5th percentile

3) Central Nervous System Abnormalities "neurodevelopmental"

  • Impaired fine motor skills,
  • Learning disabilities,
  • Behaviour disorders
  • Mental handicap (found in 50% of FAS)
  • To diagnose PFAS, only two of the three above criteria must be present and must include some facial features and brain differences. 
  • To diagnose ARND, only one of the above three criteria must be present and must be a brain difference. 
  • These fetal alcohol effects are often thought to be less damaging than the "full-blown" syndrome, however, they are often more debilitating to the person's quality of life. 
  • Fetal Alcohol Syndrome/Fetal Alcohol Effects are PERMANENT and cannot be outgrown.

FAS/FAE babies and young children may have other specific distinguishable features: 

  • Short stature
  • Small and thin
  • Hearing defects
  • Organ imperfections
  • Bone problems
  • Difficulty with eating
  • Difficulty developing a regular sleeping schedule
  • Difficulty learning how to walk
  • Difficulty learning toilet training
  • Impulsivity (i.e. running out into the street)
  • Hyperactivity

FAS/FAE children have learning disabilities, which include 

  • Difficulties in learning language and language use
  • Difficulties in generalizing information
  • Difficulties in mastering new or recently learned skills
  • Difficulties in recent memory (ie. yesterday events)
  • Difficulties inpredicting outcomes or cause and effect
  • Difficulties indistinguishing fact from fantasy
  • Difficulties in distinguishing friends from strangers
  • Donot learn from experience as they 
  • Do not understand cause and effect

FAS/FAE adults continue to have the same learning difficulties they had as youth, and also often have difficulty with:

  • Legal system (do not understand cause and effect)
  • Controlling alcohol consumption
  • Maintaining custody of their children
  • Mental health issues

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