A 26-year-old woman comes to your clinic, complaining of leakage of stool despite generally normal, pain-free bowel movements. She denies any blood in her stool or on the toilet paper. She has had no recent episodes of diarrhea. Her past medical history includes a spontaneous vaginal delivery 3 months ago. She had a fourth-degree tear of the perineal area (from the vagina through the rectum) that was surgically repaired after delivery. A few days later the patient developed an abscess in the anal area that had to be incised and drained. She denies using any tobacco, alcohol, or illegal drugs. Her mother and father are both in good health. She denies any weight gain, weight loss, fever, or night sweats. She is still breast-feeding without any problems. On examination you visualize a small opening anterior to the anus with some surrounding erythema. There is not a mass or other inflammation on inspection. Digital rectal examination reveals smooth rectal walls with no blood. She has no pain during the rectal examination. Bimanual vaginal examination is also normal. What anal or rectal disorder is the most likely cause of her symptom?

Question

Quizplus · Accepted Answer

Anorectal fistula can commonly cause a leakage of stool, even when the patient is not having a bowel movement. They are common after infections, especially after trauma to the anal musculature (such as in a fourth-degree perineal tear). With more chronic gastrointestinal symptoms, this finding may lead you to suspect Crohn's disease.

A 26-Year-Old Woman Comes to Your Clinic, Complaining of Leakage