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Location and size of the anal opening . ○ . Presence or absence of an anal wink . The pudendo-anal reflex is absent or delayed in many patients with fecal incontinence .
Anteriorly displaced anus . Tight, empty rectum in presence of palpable fecal mass . Absent anal wink . Absent cremasteric reflex . Decreased lower extremity tone or strength . 12 Evaluation .
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24-h ambulatory blood pressure monitor, urodynamic evaluation . deficits related to the sacral nerve roots, including sensory def-icits, poor sphincter tone, or absent anal wink reflex .
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