Dilatation anale
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Dilatation anale
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^ Read NW, Sun WM (June 1991). "Reflex anal dilation: effect of parting the buttocks on anal function in normal subjects and patients with anorectal and spinal disease" . Gut . 32 (6): 670–3. doi : 10.1136/gut.32.6.670 . PMC 1378886 . PMID 2060876 .
^ Bruni M (November 2003). "Anal findings in sexual abuse of children (a descriptive study)". J. Forensic Sci . 48 (6): 1343–6. doi : 10.1520/JFS2002306 . PMID 14640283 .
^ Clayden, G (1988). "Reflex anal dilation associated with severe chronic constipation in children" . Arch Dis Child . 63 (7): 832–836. doi : 10.1136/adc.63.7.832 . PMC 1779059 . PMID 3415302 .
^ Brittain, Charmaine; American Medical Association (2006). Understanding the medical diagnosis of child maltreatment: a guide for nonmedical professionals . Oxford [Oxfordshire]: Oxford University Press . pp. 126 . ISBN 0-19-517217-5 .
^ McCann J, Voris J, Simon M, Wells R (1989). "Perianal findings in prepubertal children selected for nonabuse: a descriptive study". Child Abuse Negl . 13 (2): 179–93. doi : 10.1016/0145-2134(89)90005-7 . PMID 2743179 .
^ Ashenden, S (2004). Governing child sexual abuse: negotiating the boundaries of public and private, law and science . Routledge . pp. 144–153 . ISBN 0-415-15894-X .
^ Liz Bonner; Mandy Wells (2007). Effective Management of Bladder and Bowel Problems in Children . Class Publishing. pp. 75 . ISBN 978-1-85959-165-9 .
^ Hobbs CJ, Wright CM (2014). "Anal signs of child sexual abuse: a case-control study" . BMC Pediatr . 14 : 128. doi : 10.1186/1471-2431-14-128 . PMC 4047438 . PMID 24884914 .
Reflex anal dilation ( RAD ) is the reflexive dilation of the human anus to a diameter greater than two centimeters in response to the parting of the buttocks or anal stimulation, such as brushing with a medical instrument. RAD was theorized to be a clinical marker associated with anal sexual assault in children, [1] and has been associated with other signs of sexual assault [2] but also appears in children with severe chronic constipation and those subject to invasive medical treatments of the anus. [3] The finding of RAD alone is not considered indicative of sexual abuse , [4] and a normative sample of children not suspected of having been sexually abused found that 49 per cent of children showed anal dilation either continuously or intermittently, though the dilation exceeded 20 mm in only 1.2 per cent of cases. [5]
In 1986, Marietta Higgs learned of the RAD connection with sexual assault at a conference where it was presented by Christopher J Hobbs. [ citation needed ] Higgs used this RAD diagnosis extensively the following year, leading to the Cleveland child abuse scandal . It was discredited during the trial as the sole indication of sexual abuse, determined to be considered a sign of sexual assault by a tiny minority of British doctors. [6] RAD as a clinical marker for sexual abuse is now considered discredited. [7] However Hobbs was still studying RAD in 2014. [8]
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1 Division of Surgery, Stirling Royal Infirmary, UK.
A MacDonald et al.
Br J Surg .
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A group of 100 consecutive patients undergoing manual dilatation of the anus between 1980 and 1983 were reviewed retrospectively by examining the clinical presentation, diagnosis, treatment and outcome. Anal fissure was diagnosed in 46 patients, 22 had either first- or second-degree haemorrhoids, and stenosis of the anal canal was identified in seven. Manual dilatation of the anus was performed on 25 patients in the absence of a diagnosis. Dilatation failed to treat 26 anal fissures successfully. Where it was employed alone in ten cases of haemorrhoids and seven of anal stenosis, manual dilatation failed to cure seven and five patients respectively. Of the patients with no diagnosis, 23 were relieved of their symptoms following dilatation. Episodes of incontinence occurred in 27 patients, 21 of whom were female. There should be a reduced role for manual anal dilatation in the treatment of common anorectal disorders.
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