Table 1 Definition of anal physical signs used in this study[4, 9, 24]
From: Anal signs of child sexual abuse: a case–control study
Signs summarized in RCPCH systematic review | |
Reflex Anal Dilatation | The dynamic observation of the anus opening after minimal buttock traction, with relaxation of the external and internal sphincter muscles. |
Laxity | Decreased anal muscle tone. This is a static findings; the diameter does not change upon inspection. |
Gaping | An anus which, on separation of the buttocks, is already dilated, with a view into the anal canal or rectum, and remains so for the duration of the examination. This is a static sign. Anal gaping is of greater degree than anal laxity |
Fissure/laceration | A break (split) in the perianal skin which radiates out from the anal orifice which may be superficial or deep |
Reddening | Redness of the skin and/or mucous membranes caused by dilatation of the underlying capillaries |
Perianal venous congestion | The collection of venous blood in the venous plexus of the perianal tissues creating a flat or swollen purple discoloration that may be localized or diffuse. It is distinct from bruising |
Tag | A protrusion of anal verge or perianal skin, which interrupts the symmetry of the perianal skin folds. |
Scar | Fibrous tissue that replaces normal tissue after the healing of a wound. |
Bruise | A localized collection of blood in the skin and or subcutaneous tissue occurring as a result of damage to the capillaries or larger blood vessels allowing blood to leak into the tissues leading to skin discoloration |
Novel/other signs | |
Twitching anus | Rapid contraction and relaxation of the anal sphincter without dilatation |
Swelling (“tyre sign”) | Swelling of the perianal area, giving appearance of a tyre |
Funnelling | A deep-set or dished anal appearance, but without full dilatation |
Abrasion | A superficial injury involving only the outer layers of the skin/mucous membrane that does not extend to the full thickness of the epidermis. |
Mucosal Prolapse | Rectal mucosa extending down through a dilated anal sphincter |
Anal Verge Deficit | A defect or gap in the tissue overlying the subcutaneous external anal sphincter at the most distal portion of the anal canal (anoderm) which extends exteriorly to the perianal skin. |
Fold Change | Unusual, irregular or asymmetrical folding of the perianal skin radiating from the anal verge |
Soiled | The presence of significant quantities of faeces around the anus |