title: Anal size in children: the influence of age, constipation, rectal examination and defaecation.
abstract: With the increase in the number of reported cases of child abuse it is important that medical practitioners should know the normal values for the size of the anus. Children aged 3 months to 15 years, attending a paediatric gastroenterology clinic for a routine examination, had a photographic record made of the anus 30 seconds after exposure of the anus as part of a standardised examination protocol. Anorectal disease, including Crohn's disease was present in eight children. Analysis of the 54 children without anorectal disease indicated that the anteroposterior diameter of the anus was less than 10.0 mm and the transverse diameter was less than or equal to 2.0 mm. Age, sex of the child, digital rectal examination, time since last defaecation and the capacity and contents of the rectum were unrelated to the size of the anus. In view of the difficulties which arise in suspected child abuse, medical practitioners should gain experience of the normal appearance and size of the anus. This can best be validated within a medicolegal framework if some form of standardised examination protocol is used. The key element of such an examination is not the position in which the child is examined but the time taken to observe the anus, to allow any dynamic changes to occur. An inspection time of 30 seconds in a cooperating conscious child is recommended.
authors.affiliation: Department of Obstetrics and Gynaecology, Flinders Medical Centre, Bedford Park, SA.
authors.forename: A F
authors.initials: AF
authors.lastname: Connon
authors.forename: G P
authors.initials: GP
authors.lastname: Davidson
authors.forename: D J
authors.initials: DJ
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000375:Aging / Q000473:pathology; D001003:Anal Canal / Q000033:anatomy & histology*; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis; D002675:Child, Preschool; D003248:Constipation / Q000473:pathology*; D003672:Defecation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010808:Physical Examination; D011187:Posture; D012007:Rectum; D012016:Reference Values; D013997:Time Factors