The rectum, an organ located at the lower end of the large intestine, is situated between the sigmoid colon and the anal canal. The anal canal lies between the rectum and anus. Sphincter muscles control the release of rectal contents. In this case, rectum and anus, impairment of sphincter control involves loss of voluntary control of stool of normal consistency.

The impairment may be caused by conditions including: injuries or diseases of the spinal cord; congenital abnormalities; injuries to the rectum or anus or both; complete prolapse of the rectum (procidentia); upper or lower motor neuron impairment; senility; diabetes mellitus; fecal impaction; and anorectal infections. The impairment may also be caused by tumors, following injuries from giving birth, or following surgery to the anal sphincter.

Manifestations of the condition are related to patients' reports of diminished control, leakage, or no control of defecation.

Diagnostic measures may include: physical examination; rectal-digital examination; anal sphincter ultrasound; magnetic resonance imaging (MRI) of the pelvis and perineum; pelvic floor electromyography; and anorectic manometry.

Treatment may include a bowel management program to develop a predictable pattern of defecation. Adequate fluid intake with a diet of sufficient bulk may be ordered. However, if a regular bowel pattern is not established, a low-residue diet is included in the treatment to reduce defecation. Drug therapy, perineal exercises, suppositories, or phosphate enemas may also be used. In addition, biofeedback may be recommended. Surgery may be done if the condition is due to injury. A colostomy may be done if all other treatment is ineffective.

Residuals will vary individually from healing without any leakage to total loss of sphincter control, and to the operative procedures which may have been performed.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• None.