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Taylor's response to Spence has been very informative and certainly
added to the list of reasons why a PR exam might be very valid. But what I
found interesting was Taylor's mention of testing for Bulbocavernous
reflex if suspecting lower sacral cord lesions. I had to look up
Bulbocavernous reflex test again, because I thought it was squeezing the
glans penis (or the clitoris in a female patient) while monitoring the anal
tone (that would be your other finger then.. or someone else's!). It was
indeed what I remembered from medical school.
Let's put it this way: if rectal examination is a little embarrassing,
this might definitely be a lot more.
Also, may I ask, in real practice if you suspected a sacral cord
lesion would you discharge a patient from your ward because you found a
normal anal tone and bulbocavernous reflex (I wonder how many are done in
UK hospital A&Es,surgical or medical wards) or would you still go ahead
and arrange an MRI before they'd leave the ward?