I enjoyed reading the paper by Krogh et al.1 I would recommend the addition of sensory anal examination to their physical examination. This would involve superficial anal examination with cotton and pinprick and asking about the amount of sense perceived on both the right and left sides. Comparison between both sides and with areas of normality is recommended. Observation of anal wink during sensory examination is a helpful test to see the tone of the anus. For example, if the examiner asks the patient to contract the anal sphincter and the patient answers that he/she cannot do so, but an anal wink is seen during the pinprick stimulation, it shows that tone is present. The bulbocavernous reflex and observation of the anus during a gentle pinch of glans penis should also be performed.

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