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The next step of the rectal examination involves the assessment of neuromuscular integrity. First, each side of the buttocks is scratched with the gloved finger to elicit the superficial anal reflex (the anal wink), a function of l 1 and l 2. After the external genitalia are inspected, a focused neurologic examination should be conducted to test the integrity of perineal sensation, pudendal reflex arcs (clitoral and anal wink responses), and pelvic floor muscle strength.   a reaction of the external anal sphincter muscle when the adjacent skin is briefly and briskly stimulated. A normal reflex is a contraction of the sphincter also known as anal wink. The anal wink, anal reflex, perineal reflex, or anocutaneous reflex is the reflexive contraction of the external anal sphincter upon stroking of the skin around the anus. A visible puckering at the margin of the external anal sphincter, evoked by stroking the perianal skin with a pin absence of an anal wink reflex suggests a defect in either sensory or motor nerves or in the central pathways that mediate this reflex.   case report a 41 year old woman was referred for assessment of worsening bladder and bowel dysfunction. At the age of 17 years she had suffered a traumatic fracture-subluxation of t12l1 following a trampoline accident in which she fell heavily on to her back. She immediately lost sensation below the waist but this returned over several days. The anal wink reflex, or perineal reflex, is related to anal sphincter injury. According to a study published in the journal obstetrics & gynecology, anal sphincter disruption is common in women with pelvic floor disorders and likely plays a significant role in the development of anal incontinence in this population.   examine the anus for the presence of any fissures, fistulae, or hemorrhoids. To elicit an anal wink, stroke the perianal skin with a pin or probe.

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