Author: A. Chandrasekhar, MD

Consultant: J. Pickleman, MD
and M. Klamut, MD

Ask the patient to lie on his left side with his left leg extended and right leg flexed.
Wear gloves.
Spread the buttocks and systematically inspect and palpate the sacral, coccygeal and perineal regions.

Normal:

The perianal skin is normally coarse, pigmented and puckers towards the anus. Soft pliable tags of redundant skin can be seen at the anal margin.