Examination per rectum

Examination per rectum (indagatio per rectum, examination of the finger through the rectum) is a very important, but often neglected examination. At the same time, the examination is fast, cheap and highly effective. The detection of serious pathological conditions (colorectal carcinoma) by this examination is definitely not negligible.

Indication[edit | edit source]

The per rectum examination should be a part of every more complex examination, every preventive examination, and also in case of suspicion or screening of the following pathological conditions:

A sudden abdominal incident.
Melena or enterorrhea.
Colorectal cancer screening (every man over the age of 50 should have a rectal examination regularly - at least every 2 years).
Screening Prostate cancer a benign prostatic hyperplasia.

Implementation and evaluation[edit | edit source]

Examination per rectum
The patient occupies a position on his back - gynecological position or also lithotomy, on "all four" - genupectoral position or on the side. In practice, the most commonly used position is on the left side with the knees flexed slightly to the head.

The doctor puts on a glove. The examination is performed with one finger (forefinger), on which he applies a suitable gel (eg a gel with mesocaine, which serves both as a lubricant and anesthetic). He must inform the patient that he will begin before the procedure begins

Then:

We will evaluate the landscape of the anal orifice (hemorrhoids, fissure, postoperative scars, etc.).

We carefully penetrate the rectum with an examining finger, evaluate the tone of the anal sphincters and possible pain
We will also be interested in the contents of the rectum, rectal mucosa and especially the presence of tumors. The location of the disease findings is determined by the clock face, with the number 12 adjacent to the coccyx (for example, the description reads: tumor located between the number 1 to 3)
We palpate the prostate (physiological prostate is soft, painless, chestnut-sized, symmetrical).
In women, we palpate the cervix (physiological cervix is smooth, painless, medium-firm consistency, symmetrical).
At the end of the examination, we evaluate the consistency and color of the stool on the glove (we look especially carefully for the presence of blood, mucus and pus).

Some pathological findings:

If Douglas's space is filled with pus – the patient feels pain during the examination on the left side of the right. The rectal mucosa in this locality has a pasty consistency and is smooth.
Weak sphincter tone is present in low bowel obstruction and peritonitis.

We would enter the physiological finding in the medical record or course as follows:

Per rectum:

without a disease finding - it is enough
surroundings anu calm, indagation painless, the tone of the sphincter in the norm, at your fingertips without resistance, on the glove brown stool without blood - to be absolutely accurate.