A rectal examination is part of the mandatory annual preventive examinations. The majority of patients carrying out this manipulation frightens and forces them to push the time for visiting specialists away, under the pretext that the absence of complaints indicates a good level of health. Rectal examination of the rectum is used in gynecology, proctology, urology, surgery and allows you to determine the presence of pathological conditions of neighboring organs.
Types of Examination
Using the method of digital research, as well as instrumental, during which rectal mirrors and a sigmoidoscope are involved. The finger method allows you to evaluate the condition of the pelvic organs in women, the prostate gland in men and abdominal organs.
A rectal examination by the finger method is carried out each time during the medical examination, the appearance of abdominal pain, disruption of the intestinal tract and organs of the reproductive system. This method is used before each instrumental examination to check the rectal patency, avoiding further complications.
Instrumental rectal examination is carried out in order to assess the condition of the directly intestinal tract, rectum. It allows you to determine the presence of inflammatory processes, polyps and neoplasms, obstruction, strictures.
Indications for
Such manipulation is carried out in the following cases:
- rectal pathology (infiltration, the presence of ulceration, narrowing, compression of the walls by neoplasms);
- paraproctitis - inflammation of the pelvic fiber;
- peritonitis;
- assessment of the performance of the sphincter;
- determination of pathologies of the coccyx, Bartholin and Cooper glands;
- diseases and neoplasms of the prostate gland;
- inflammatory processes, the presence of tumors of female reproductive organs;
- for diagnostic purposes.
Rectal research in proctology
Before the manipulation, the doctor examines the anus. The presence of hyperemia, maceration, inflammatory processes, pathological secretions, external hemorrhoidal nodes is determined. Next, the patient takes one of the poses:
- on the side with the knees brought to the chest;
- knee-elbow posture;
- lying on the gynecological chair, and the legs are bent at the knees and pressed to the stomach.
How is the procedure
Digital rectal examination does not require prior preparation of the patient. It is enough that after the last bowel movement the patient takes a shower and conducts hygienic treatment of the genitals and the anus. The procedure is as follows:
- The patient takes one of the poses (at the request of a specialist, she changes during the manipulation).
- The doctor treats his hands and puts on gloves.
- Vaseline oil is applied to the index finger and the anus.
- With a gentle, slow motion, a finger is inserted along the posterior wall of the intestine to a depth of 5 cm.
- During the study, the doctor may ask you to strain or relax the sphincter.
- The finger is removed. On the glove should not remain any pathological secretions (mucus, blood streaks, pus).
Rectal examination
Consider how the examination of the rectum is carried out using medical instruments. After the digital method, rectal mirrors in the jaw area are smeared with liquid paraffin. In the same way, the area of the anus is treated .
The patient takes a knee-elbow pose. The branches are introduced into the rectum by 8-10 cm, spread apart and slowly removed, while examining the intestinal mucosa. The same principle is used for vaginal gynecological examination of women.
Sigmoidoscopy
This is an endoscopic method for diagnosing the state of the sigmoid and direct intestines. The examination is carried out using a sigmoidoscope. The device is inserted into the rectum, the patient is in the knee-elbow position. With the help of a lighting device, which is part of the apparatus, and the optical system, you can examine the mucous membrane for 30 cm.
A picture of the examined area is displayed on the monitor screen, where a doctor with an assistant can assess the presence of an inflammatory process, tumors, polyps, internal hemorrhoidal nodes, cracks.
Indications for:
- the presence of discharge of a pathological nature;
- false urge to defecate;
- hemorrhoids;
- discomfort in the rectum;
- suspected neoplasm;
- colitis.
Contraindications to sigmoidoscopy:
- acute peritonitis;
- acute inflammatory processes of the rectum;
- general serious condition of the subject.
Highly specialized institutions
The proctology center is one of the specialized medical and diagnostic institutions, in which a rectal examination is a mandatory procedure for examining patients. Any diagnostic and some medical manipulations take place immediately after assessing the condition of the rectum.
A proctology center is an institution whose specialists are involved in the differentiation of pathology, the development of comprehensive programs for the treatment of patients using medical, surgical and physiotherapeutic methods of treatment.
Here they deal with such conditions as:
- hemorrhoids;
- inflammatory processes of the rectum and colon, fiber, anorectal region;
- sphincter failure;
- removal of foreign bodies;
- helminthic infestations;
- congenital pathologies of the anorectal region;
- strictures and atresia of the rectum;
- injuries
- fistulas;
- tumor processes;
- prolapse of the rectum.
Rectal examination of the prostate
In the field of urology, examination of the prostate through the rectum is a must for all men after 40 years. This method allows you to recognize the presence of pathologies in the initial stages. The finger method is used. Before conducting it, it is necessary to explain to the patient the purpose of the diagnosis in order to avoid stress and a negative reaction.
A rectal examination of the prostate gland allows you to evaluate the following indicators:
- size and shape;
- density and elasticity;
- clarity of contours;
- symmetry of the lobules of the gland;
- the presence or absence of pain;
- the presence of scars, cysts, stones on the surface;
- condition of seminal vesicles;
- gland mobility;
- condition of lymph nodes, their size, mobility, elasticity.
Normal indicators are as follows:
- The gland has two symmetrical lobules separated by a groove.
- Dimensions (in cm) - 2.5-3.5 x 2.5-3.
- The round shape of the organ.
- Lack of pain on palpation.
- Clear contours.
- Tight elastic consistency.
- Smooth surface.
- Seminal vesicles are not palpable.
Rectal examination in gynecology
In this area of medicine, a rectal examination is performed by a gynecologist, not a proctologist. We will examine in more detail how the examination is conducted in women and why it is performed.
Examination using the finger method is necessary in the following cases:
- assessment of the condition of the pelvic organs in girls who did not have sex;
- in the presence of atresia (fusion of the walls) or stenosis (narrowing) of the vagina;
- as an additional examination of the prevalence of the tumor process, if established;
- in the presence of inflammatory diseases, in order to assess the condition of ligaments, fiber;
- at parametrite;
- as a stage of bimanual examination.
Since the proctologist does not participate in this manipulation, how the examination is conducted in women and in what cases it is necessary, the attending gynecologist decides. During the procedure, you can clearly assess the condition of the cervix, the presence of cicatricial changes, fluid accumulation. In addition, the specialist can determine the presence of pathological changes in the rectum itself, which arose against the background of gynecological diseases or compression of the tumor.
Examination of women in childbirth
A rectal examination can be used to re-monitor the condition of women in childbirth. You can determine the degree of cervical dilatation, presentation of the child, the state of the amniotic fluid and its integrity, the location of the sutures and fontanelles of the baby (this point is not in all cases).
Before the procedure, a woman should empty her bladder. Lie on your back, bend your legs at the knees and spread to the sides. A woman in labor should breathe absolutely calmly to relax her muscles as much as possible. Use several methods for diagnosis:
- Finger - with one finger, densely greased with liquid paraffin, necessary indicators are estimated.
- Rectovaginal - the index finger is inserted into the vagina, and the middle finger into the rectum. The second hand examines the reproductive organs of a woman through the abdominal wall.
Rectovaginal examination can also be done in several ways. Sometimes the introduction of the index fingers of both hands is necessary: one in the vagina, the other in the rectum. In order to study the state of the cystic-uterine space, it is possible to introduce the thumb into the vagina, and the index finger, rectally.
Conclusion
Rectal examination is a reliable and informative method of initial assessment of the patient's condition. This method is affordable and allows you to get additional data about the patient’s health level.