Rectal examination: appointment, preparation and implementation of the survey

Rectal examination is part of the mandatory annual preventive examinations. The majority of patients carrying out this manipulation is frightening and forces to postpone the time of visiting specialists far away, on the pretext that the absence of complaints indicates a good level of health. Rectal rectal examination is used in gynecology, proctology, urology, surgery and allows to determine the presence of pathological conditions of neighboring organs.

Types of examination

Use the method of finger research, as well as instrumental, during which involved rectal mirrors and a sigmoidoscope. The finger method allows you to assess the condition of the pelvic organs in women, the prostate gland in men and the abdominal cavity.

Rectal examination using the finger method is carried out every time during the prophylactic examination, the appearance of abdominal pain, abnormalities of the intestinal tract and organs of the reproductive system. This method is used before each instrumental examination to check the patency of the rectum, avoiding complications in the future.

Instrumental rectal examination is carried out in order to assess the condition of the intestinal tract itself, the rectum. It allows to determine the presence of inflammatory processes, polyps and neoplasms, obstruction, strictures.

Indications for conduction

Such manipulation is carried out in the following cases:

• Pathology of the rectum (infiltration, the presence of ulcers, constrictions, compression of the walls neoplasms);
• Paraproctitis - inflammation of the pelvic fat;
• peritonitis;
• Assessment of the sphincter's performance;
• The definition of the pathology of the coccyx, Bartholin and Cooper glands;
• Diseases and neoplasms of the prostate;
• Inflammatory processes, presence of tumors of female reproductive organs;
• With diagnostic purposes.

Rectal research in proctology

Before the manipulation, the doctor examines the area of the anus. Defined the presence of hyperemia, maceration, inflammatory processes, pathological discharge, external hemorrhoids. Then the patient takes one of the poses:

• On his side with knees brought to his chest;
• Knee-elbow position;
• Lying on the gynecological chair, and the legs are bent at the knees and pressed against the stomach.

How is the procedure performed?

Finger rectal examination does not require preliminary preparation of the patient. It is enough that after the last bowel movement the patient took a shower and performed hygienic treatment of the genital organs and the anus. The algorithm of the procedure is as follows:

1. The patient takes one of the poses (at the request of a specialist, she changes during manipulation).
2. The doctor treats his hands and puts on gloves.
3. Vaseline oil is applied to the index finger and the anal area.
4. With gentle slow motion, insert a finger on the back of the intestine to a depth of 5 cm.
5. During the examination, the doctor may ask for straining or relaxing the sphincter.
6. Finger is withdrawn. On the glove there should be no pathological discharge (mucus, blood veins, pus).

Rectal mirror examination

Consider how a rectum examination is performed using medical instruments. After the finger method, the rectal mirrors in the branch area are lubricated with petrolatum oil. The anal area is treated in the same way.

The patient occupies the knee-elbow position. Branshi is injected into the rectum by 8-10 cm, spread apart and slowly removed, in parallel examining the intestinal mucosa. The same principle is used for vaginal gynecological examination of women.

Recto-manoscopy

This is an endoscopic method for diagnosing the state of sigmoid and direct intestinal tract. The examination is carried out with the help of a sigmoidoscope. The apparatus is inserted into the rectum, the patient is in the knee-elbow position. Using a lighting device that is part of the device and an optical system, you can inspect the mucosa for 30 cm.

The image of the monitored area is displayed on the monitor screen, where a doctor with an assistant can evaluate the presence of the inflammatory process, tumors, polyps, internal hemorrhoids, cracks.

Indications for conducting:

• Presence of secretions of pathological character;
• False urge to defecate;
• hemorrhoids;
• Discomfort in the rectum;
• Suspected neoplasm;
• colitis.

Contraindications to sigmoidoscopy:

• Acute peritonitis;
• Acute inflammatory processes of the rectum;
• General severe condition of the subject.

Narrowly specialized institutions

The proctology center is one of the specialized medical and diagnostic institutions, rectal examination in which is an obligatory procedure for the examination of patients. Any diagnostic and some medical manipulations take place immediately after assessment of the condition of the rectum.

Proctological center is an institution whose specialists are engaged in differentiation of pathology, the development of complex programs for the therapy of patients with the use of medical, surgical and physiotherapeutic methods of treatment.

Here are engaged in such states as:

• hemorrhoids;
• Inflammatory processes of the rectum and large intestine, cellulose, anorectal area;
• Insolvency of sphincters;
• Removal of foreign bodies;
• Helminthic invasions;
• Congenital pathologies of the anorectal region;
• Stricture and atresia of the rectum;
• Injuries;
• Fistula;
• Tumor processes;
• Prolapse of the rectum.

Rectal examination of the prostate

In the field of urology, an examination of the prostate through the rectum is an obligatory measure for all men after 40 years. This method allows you to recognize the presence of pathologies in the early stages. The finger method is used. Before it is carried out, it is necessary to explain to the patient the purpose of the diagnosis in order to avoid stress and negative reaction.

Rectal examination of the prostate gland allows estimating the following indices:

• Size and shape;
• Density and elasticity;
• Sharpness of contours;
• Symmetry of the lobules of the gland;
• Presence or absence of painful sensations;
• The presence of scars, cysts, stones on the surface;
• Condition of seminal vesicles;
• The mobility of the gland;
• The condition of the lymph nodes, their size, mobility, elasticity.

Normal indicators are as follows:

1. The gland has two symmetrical lobes, separated by a groove.
2. Dimensions (in cm) - 2,5-3,5 х 2,5-3.
3. The round shape of the organ.
4. Absence of tenderness in palpation.
5. Clear contours.
6. Dense-elastic consistency.
7. Smooth surface.
8. Seminal vesicles are not probed.

Research of the rectum in gynecology

In this area of medicine, rectal examination is performed by a gynecologist, not a proctologist. How is the examination of women and for what it is carried out, consider in more detail.

Examination using the finger method is necessary in the following cases:

• Assessment of the pelvic organs in girls who did not have a sexual life;
• In the presence of atresia (fusion of the walls) or stenosis (narrowing) of the vagina;
• As an additional survey of the prevalence of the tumor process in case of its establishment;
• In the presence of inflammatory diseases, to assess the condition of ligaments, fiber;
• With parameter;
• As a stage of bimanual examination.

Since the proctologist does not participate in this manipulation, how the examination takes place in women and in what cases it is necessary, the treating gynecologist decides. During the procedure, you can clearly assess the condition of the cervix, the presence of cicatricial changes, fluid accumulation. In addition, a specialist can determine the presence of pathological changes in the rectum itself, which have arisen against the background of gynecological diseases or compression of the tumor.

Examination of parturient women

Rectal examination can be used for repeated monitoring of the status of parturient women. You can determine the degree of cervical dilatation, the presentation of the baby, the condition of the amniotic fluid and its integrity, the location of the stitches and fontanel of the baby (this point is not in all cases).

Before the procedure, a woman should empty the bladder. Lie on your back, legs bend at the knees and spread apart. The parturient should breathe absolutely calmly, in order to relax muscles as much as possible. Use several methods for diagnosis:

1. Finger - with one finger, densely greased with petroleum jelly, the necessary indicators are evaluated.
2. Rectovaginal - the index finger is inserted into the vagina, and the middle finger is inserted into the rectum. The second hand examines the reproductive organs of the woman through the abdominal wall.

Rectovaginal research can also be conducted in several ways. Sometimes it is necessary to introduce the index fingers of both hands: one - into the vagina, the other - into the rectum. In order to study the state of the vesicoureteral space, it is possible to insert a thumb into the vagina, and rectally to the index finger.

Conclusion

Rectal examination is a reliable and informative method of primary assessment of the patient's condition. This method is accessible and allows obtaining additional data on the patient's health level.