Rectal Examination
o


Anatomy I
oThe rectum is the curved lower, terminal segment of large bowel.
oIt is about 12 cms long and runs along the concavity of the sacrum.
oAnterior to the lower 1/3 of the rectum lie different structures in men and women

Anatomy II
oIn men, anterior to the lower 1/3 of the rectum lie the prostate, bladder base and seminal
vesicles.
oIn women, anterior to the lower 1/3 of the rectum lies the vagina. At the tip of the examining
finger it may be possible to feel cervix and even a retroverted Uterus







When is it done?
oThis is an intimate and sometimes uncomfortable examination which is most often done when disease
(usually gastrointestinal or genitourinary disease) is suspected or already identified.
oIt may also be done as part of a screening examination when there is no suspicion or expectation
of disease but the examination is performed as part of a thorough screening process.
oIt is important in all cases to explain the reasons for the examination and to get verbal consent.




Indications for R.E.
oAssessment of the prostate (particularly symptoms of outflow obstruction).
oWhen there has been rectal bleeding (prior to proctoscopy, sigmoidoscopy and colonoscopy).
oConstipation.
oChange of bowel habit.
oProblems with urinary or faecal continence.
oIn exceptional circumstances to detect uterus and cervix (when vaginal examination is not
possible).




Procedure
oThe finger is then moved through 180°, feeling the walls of the rectum.
oWith the finger then rotated in the 12 o'clock position, helped usually by the examiner bending
knees in a half crouched position and pronating the examining wrist, the anterior wall can be
palpated.
oRotation facilitates further examination of the opposing the walls of the rectum. In men, the
prostate will be felt anteriorly. In women, the cervix and a retroverted uterus may be felt with
the tip of the finger.
oIt is important to feel the walls of the rectum throughout the 360°. Small rectal wall lesions may
be missed if this is not done carefully.

Examination of the Prostate Gland
o
oNormal size is 3.5 cms wide, protruding about 1 cm into the lumen of the rectum.
oConsistency: it is normally rubbery and firm with a smooth surface and a palpable sulcus between
right and left lobes.
oThere should not be any tenderness.
oThere should be no nodularity.










ohttp://beta.medicalvideos.us/videos-354-Rectal-Examinations
o
ohttp://beta.medicalvideos.us/videos-2539-Proctoscope-Medical-Examination-of-the-Rectum

External Inspection
o
oSkin disease.
oSkin tags
oGenital warts
oAnal fissures
oAnal fistula
oExternal haemorrhoids
oRectal prolapse
oSkin discolouration with Crohn's disease
oExternal thrombosed piles

Internal Inspection
oSimple piles (but best examined at proctoscopy)
oRectal carcinoma
oRectal polyps
oTenderness
oDiseases of the prostate gland
oMalignant or inflammatory conditions of the peritoneum (felt anteriorly)

Contraindications
oImperforate Anus
oUnwilling patient
oImmunosuppressed patient
oAbsence of anus following surgical excision
oStricture
oModerate to severe anal pain
oProlapsed thrombosed internal hemorroids

oTHANKS FOR LISTENING



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