1. Physical examination + per rectum examination

-          the per rectum examination can be performed in the position on the left side (Sims position), in the genocubital position or in the gynaecological (lithotomy) position

-          the examiner puts on a glove. The examiner uses one finger (index finger) to apply a suitable gel (e.g. a gel with mesocaine, which acts as both a lubricant and an anaesthetic). The examination itself begins with an aspect of the perianal area. We note, among other things, the presence of thrombosed external haemorrhoids, anal fissures, warts, skin growths, anal prolapse or visible scars. We look for the possible presence of external perianal fistulae or periproctal abscesses. The presence of prolapsed internal hemorrhoids or prolapsed rectal mucosa can be investigated by indagation after inviting the patient to briefly push on the stool. The examining finger is gently inserted into the rectum in a circular motion, assessing anal sphincter tonus and any pain. We will also be interested in the filling of the rectum, the rectal mucosa, and especially the presence of tumor formations. The location of the lesions is determined by the clock face, with the number 12 adjacent to the coccyx. In a man, we palpate the prostate (the physiological prostate is soft, painless, chestnut-sized, symmetrical). In a woman, palpate the cervix (the physiological cervix is smooth, painless, medium firm, symmetrical). At the end of the examination, we assess the consistency and colour of the stool on the glove (we look particularly carefully for the presence of blood, mucus and pus).

-          the appearance of pain right at the beginning of the examination or sphincter hypertonus may indicate the presence of a perianal fissure.  Reduced tonus may be caused by, for example, a sphincter rupture or damage to its innervation and may be the cause of faecal incontinence. We note any pathological resistances at all times

-          the per rectum examination is completed by examining the stool and any impurities on the glove, noting in particular the presence of blood, pus or mucus

Frurlan AB, Kato R, Vicentini F, Cury J, Antunes AA, Srougi M. Patient's reactions to digital rectal examination of the prostate. Int Braz J Urol. 2008

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2. Laboratory tests - see individual diseases

3.Stool examination

•      macroscopical

•      microscopical

•      occult bleeding – FOBT – a screening method in colorectal cancer detection in Czech Rep.

4. Imaging methods

•      X-ray (klasický snímek břicha ve stoje)

•      RTG pasáž, irigografie (abdominal erect view)

•      Ultrasonography of abdomen

•      TRUS – transrectal ultrasound

•      CT scan of abdomen and small pelvis, angiography

•      MRI – magnetic resonance imaging

•     PET CT/MRI – positron emission tomography in combination with CR or MRi

5. Endoskopic methods

•      anoscopy

•      rectoscopy

•      coloscopy

6. Functional testing

•      defekography – contrast exam.

of the defecation process

•      anorectal manometry – exam. of sphincters function

•      EMG of anorectal and pudendal nerves

 Anoscope and rectoscope (Authors archive)

For more detailed information on examination methods, see Propedeutics.