When is a digital rectal examination performed? How is a rectal examination performed? Digital rectal examination.

Today, digital rectal examination is a valuable diagnostic method, after which the doctor can advise the patient to undergo endoscopic procedures. Palpation of internal organs and tissues through the rectum is indicative and serves as a complement to the external examination.

Thus, doctors assess the condition of the tissues of the anal canal and the function of the anal sphincter, determine the position of the surrounding tissues, and check the degree of preparation of the rectum for endoscopic examination. In some cases, this method allows you to detect the pathological process in time, so you should not postpone a visit to the proctologist.

Indications for medical examination

A digital examination of the rectum is performed in cases where the patient complains to doctors of periodic abdominal pain, especially during bowel movements, and it always precedes an instrumental rectal examination. The method is also appropriate in the following cases:

the presence of symptoms of hemorrhoids and related ailments;
dysfunction of the prostate gland in men;
diseases of the internal genital organs in women;
constipation and other bowel problems.

Thus, a detailed examination will help to recognize the condition of the intestinal mucosa and determine the tone of the anal canal, which will affect further examination of the patient’s body. The doctor will record important information - the presence or absence of hemorrhoids, tumors and polyps, cracks, inflammatory elements.

The described method also makes it possible to diagnose prostate enlargement in men and pathologies of the internal genital organs in women.

Examination of the rectum using a finger occupies a separate place in gynecology. It is a complement to a vaginal examination when establishing the nature of the tumor process, checking the condition of the uterosacral ligaments; such an examination is also indispensable during observations of women who have given birth.

A rectal examination provides sufficient data on the degree of opening of the cervix, the position of the fetus, and the location of the sutures, so it should not be underestimated. This method of examining the organ is contraindicated in cases of severe sphincter spasms, narrowing of the anal canal, or pain in the anus.

Preparing for examination by a proctologist

Despite the fact that such a study does not require preliminary medication or diet, the day before the visit to the doctor it is necessary to give up high-calorie and fatty foods, fresh vegetables and foods that cause the formation of gases in the intestines. Patients suffering from frequent constipation are advised to do a warm water enema 8 hours before the examination.

Diarrhea makes diagnosis difficult, so you should introduce foods that strengthen the stool into the diet - dairy products, rice water.

If the patient suffers from severe pain, it is recommended to cleanse the intestines using laxatives prescribed by a doctor. There is no need to prescribe such medications yourself, as they can cause harm and interfere with further examination. Before digital examination of the rectum, the bladder must be emptied, and the doctor may advise the patient to relieve pain by using analgesics or medicinal ointment.

Technique for performing proctological examination

The doctor conducts a rectal examination of the rectum using an index finger in a medical glove; to reduce discomfort, it is lubricated with Vaseline, and the anus is treated with an anesthetic gel. The action implies a certain position of the patient’s body, depending on his complaints and suspicion of a specific illness.

Most often, a person lies on his side, his knees are bent, thanks to which the doctor will be able to notice dangerous tumors in the area of the organ being examined.

In order to determine the nature of the detected tumor, the doctor will ask the patient to take a knee-elbow position. This position will also reveal damage to the mucous membrane of the organ. If diseases of the genitourinary system are suspected in men and women, a gynecological chair is used, which provides a detailed examination.

Less often, a doctor examines a person squatting - a position necessary for diagnosing the upper parts of the rectum. Doctors will be able to detect an abscess if the patient is in an upright position on the couch, with his arms and legs extended.

Methods for conducting proctological examination

Medical manipulation, which is the subject of the video and medical work, is applied based on the patient’s complaints and his individual characteristics. Experts distinguish the following research methods:

one-finger;
two-fingered;
two-handed.

In the first case, the doctor inserts the index finger into the rectum and begins an examination, noting the features of the walls of the anus, the presence or absence of tumors and other features. An experienced proctologist will be able to check the condition of the genital organs - the cervix and vaginal septum in women, as well as the size of the prostate in male patients.

Considering a person’s complaints of pain in the groin area, the doctor palpates the sacrum and coccyx, since the lower part of the spine needs diagnosis. At the end of the examination, doctors analyze the mucus remaining on the finger, they note the presence or absence of particles of blood, pus and other secretions.

The doctor conducts a two-finger examination in the same way as a normal one, but in this case, the finger of the second hand presses on the patient’s pubic area. The method helps to identify diseases and tumors of the upper rectum or peritoneum. For women, this technique is important because it determines the mobility of the organ wall towards the vagina.

A digital examination of the rectum using both hands of the doctor is aimed at identifying malignant tumors on the anterior wall of the organ; the sooner it is carried out, the better for the patient. After completing the examination, the doctor records the results in the medical record of the person who applied and informs him about further treatment of the disease.

The need for finger diagnostics

A digital examination, the technique of which depends on the patient’s complaints, is an integral part of the proctologist’s appointment. During the examination, the person must first push and then relax as much as possible so that the specialist can examine the organ.

In some cases, the method is used in the practice of gynecologists, but most often it helps to recognize the symptoms of a dangerous disease - hemorrhoids.

Sometimes upon palpation dense nodes of the venous plexuses are found, enlarged and painful. This sign indicates the presence of thrombosis. The edematous elements are compacted, but upon examination they are easily displaced, which indicates the presence of an inflammatory process. Using a simple and informative method for identifying diseases, it is easy to prevent the development of complications and begin treatment on time.

Rectal examination I Rectal examination (lat. rectum)

special examination techniques to assess the condition of the rectum and surrounding organs and tissues, performed through the lumen of the rectum.

In clinical practice, finger and instrumental R. and. Finger R. and. is a mandatory method for diagnosing diseases of the rectum, pelvis and abdominal organs. It must be performed in all cases where there are complaints of abdominal pain, dysfunction of the pelvic organs, and intestinal activity. It always precedes instrumental R. and., allows us to resolve the issue of the possibility of performing the latter, to avoid serious complications in the event of a sharp narrowing of the anal canal or rectal lumen by a tumor or inflammatory infiltrate. Finger R. makes it possible to assess the functional state of the anal muscles, identify diseases, pathological changes in the anal canal and rectum (cracks, hemorrhoids, cicatricial changes and narrowing of the intestinal lumen, benign and malignant neoplasms); inflammatory infiltrates, cystic and tumor formations of pararectal tissue, sacrum and coccyx; changes in the prostate gland in men and internal genital organs in women; condition of the pelvic peritoneum, rectouterine or rectovesical recess. Sometimes finger R. and. is the only method for detecting a pathological process localized on the posterior semicircle of the rectal wall by the anal canal, in an area that is difficult to access during any type of instrumental rectal examination.

Finger R. and. It is contraindicated in case of a sharp narrowing of the anus, as well as in case of severe pain until the pain is relieved with the help of ointment with dicaine, analgesics or narcotics.

A rectal examination is carried out in various positions of the patient: lying on his side with the legs bent at the hip and knee joints, in the knee-elbow position, in the supine position (on a gynecological chair) with the knees bent and legs brought to the stomach. Sometimes, to assess the condition of the hard-to-reach upper parts of the rectum with digital R. and. The patient is placed in a squatting position. If an abscess or Douglas pouch is suspected, digital R. and. must be carried out with the patient in the supine position, because Only under this condition can overhangs and the anterior semicircle of the rectal wall be identified.

Paltsevoy R. and. should always be preceded by a thorough examination of the anal area, which often makes it possible to identify signs of the disease (external fistulas, external hemorrhoids, insufficient closure of the edges of the anus, proliferation of tumor tissue, maceration of the skin, etc.), after which the index hand of the right hand, on which a rubber a glove generously lubricated with Vaseline is carefully inserted into ( rice. 1 ). Consistently palpating the walls of the anal canal, assess the elasticity and extensibility of the anal sphincter, the condition of the mucous membrane, the presence and degree of pain of the examination. Then the finger is passed into the ampulla of the rectum, determining the state of its lumen (gaping, narrowing), the intestinal wall is sequentially examined over the entire surface and along the entire accessible length, and the condition of the prostate gland (in men) and the rectal-vaginal septum, cervix (in men) is examined. women), pararectal tissue of the inner surface of the sacrum and coccyx. After removing the finger from the rectum, the discharge is assessed (mucous, bloody, purulent).

To diagnose diseases of the upper ampullary part of the rectum, the fiber of the pelviorectal or retrorectal space (, presacral), and pelvic peritoneum (inflammatory process or tumor), they resort to bimanual digital examination. For this purpose, the index finger of one hand is inserted into the rectum, and the fingers of the other hand press on the anterior abdominal wall above the pubic symphysis ( rice. 2 ).

The condition of the rectal-vaginal septum, the mobility of the rectal wall in relation to the posterior wall of the vagina and the body of the uterus can be assessed by performing bimanual digital rectal and ( rice. 3 ).

Bibliography: Aminev A.M. Guide to proctology, vol. 1-4, Kuibyshev, 1965-1978; Henry M.N. and Swasha M. Coloproctology and, p. 89, M., 1988; Fedorov V.D. rectum, p. 79, M., 1987; Fedorov V.D. and Dultsev Yu.V. , With. 24, M., 1984.

Rice. 2. Bimanual rectal-vaginal examination: the index finger of the doctor’s right hand is inserted into the vagina, and the middle finger of the same hand is inserted into the rectum; with the fingers of the left hand, press on the anterior abdominal wall above the pubic symphysis.

II Rectal examination (exploratio rectalis)

the general name for diagnostic manipulations (for example, digital examination, endoscopy) performed through the anus in the lumen of the rectum in order to determine its condition or the condition of adjacent organs and tissues.

Bimanual rectal examination(e. r. bimanualis; synonym: rectal-abdominal wall examination) - R. and., in which a finger is inserted into the lumen of the rectum, and the other hand is placed on the surface of the anterior abdominal wall and the pelvic organs are palpated.

Digital rectal examination(e.r. palpatoria) - R. and., in which the walls of the rectum and adjacent organs are palpated with a finger inserted through the anus.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what “Rectal examination” is in other dictionaries:

- (exploratio rectalis) is the general name for diagnostic manipulations (for example, digital examination, endoscopy) performed through the anus in the lumen of the rectum in order to determine its condition or the condition of the organs adjacent to it and... ... Large medical dictionary

RECTAL EXAMINATION- rectal examination, manipulation performed through the rectum for the purpose of diagnosing diseases of internal organs and determining pregnancy. Particularly valuable is R. and. in large animals, since they have external palpation of organs through the abdominal... ... Veterinary encyclopedic dictionary

animal rectal examination- Examination of animals rectally to determine pregnancy and diagnose diseases of the genital organs. [GOST 27775 88] Topics: artificial insemination... Technical Translator's Guide- (prostata) accessory sex gland of the male reproductive system. Performs an excretory function, secreting a secret that is part of sperm, and an endocrine function, producing a hormone that supports spermatogenesis. Located in the anterior inferior part of the small... ... Medical encyclopedia

I Sigmoidoscopy (an. rectum rectum + sigma romanum sigmoid colon + Greek scopeō observe, examine; synonym rectosigmoidoscopy) a method of endoscopic examination of the rectum and distal sigmoid colon by ... ... Medical encyclopedia

A rectal examination is a diagnostic procedure performed through the rectum in order to study it, as well as adjacent organs and tissues.

Rectal examination can be digital or instrumental (performed using a rectal speculum and a rectoscope). Indications: diseases of the rectum (see) (infiltration of the walls, ulcers, narrowing or compression of the rectum by a tumor, etc.); pelvic tissue (see), internal organs located in the lower parts of the abdominal cavity, in the small pelvis.

A rectal examination is preceded by an examination of the anal area. The patient is placed on the table on his side with his legs brought to the stomach or in a knee-elbow position. During examination, you can detect hemorrhoids (sometimes they are visible better if you ask the patient to strain), anal fissures,.

Then perform a careful examination with a gloved finger; In addition, a rubber fingertip lubricated with petroleum jelly is put on the finger.

In the absence of a special fingertip, the examination can be done simply with a rubber glove. During rectal examination, it is recommended to insert the finger while straining, pressing backwards; must first be emptied (enema). Digital examination can detect internal hemorrhoids, tumors, cracks, and determine the size and condition.

An examination using a rectal speculum is carried out after first lubricating its branches with Vaseline. The branches are inserted into the rectum (to a depth of 8-10 cm) with the patient in the knee-elbow position. They are pulled apart and, slowly removed, the rectal mucosa is examined. Examination using a rectoscope - see.

Recto-abdominal examination.

Rectal examination in. In gynecological practice, a rectal examination is performed in the following cases: 1) in girls and young women, as well as with atresia and when it is impossible to perform a vaginal examination; 2) in addition to vaginal examination for uterine cancer to determine the extent of the tumor process (transition of the tumor to the pelvic tissue, lymph nodes and rectal wall); 3) for inflammatory diseases of the internal genital organs to clarify the condition of the uterosacral, perirectal tissue, etc.; 4) at ; 5) to clarify the nature of the tumor located in the rectal-uterine space (ovarian cancer).

Even more data can be obtained using a bimanual (recto-abdominal) examination (Fig.), which allows you to clearly palpate the uterus, uterine appendages, and also get an idea of the condition of the ligaments of the uterus and pelvic peritoneum.

Rectal examination - examination of the rectum (rectum), consisting of examination of the anus, examination of the rectum with a finger, using an anuscope, rectal mirror, rectoscopy and x-ray examination.

When examining the anus, you can see external hemorrhoids, anal papillae and fimbria (see Anus), the edge of a low-lying cancerous tumor or tuberculous ulcer, external openings of pararectal fistulas, acute condylomas, atheromas, etc. With sphincter insufficiency, leakage of intestinal contents is noted , irritation of the surrounding skin, diaper rash, eczema, excoriation. To detect a fissure, it is necessary to force the patient to strain, while the examiner with both hands stretches and straightens the skin folds of the external anal funnel.

A finger examination is mandatory in all patients with complaints of disease of the anus or rectum. It is performed with the patient lying on his back with bent legs, on his side, in a knee-elbow position, or sitting (as during defecation). In the latter case, especially when the patient strains, the doctor’s finger penetrates the rectum 2-3 cm deeper than when examining the patient in a supine position.

To examine the rectum using instruments, the skin surrounding the anus is lubricated with Vaseline. The assembled anuscope, lubricated with Vaseline, is inserted into the rectum, and the stylet is removed. Examine the mucous membrane of the lower rectum.

The rectal speculum is inserted into the rectum in a closed form. The branches are pulled apart and the lower part of the rectum is examined - statically and when removing the instrument, which can then be slightly rotated, making rotational movements with it. Many design options for anuscopes and rectal mirrors have been proposed (Fig. 1 and 3). Rectoscopy - see Sigmoidoscopy.

Rice. 1. Instruments for examining the rectum: 1 - sphincteroscope; 2 - anuscope; 3 - small proctoscope; 4 - large proctoscope.

Rice. 2. Scheme of sphincterometry using the Aminev sphincterometer.

Rice. 3. Various types of rectal specula.

An X-ray examination of the rectum is performed either after 18-24 hours. after taking barium contrast mass through the mouth, or using irrigoscopy - filling the intestine with a contrast suspension through an enema (the latter is preferable). Some details can be better seen after bowel movement from a contrast suspension through natural defecation, especially with double contrast - barium suspension and air. Minor traces of the contrast mass remaining on the surface of the mucous membrane make it possible to contour pathological formations of even small sizes.

The study of sphincter strength is carried out using an Aminev sphincterometer (Fig. 2), consisting of an olive with a rod and a steelyard. The olive is lightly lubricated with Vaseline and inserted into the rectum. When you pull the steelyard, the needle moves along the steelyard scale. It stops after the olive is removed from the rectum and shows the strength of the sphincter in grams. During the first measurement, in a quiet position of the subject, the sphincter tone is recognized. During the second measurement, the subject strongly contracts the sphincter. The maximum strength of this muscle is determined. In women, the tone is on average 500 g, maximum strength is 800 g, in men - 600 and 900 g, respectively.

A rectal examination in gynecology is indicated both to supplement the data of a vaginal examination and to replace it when it is not possible (in girls, girls, with aplasia, vaginal atresia).

With a rectal examination, it is possible to clearly identify the cervix, scars, changes in the vagina, the accumulation of fluid in it (hematopyocolpos, etc.), examine the peri-vaginal tissue, and the uterosacral ligaments. Determine some changes in the intestine itself (infiltration of the walls, sometimes ulcerative defects or pathological growths), narrowing and compression by a tumor or exudate in the peri-vaginal tissue, etc. Rectal examination is considered a mandatory method of examination for cervical cancer, as it facilitates the detection of infiltrates in the parametrium .

For repeated observations of women in labor, a vaginal examination can be replaced by a rectal examination, which provides enough data to judge the degree of opening of the cervix, fetal presentation, integrity of the amniotic sac, and in some cases, the location of sutures and fontanelles. You can also feel the concavity of the sacral bone, determining the degree of filling of the sacral cavity with the presenting part of the fetus. Rectal examination can be a method of systematic observation of labor.

Before a rectal examination, the bladder must be emptied. It is necessary to place the patient in a horizontal position on her back: the upper body should be slightly raised, the knees slightly bent, the legs apart, the stomach relaxed. The patient should breathe freely and avoid any muscle tension.

Another position of the patient during a rectal examination is as during stone cutting; while the doctor stands between the patient’s knees. A rectal examination is performed with the index finger of the right or left hand, wearing a rubber glove, thickly lubricated with petroleum jelly. The thumb of the examining hand is retracted posteriorly to prevent pressure on the external genitalia (Fig. 4). In some cases (to study the characteristics of the rectovaginal septum), a combined rectovaginal examination is performed, in which the index finger is inserted into the vagina and the middle finger into the rectum (Fig. 5): the pelvic organs are examined through the abdominal wall with the free hand. In rare cases, to study the vesicouterine space, a thumb is inserted into the anterior vaginal fornix, and the index finger is inserted into the rectum. In some cases, rectovaginal examination is performed with the index fingers of both hands.

Rice. 4. Rectal-abdominal examination.
Rice. 5. Rectovaginal examination.

A rectal examination can be carried out by different doctors as part of treatment and diagnosis in their specialty. The word inspection is purely conditional. This is a term. In relation to the research process itself, it would be more correct to say probing.

Features of the study

Medical specialists who use this type of research in their practice:

proctologist;
urologist;
gynecologist;
surgeon.

Rectal examination is carried out according to the following algorithm:

The patient takes one of three positions for the study: on his side, on all fours, or in a gynecological chair with his limbs tucked to his stomach.
The doctor puts on gloves, coats his finger with Vaseline and inserts it into the anus. To begin with, the depth of insertion is up to 5 cm. If necessary, deeper insertion is possible (up to 10 cm).
Manipulations are performed with the finger in accordance with the diagnostic algorithm.
If necessary, they may be asked to tense the sphincter or relax it.

This examination is completely painless, although most people find it unpleasant. With diseases of the rectum, minor pain and a small amount of blood may occur. But in case of exacerbation of inflammatory diseases (a situation where it can really hurt), an examination is not carried out.

No special preparations are required to prepare for such an inspection. It is enough to empty yourself and wash yourself. An enema is not required, since the rectum is quite well cleared of feces after a bowel movement (unless there are certain diseases).

Thus, if there are no diseases, then during a rectal examination there should be no feces, no blood, no pus or mucus on the gloves. The presence of any of these elements indicates abnormal processes occurring in the intestines. In addition, when examining the organs of the urinary and reproductive system using the rectum, no lumps or seals should be felt.

As for discomfort, it should be remembered that being sick is uncomfortable in itself, and treatment and diagnosis are primarily focused not on comfort, but on speedy and correct diagnosis and treatment. You can, of course, refuse treatment for the sake of comfort, but a sick organism, by definition, will not have comfort.

Diagnosis by a proctologist

Let's consider the features of conducting a rectal examination by a proctologist (a doctor who treats diseases of the rectum, colon, and anus). This problem can occur in both women and men, since it is not associated with gender differences, but only with the digestive system, in particular, with the excretory branch of the digestive tract.

The main disease in the practice of a proctologist is hemorrhoids. This is a disease in which the veins of the rectum and anus become swollen. It is not possible to see these symptoms visually, but with the help of rectal diagnostics it is quite possible to diagnose the disease. At the last stage, when hemorrhoids begin to fall out, of course, such an examination is not required, but in the initial stages it is necessary in order to start treatment on time and prevent the patient’s condition from worsening.

Urologist

A urologist is a doctor who treats the genitourinary system in men and the urinary system in women. The differences in terminology for men and women are due to the fact that in the former, unlike the latter, it is not possible to separate the functioning of the urinary and reproductive systems. Many organs, if not working on two fronts, are at least connected. For example, the prostate, which is not a urinary organ, is located under the bladder, enveloping the urethra. In case of inflammation, the prostate begins to compress the urethra, which causes severe pain when urinating. In women, the urinary and reproductive systems are simply physiologically nearby, but a certain, although not so pronounced, connection is also present.

A rectal digital examination of a man by a urologist involves mandatory palpation of the prostate gland. The easiest way to do this is this way, through the rectum. Therefore, you should treat such a study with understanding and not think that the doctor is doing something wrong by sticking a finger into the opening for the exit of feces, while treating the urinary tract.

Gynecologist

A rectal examination of women is an additional test during examination by a gynecologist and is prescribed as needed. The female reproductive system is located quite close to the intestines, and in some cases, inflammation and tumors located in the female genital organs can be detected during a rectal examination.

The purpose of the examination by a gynecologist may be:

degree of cervical dilatation in pregnant women;
scars and changes in the vagina;
hematopyocolpos (fluid accumulation in the vagina);
parameters of the uterosacral ligaments and tissue of the peri-vaginal zone.

In some cases, when examining pregnant women, a rectal examination can help the doctor determine the position of the fetus (presentation) or obtain information about rupture of the amniotic sac. In relation to women in labor, a rectal examination can be either individual or systematic during the birth process.

During a gynecological rectal examination, procedures with an enema and emptying the bladder are required. This, in addition to the sanitary standards of gynecology, also helps the doctor to separate problems of a gynecological nature from, for example, problems of urology or proctology.

This examination by a gynecologist has several fundamental differences from examinations by a proctologist and urologist. This is not surprising, because the proctologist examines the intestines directly and it is important for him to find out the location of tumors and abscesses of the intestine itself. Although the urologist palpates the rectum, the examination of the prostate is, one might say, spot-on. A gynecologist has a broader task. The examination goes through the intestines, but other organs are palpated. Moreover, these organs are not point-like, but extended. In some cases, such an examination is carried out with two fingers (one finger is inserted into the anus and the other into the vagina). In some cases, research involves pressing on the abdomen or other actions necessary for a more accurate diagnosis.

Pathologies of the rectum and its anus require careful diagnosis to prescribe adequate treatment. Digital rectal examination of the rectum is still the most effective and efficient way to detect various problems such as fistula, hemorrhoids and prolapse. By examining the rectum, the doctor has the opportunity to assess the condition of the mucous layer, exclude the presence of tumor processes, polyps, etc. Therefore, the technique of such manipulation should be adopted by all practicing doctors.

Typically, a digital examination of the rectum is carried out solely according to indications, if the patient has characteristic complaints: pain, itching, burning in the anus, lack of bowel movements, bloating from the inside, etc. Also, a rectal examination of the rectum allows timely diagnosis of pathological proliferation of prostate tissue.

Anatomical and topographical information

Anatomical and topographic information must be taken into account so as not to cause harm to the patient’s health. In the rectum, there is a supramullary (rectosigmoid) section, an ampulla (ampullary section) and an anal canal. The ampoule (with a capacity of up to 500 ml) distinguishes between the upper, middle and lower ampullary sections. The length of the rectum is 15-16 cm. In front of the rectum in men are the bladder, prostate gland and seminal vesicles, in women - the uterus and vagina.

In the upper section, corresponding to the third sacral vertebra, the parietal peritoneum adjoins the rectum, forming in men between the rectum and the bladder a rectovesical cavity (excavatio rectovesicalis), bounded on the sides by rectovesical folds. In women, there is a rectouterine cavity in the parietal peritoneum, located between the uterus and the rectum, bounded on the sides by the rectouterine folds of the peritoneum (excavatio rectouterina, synonym: pouch of Douglas, space of Douglas). The blood supply to the rectum mainly comes from an unpaired artery - the superior hemorrhoidal artery (a branch of the inferior mesenteric artery) and two paired ones - the middle and inferior hemorrhoidal arteries (from the iliac artery system). The veins of the rectum belong to two venous systems: the superior hemorrhoidal vein through the inferior mesenteric vein (to the mesenterica inferior) flows into the portal vein; lower and middle through i. putenda, V. hypogastrica flow into the inferior vena cava.

The superior hemorrhoidal vein is the main route of outflow of venous blood. Its branches originate in the venous submucosal plexuses of the anal part of the rectum, in the venous ampoules, which under pathological conditions form hemorrhoids (varices haemorrhoidales). Knowledge of the venous circulation of the rectum allows us to understand the mechanism of formation of secondary hemorrhoids when blood circulation is obstructed both in the portal vein system (liver cirrhosis) and in the inferior vena cava system (grade III circulatory disorder).

Preparing for a rectal examination

The examination of the anus should be carried out in four positions of the patient: on the side with the limbs bent at the hip joints, in the knee-elbow position, on the back with the hips brought to the stomach, in a squatting position. Preparation for the examination of the rectum consists of emptying the intestines and positioning the patient in the above position.

The anus area is mentally divided into 4 sectors: anterior-right, anterior-left, posterior-left and posterior-right. Examine the skin around the anus; recognize swelling of various sizes and shapes at the border of the skin and mucous membrane - external hemorrhoids, fistulas with purulent discharge, swelling with inflammatory redness (paraproctitis), weeping flat syphilitic papules, eczema, genital warts.

Bleeding ulceration detected during visual examination of the anus may be a manifestation of cancer of the anal canal, eczema-like changes in the skin of the perineum - a manifestation of a rare form of cancer of the apocrine glands - extra-mamillary Paget's cancer (Paget's extra-mamillary dermatosis) - cancer of the apocrine glands and their ducts, localized in perianal area, armpits, external genitalia, also characterized by the presence of sharply defined, slightly infiltrated foci of erythema with peeling, weeping and crusts.

If swelling is detected, its consistency and sensitivity are determined. Uncomplicated hemorrhoids that appear cyanotic in color when straining are painless and have a soft, pliable consistency. Hemorrhoids that fall out of the anus often undergo thrombosis and inflammation, which is accompanied by severe pain that prevents walking and sitting, and an increase in temperature. With thrombosis of the nodes, the anal sphincter is spastically contracted, the prolapsed nodes acquire a bluish (black) color, become dense, and sharply painful. In the future, thrombosed and inflamed nodes can fester. In a number of patients, when straining, round-shaped polyps may appear on the leg, and when the folded skin is pulled apart during straining, small cracks in the anus are sometimes detected.

Some diseases of the rectum and anus in humans

Let's consider some diseases of the rectum and anus that can be successfully diagnosed during such a study.

Anal fissure ( fissura ani) has the appearance of a linear defect of the anal mucosa. The length of the crack is usually 2 cm, width 2-3 mm. More often, the crack is located in the area of the posterior commissure of the anus (there can be several cracks, their most typical location is: anterior and posterior commissures: “mirror” cracks).

At the initial stage of anal disease, fissures represent a tear in the skin in the area of the transitional fold and the mucous membrane of the rectum in the area of the anal canal. Gradually, the soft edges of the crack become hard, callous, it expands and takes on the appearance of a trophic ulcer, the bottom of which is covered with granulations. The addition of spasm of the rectal sphincter reduces the possibility of healing of the fissure due to tissue ischemia. In the area of the inner edge of the crack, a connective tissue scar develops - the so-called border tubercle. A patient with a chronic fissure experiences pain at the time of defecation, and minor bleeding occurs. The pain is cutting, burning, stabbing (sometimes intense), lasting from several minutes to several hours after defecation.

The prolonged sphincter spasm observed in people with this disease of the anus after defecation and severe pain syndrome cause the phenomenon of “stool phobia”. The blood released from the fissure during defecation is usually not mixed with feces, but is located on its surface in the form of stripes or appears at the end of defecation in the form of several drops.

To detect prolapse of the mucous membrane or all layers of the rectal wall, the patient is asked to push in a squatting position. Rectal prolapse is a condition in which the entire rectum or part of it is located outside the anus for a long period or for a short time. Rectal prolapse is characterized by prolapse of all layers of its wall with exit through the anus to the outside (without prolapse of the anus). The main cause of prolapse of the rectal mucosa is the weakening of its connection with the submucosa due to inflammatory processes.

In addition, in adults, prolapse of the rectal mucosa most often occurs as a complication of hemorrhoids with a tendency for the nodes to prolapse outward. In these cases, constipation is a predisposing factor. Diarrhea accompanied by tenesmus can also lead to rectal prolapse. The pathogenesis of prolapse of all layers of the rectum seems different - predisposing and producing causes are distinguished. The first include the structural features of the sacrum (the degree of its bending), the presence of a long mesentery at the pelvic part of the rectum, weakness of the pelvic floor muscles and the muscular apparatus that lifts the rectum. The second is an increase in intra-abdominal pressure, noted with constipation, diarrhea, heavy physical labor, and coughing.

There are 4 degrees of rectal prolapse.

At I degree The rectum prolapses only during defecation and then resets itself when the patient retracts his abdomen. The dimensions of the fallen part are 4-6 cm.
At II degree The patient is forced to straighten the prolapsed intestine himself. The size of the prolapse increases to 6-8 cm.
At III degree The rectum prolapses not only during defecation, but also during slight straining (coughing, laughing), and incontinence of gases (and then liquid feces) is noted due to the associated relaxation of the sphincter. The dimensions of the fallen part are 8-12 cm.
At IV degree The rectum always falls out when the patient takes a vertical position. The relaxation of the sphincter is accompanied by inflammation of the mucous membrane of the prolapsed part of the intestine, erosions and ulcers appear on it. Dimensions of the fallen part > 12 cm.

The diagnosis of rectal prolapse (prolapsus recti) is made immediately after straining the patient in a squatting position - a downward displacement of the rectum with its exit (evering) through the anus (appearance in the perineum of a pink cylinder of varying size with circular folding) is typical.

Depending on the severity of pathological changes, 4 forms of prolapse are distinguished:

Only the mucous membrane of the anus;
All layers of the wall of the anal canal (prolapsus ani);
Rectum without prolapse of the anus (actually prolapsus ani);
Anus and rectum (prolapsus ani et recti).

Palpation through the rectum as a research method

To diagnose diseases, various methods of examining the rectum are used, mainly palpation and inspection.

In addition to examining and determining the size of the prolapsed intestine, a digital examination is performed to determine the contractile function of the sphincter. To do this, without removing the finger from the rectum, the patient is asked to squeeze the anus, while the examiner gets an impression of the force of compression of the finger by the sphincter.

Palpation of the rectum in proctological patients is mandatory as a diagnostic method; in acute inflammatory processes (paraproctitis, acute thrombosis of hemorrhoids or acute anal fissure), it can be temporarily postponed. Digital examination makes it possible to timely detect rectal tumors that develop unnoticed, occur under the guise of hemorrhoids and are sometimes recognized in an advanced, inoperable state.

When a tumor is detected, palpation through the rectum gives an idea of its location, size, surface, consistency and connection with neighboring organs. To expand diagnostic capabilities in a number of patients, digital examination of the rectum is performed when transferring from the knee-elbow to the squatting position, which allows palpation to reach the upper ampullary part of the rectum.

Rectal examination can also detect a number of other surgical diseases:

Stenosing scars after inflammatory processes;
Enlarged (up to 5 cm in diameter, on a stalk) movable anal papillae (papillae anales) - small outgrowths of the mucous membrane of the anus, which are remnants of the cloacal membrane);
Ulcers, infiltrates and pelvic tumors;
Coccyx fractures;
Diseases of the genitourinary system - purulent prostatitis, prostate hyperplasia and cancer, inflammation of the seminal vesicles, bladder tumors, etc.

Technique for performing digital rectal examination of the rectum

Digital rectal examination is performed with the index finger wearing a rubber glove. Before inserting a finger into the anal canal, the tone of the external anal sphincter is determined using the palmar surface of the nail phalanx - a sharp increase in it is observed in case of an acute anal fissure, in this case, due to the severe pain syndrome, digital examination is impossible.

According to the technique of digital examination of the rectum, a finger thickly lubricated with Vaseline is carefully inserted into the anus, while the tone of the internal sphincter of the anal canal is examined, soft (collapsing) or hardened hemorrhoids are palpated, and the area of possible greatest pain is identified. The finger is then advanced into the rectal ampulla.

The developed rectal examination technique allows us to detect all pathological changes. Continuing the rectal examination of the rectum, two thumbs push apart the folded skin of the anus, which helps to detect pinpoint openings of rectal fistulas and cracks in the mucous membrane of the anus. Having discovered fistulas in the perianal area, they find out whether they communicate with the rectum, for which a button-shaped probe is inserted into the fistula and its appearance in the cavity is controlled with a finger (fistula ani complete).

Complete fistulas have holes both on the skin and on the mucous membrane - in the lumen of the intestine and anus, incomplete - have only one hole: either on the skin around the anus (incomplete external fistula), or on the mucous membrane of the rectum or anus (incomplete internal fistula). Diagnosis of fistulas of the anus and rectum with external incomplete and complete fistulas involves probing them. A rectal examination can be combined with probing: a probe inserted into the external fistula can be detected in the lumen of the rectum with a finger inserted into the intestine.

When palpating the inflammatory infiltrate (paraproctitis), its boundaries and consistency are determined, and possible softening in the center is diagnosed.

In men, at a distance of 5-6 cm from the anus through the anterior wall of the rectum, a finger feels the dense body of the prostate gland, in the middle part of which there is a small groove. The size, nature of the surface, consistency and soreness of the prostate gland are noted.

There are various changes in the prostate gland. Thus, a significant increase and dense elastic consistency are characteristic of benign hyperplasia; hard cartilaginous consistency with an uneven surface and the impossibility of delimiting the gland from the pelvic wall - for a malignant tumor; severe soreness of the enlarged gland (sometimes with softening in the center) - for acute prostatitis. When the inflammatory process is localized in the seminal vesicles (vesiculitis), they are palpated in the area of the upper pole of the prostate gland in the form of two dense diverging ridges.

In women, the cervix is palpated through the anterior wall of the rectum, which novice surgeons sometimes mistake for a tumor of the ampullary part of the rectum.

During a rectal digital examination, the anterior and posterior walls of the rectum and the concave part of the sacrum (flexura sacralis recti) are palpated in detail. Digital examination of the rectum makes it possible to detect not only localized pain in fractures of the sacrum, coccyx and ischium, but also mixing of fragments.

In case of destructive processes of the femoral head with transition to the acetabulum (coxitis pelvica, tumors), central dislocations of the hip, comparative palpation of the right and left walls of the ampulla makes it possible to detect, in addition to pain, the presence of bone exostoses, protrusions, and infiltrates.

If the ampullary section of the rectum is narrowed, its degree is determined (whether the finger passes through), the nature of the infiltrate, its location, shape, size, and mobility. If an ulcerative process is detected (ulcerative proctitis, neoplasm), the nature of the depression, the edges of the ulcer, the condition of the surrounding tissues, as well as the mobility of the entire infiltrate are studied.

Digital examination of the rectum is necessary in all patients with malignant tumors of the digestive tract to exclude or confirm stage IV of the disease - detection of Schnitzler implantation metastasis - cancer metastasis located in the pelvic tissue between the bladder or uterus and the rectum. Metastasis in the form of a tuberous tumor can be felt through the anterior wall of the rectum; in men, it is located above the prostate gland.

In case of purulent processes in the abdominal cavity (diffuse peritonitis), a mandatory rectal examination helps to clarify the extent of the process (presence or absence of pus in the pelvis). A pelvic abscess is found anterior to the rectum in the form of a painful overhang, protrusion of the anterior wall of the ampulla and softening in the center of the infiltrate.

Protrusion of the anterior wall of the rectum, determined by digital examination, with the accumulation of fluid (pus, blood) or tumor (Schnitzler's metastasis) in the rectal-uterine - in women or the rectal-vesical cavity in men - is defined as Bloomer's symptom and in the English-language literature is called Douglas abscess . When examining patients with suspected pelvic abscess, one should focus on its clinical picture, manifested by a feverish state, dysuric phenomena, tenesmus, and diarrhea with a large amount of mucus.

With low mechanical intestinal obstruction, a digital examination reveals relaxation of the sphincter, a sharp (balloon-shaped) expansion of the empty ampulla of the rectum - a symptom of the Obukhov Hospital - a sign of low obstructive colonic obstruction, observed, for example, with volvulus of the sigmoid colon.

After removing the finger from the rectum, you need to carefully examine the nature of the discharge remaining on the glove (unchanged blood, traces of tarry feces, mucus, pus).

Watch how the rectum is examined in the video, which demonstrates basic manual techniques:

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