Abstract Rectal examination, description of status. Prostate examination in men

Rectal examination(lat. rectum 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 when the patient complains 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, foreign bodies); 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 above the anal canal, in an area that is difficult to access with 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.

And. must be carried out with the patient in the supine position, because Only under this condition can one identify the symptom of overhang and pain in the anterior semicircle of the rectal wall.

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 and external hemorrhoids, insufficient closure of the edges of the anus, proliferation of tumor tissue, maceration of the skin, etc.), after which the index finger of the right hand on which a rubber glove generously lubricated with Vaseline is carefully inserted into the anus ( rice. 1 ). Consistently palpating the walls of the anal canal, assess the elasticity, tone 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, attention is paid to the condition of the prostate gland (in men) and the rectal-vaginal septum, cervix ( in women), pararectal tissue of the inner surface of the sacrum and coccyx.

After removing the finger from the rectum, the nature of the discharge is assessed (mucous, bloody, purulent).

To diagnose diseases of the upper ampullary rectum, tissue of the pelviorectal or retrorectal space (paraproctitis, presacral), pelvic peritoneum (inflammatory process or tumor lesion), bimanual digital examination is used. 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 a bimanual digital rectal and vaginal examination ( rice. 3 ).

Instrumental R. and. carried out using a rectal speculum or anoscope (see. Rectum ) or sigmoidoscope (see.

Rectal examination is the main procedure that is necessary for urological examination and identification of pathological processes of the prostate gland. The prostate is a glandular organ of the male body, which is very susceptible to negative factors.

Basics of the finger examination

A digital rectal examination is performed by palpating the prostate with your fingers. To do this, a finger is inserted into the rectum of a man who has consulted a urologist with complaints of pain and discomfort in the posterior canal and perineum. A rectal examination allows for diagnosis to prescribe effective treatment.

The diagnostic method under consideration allows examination without instrumental examinations, which prevents the risk of injury and pain when testing the prostate using other methods.

Digital rectal examination is as follows:

Doctor and patient

The doctor questions the patient about the presence of disturbing symptoms, which may indicate the occurrence of an inflammatory process of the prostate. One survey, as a rule, is not enough to establish a diagnosis, since it is impossible to prescribe therapy based on complaints alone.
To confirm his doubts, the doctor performs a digital rectal examination. After this, the urologist can prescribe an additional instrumental examination to the patient to diagnose a more accurate nature of the pathological process.
Rectal digital examination is considered the most informative method for diagnosing a glandular organ. Therefore, such a study is very important to conduct before prescribing effective treatment.

Who is this examination indicated for?

A rectal examination is carried out according to a specialist’s indications when:

Anatomy of the genitourinary system

complaints of painful symptoms in the lower peritoneum;
impaired functionality of the intestines, urinary and genital organs;
pain syndrome in the anal canal area;
discomfort during bowel movements;
to determine the method of therapy;
for preventive purposes (rectal massage);

Rectal massage is performed not only for research; using this procedure, you can take an analysis of prostatic juice.

After conducting a digital examination, the specialist makes a decision to prescribe other methods for diagnosing the prostate gland, among which are: anoscopy, rectoscopy, colonoscopy.

What can be determined after a rectal examination?

During digital diagnostics, you can recognize the texture of the tissue of the glandular organ and the mucous membrane of the rectum, determine the tone of the anal passage, the characteristic possibilities for further research, the condition of the rectum, the size of the prostate, the presence of nodular seals, and also take an analysis of prostatic juice for bacteriological examination.

During diagnosis, it is possible to identify the occurrence of benign and malignant neoplasms, polyps, anal fissures, foreign bodies, and inflammatory infiltrates.

Carrying out an inspection

Rectal diagnosis is carried out in several positions of the patient:

lying on your side with your knees bent and pressed tightly to your chest - such an examination allows you to identify pathologies of the rectum and the presence of formations;
the knee-elbow position is recommended to identify the degree and shape of tumors with injury to the mucous membranes of the intestine;
a position lying on your back with bent legs is suggested for examinations for inflammatory processes in the urinary and genital areas of the female body to identify peritonitis and abscess.

A rectal examination is performed in several ways:

Prostate palpation

Single-finger examination - the urologist lubricates the finger (index), which easily penetrates the rectum for palpation. With such an examination, it is possible to diagnose the condition of the anal canal, detect neoplasms, and examine the internal genital organs and prostate. Using the inspection method with one finger, the sacrum and coccyx are palpated, since in some cases pain in the groin, lower abdomen, can be caused by injury to the lower part of the spinal column. After removing the finger, the remaining mucus on it is examined. Sometimes there are traces of pus, blood, and other pathological discharge.
Two-finger examination - one finger penetrates the rectum, the other finger applies pressure in the pubic area. In this way, it is possible to recognize a pathological process, tumors of the upper intestine or in organs located in the pelvis. A two-finger examination can tell about the mobility of the walls of the rectum in relation to the female vagina.
Two-handed examination - this method is no different from two-finger examination. When the health status of the male body is diagnosed, a digital examination is carried out through the anus. The female body can be diagnosed by penetration into the vagina. This method is used when there is a suspicion of the occurrence of an oncological process on the anterior wall of the rectum.

Rectal massage of the prostate gland is carried out both for examination and for the purpose of effective treatment and prevention of the glandular organ. Of course, some patients do not want to seek the help of a specialist for massage sessions, and resort to the help of massagers. Such devices are sold in pharmacies, but their use is only possible if authorized by a specialized specialist.

Digital rectal testing is an extremely necessary procedure that cannot be ignored. Every proctologist has such an examination - this is an important component for diagnosing diseases. Finger diagnostics may have contraindications, which include severe pain, sharp narrowing of the anal canal, infectious prostatitis, acute course. For infectious pathologies, antibiotic therapy is first carried out, and then a rectal examination is prescribed for further prescriptions of effective therapy.

Patients with chronic prostatitis undergo prostate massage annually. This is necessary for prevention.

Rectal examination(lat. rectum 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 rectal examination. Finger rectal examination is a mandatory method for diagnosing diseases of the rectum, pelvis and abdominal organs. It must be performed in all cases when the patient complains of abdominal pain, dysfunction of the pelvic organs, and intestinal activity. It always precedes the instrumental rectal examination, allows us to resolve the issue of the possibility of carrying out 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, fistulas, hemorrhoids, cicatricial changes and narrowing of the intestinal lumen, benign and malignant neoplasms, foreign bodies); 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 rectal examination is the only method for detecting a pathological process localized on the posterior semicircle of the rectal wall above the anal canal, in an area that is difficult to access with any type of instrumental rectal examination.

Finger rectal examination 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 rectum with digital rectal examination The patient is placed in a squatting position. If peritonitis or abscess of the pouch of Douglas is suspected, digital rectal examination must be carried out with the patient in the supine position, because Only under this condition can one identify the symptom of overhang and pain in the anterior semicircle of the rectal wall.

Finger rectal examination 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, thrombosis of external hemorrhoids, insufficient closure of the edges of the anus, proliferation of tumor tissue, maceration of the skin, etc.), after which the index finger of the right hand, on which put on a rubber glove, generously lubricated with Vaseline, carefully insert into the anus ( rice. 1 ). Consistently palpating the walls of the anal canal, assess the elasticity, tone 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, attention is paid to the condition of the prostate gland (in men) and the rectal-vaginal septum, cervix ( in women), pararectal tissue of the inner surface of the sacrum and coccyx. After removing the finger from the rectum, the nature of the discharge is assessed (mucous, bloody, purulent).

To diagnose diseases of the upper ampullary rectum, tissue of the pelviorectal or retrorectal space (paraproctitis, presacral cyst), pelvic peritoneum (inflammatory process or tumor lesion), bimanual digital examination is used. 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 ).

Instrumental rectal examination carried out using a rectal speculum or anoscope (see. Rectum) or sigmoidoscope (see. Sigmoidoscopy).

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

For adhesive (stick-on) colostomy bags, remove the wrapping paper, position the center of the hole over the stoma, and apply even pressure, making sure the plate is smooth and free of wrinkles. Check that the drainage hole of the bag is correctly positioned (with the hole facing down) and that the lock is in the closed position (Fig. 5.10).

Fig.5.10. Fixing the drainage hole of the colostomy bag.

For a used closed colostomy bag, cut off the bottom part of the bag with scissors and empty the contents into the toilet. Next, the colostomy bag should be rinsed under running water and thrown into the trash.

5.7. Digital examination of the rectum

Digital rectal examination is a mandatory method for diagnosing diseases of the rectum, pelvis and abdominal organs. Any instrumental, endoscopic, X-ray examination of the rectum can be carried out only after a digital examination.

Indications for digital rectal examination:

It is performed in all cases when the patient complains of abdominal pain, dysfunction of the pelvic organs, and intestinal activity. It always precedes an instrumental rectal examination (anoscopy, sigmoidoscopy, colonoscopy) and makes it possible 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. Digital rectal examination makes it possible to assess the functional state of the anal muscles, identify diseases, pathological changes in the anal canal and rectum (cracks, fistulas, hemorrhoids, cicatricial changes and narrowing of the intestinal lumen, benign and malignant neoplasms, foreign bodies), inflammatory infiltrates, cystic and tumor formations of the pararectal tissue, sacrum and coccyx, changes in the prostate gland in men and internal genital organs in women, the condition of the pelvic peritoneum, rectouterine or rectovesical cavity. Sometimes digital rectal examination is

the only method for detecting a pathological process localized on the posterior semicircle of the rectal wall above the anal canal, in an area difficult to access with any type of instrumental rectal examination.

Contraindications:

Digital rectal examination is contraindicated in cases of sharp narrowing of the anus, as well as in cases of severe pain until the pain is relieved using Dicaine ointment, analgesics or narcotics.

Execution technique

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 rectum during digital rectal examination, the patient is placed in a squatting position. If peritonitis or an abscess of the pouch of Douglas is suspected, a digital rectal examination should be performed with the patient in the supine position, because Only under this condition can one identify the symptom of overhang and pain in the anterior semicircle of the rectal wall.

A digital rectal examination should always be preceded by a thorough examination of the anal area, which often reveals signs of the disease (external fistulas, thrombosis of external hemorrhoids, insufficient closure of the edges of the anus, proliferation of tumor tissue, maceration of the skin, etc.), after which the index finger of the right hand , wearing a rubber glove and generously lubricated with Vaseline, is carefully inserted into the anus. The patient is advised to “push”, as when defecating, and to relax as much as possible during the examination.

Consistently palpating the walls of the anal canal, assess the elasticity, tone 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, attention is paid to the condition of the prostate gland (in men) and the rectal-vaginal septum, cervix ( in women), pararectal tissue of the inner surface of the sacrum and coccyx. After removing the finger from the rectum, the nature of the discharge is assessed (mucous, bloody, purulent).

intestine, and with the fingers of the other hand they press on the anterior abdominal wall above the pubic symphysis.

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 conducting a bimanual digital rectal and vaginal examination.

CHAPTER 6. PUNCTURE OF SEROUS CAVITIES

6.1. Abdominal puncture

The purpose of the operation: evacuation of ascitic fluid in case of abdominal dropsy.

Methodology: the puncture is made along the midline of the abdomen. The puncture point is chosen in the middle of the distance between the navel and pubis. The bladder must be emptied first. The patient is seated on the operating or dressing table. The surgical field is treated with alcohol and iodine. The skin and deep layers of the abdominal wall are anesthetized with a 0.5% novocaine solution. The skin at the puncture site is incised with the tip of a scalpel. The puncture is made with a trocar. The surgeon takes the instrument in his right hand, displaces the skin with his left and, placing the trocar perpendicular to the surface of the abdomen, pierces the abdominal wall, removes the stylet and directs a stream of liquid into the pelvis. To avoid a rapid drop in intraperitoneal pressure during fluid extraction, which could lead to collapse, the external opening of the trocar is periodically closed. In addition, the assistant tightens the abdomen with a towel as the ascitic fluid flows out.

6.2. Laparocentesis

Laparocentesis is a puncture of the peritoneum with the introduction of a drainage tube into the cavity. The puncture is performed by a doctor (Fig. 6.1).

Indications: ascites, peritonitis, intra-abdominal bleeding, pneumoperitoneum.

Contraindications: coagulopathy, thrombocytopenia, intestinal obstruction, pregnancy, inflammation of the skin and soft tissues of the abdominal wall.

Equipment and tools: trocar for puncture of the abdominal wall with a diameter of 3-4 mm with a pointed mandrel, a drainage rubber tube up to 1 m long, a clamp, a syringe with a volume of 5-10 ml, 0.25% novocaine solution, a container for collecting ascitic fluid, sterile tubes, dressing material, sterile cotton swabs, sterile tweezers, skin needles with sterile suture material, scalpel, adhesive plaster.

Methodology: the doctor and the nurse assisting him put on caps and masks. Hands are treated as before surgery; sterile rubber gloves are worn. It is necessary to ensure complete sterility of the trocar, tube and all instruments in contact with the skin. The puncture is performed in the morning, on an empty stomach, in the treatment room or dressing room. The patient empties his bowels and bladder. The patient's position is sitting, or in severe cases lying on the right side. As a premedication 30 min. Before the study, 1 ml of a 2% solution of promedol and 1 ml of a 0.1% solution of atropine are administered subcutaneously. The puncture of the abdominal wall is carried out along the midline of the abdomen at the middle of the distance between

navel and pubic bone or along the edge of the rectus abdominis muscle (before puncture, it is necessary to ensure the presence of free fluid in the abdominal cavity). After disinfection of the puncture site, infiltration anesthesia of the anterior abdominal wall and parietal peritoneum is performed. To prevent damage to the abdominal organs, it is advisable to suture the aponeurosis of the abdominal wall with a thick ligature, through which to stretch the soft tissues and create free space between the abdominal wall and the underlying organs. The skin at the puncture site is moved with the left hand, and the trocar is inserted with the right hand. In some cases, a small skin incision is made with a scalpel before inserting the trocar. After the trocar penetrates the abdominal cavity, the mannerens are removed and the liquid begins to flow freely. A few ml of liquid is taken for analysis and smears are made, then a rubber tube is put on the trocar and the liquid flows into the pelvis. The liquid should be released slowly (1 liter over 5 minutes); for this purpose, a clamp is periodically applied to the rubber tube. When the fluid begins to flow out slowly, the patient is slightly moved to the left side. If the release of fluid has stopped due to the closure of the internal opening of the trocar with a loop of intestine, you should carefully press on the abdominal wall, while the intestine is displaced and the flow of fluid is restored. During the removal of fluid, a sharp decrease in intra-abdominal pressure occurs, which leads to a redistribution of blood flow and, in some cases, to the development collapse. To prevent this complication, during the removal of fluid, the assistant tightly tightens the abdomen with a wide towel. After removing the fluid, the trocar is removed, sutures are applied to the skin at the puncture site (or tightly sealed with a sterile swab with cleol), a pressure aseptic bandage is applied, an ice pack is placed on the abdomen, and a strict pastel regimen is prescribed. It is necessary to continue monitoring the patient after the puncture in order to early identify possible complications.

Complications:

Cellulitis of the abdominal wall due to violation of the rules of asepsis and antisepsis.

Damage to the vessels of the abdominal wall with the formation of hematomas of the abdominal wall or bleeding of the abdominal cavity.

Subcutaneous emphysema of the abdominal wall due to the penetration of air into the wall through a puncture.

Damage to abdominal organs.

Release of fluid from the abdominal cavity through the puncture hole, which is associated with the danger of infiltration of the wound and abdominal cavity.

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.

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 anus, 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 of the right hand, on which a rubber a glove generously lubricated with Vaseline is carefully inserted into ( rice. 1 ). Consistently feeling 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, fiber of the pelviorectal or retrorectal space (presacral), pelvic peritoneum (inflammatory process or tumor), bimanual digital examination is used. 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:

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