Abstract Rectal examination, status description. Examination of the prostate gland in men

Rectal examination(lat. rectum rectum) - special examination techniques to assess the condition of the rectum and its surrounding organs and tissues, performed through the lumen of the rectum.

In clinical practice apply manual 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 you to decide on the possibility of the latter, to avoid serious complications with a sharp narrowing of the anal canal or rectal lumen by a tumor, inflammatory infiltrate. Finger R. and makes it possible to assess the functional state of the muscles of the anus, to 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, recto-uterine or recto-vesical depression. 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 for inspection 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 soreness until the pain syndrome is relieved with the help of an ointment with dikain, analgesics or narcotic drugs.

and. it is necessary to carry out in the position of the patient on the back, because. only under this condition can a symptom of overhanging and soreness of the anterior semicircle of the rectal wall be detected.

Finger R. and. a thorough examination of the anus should always be preceded, which often makes it possible to identify signs of the disease (external and external hemorrhoids, insufficient closure of the edges of the anus, growths of tumor-like tissue, maceration of the skin, etc.), after which the index finger of the right hand, which is worn a rubber glove heavily lubricated with petroleum jelly is carefully inserted into the anus ( rice. one ). Consistently feeling the walls of the anal canal, evaluate the elasticity, tone and extensibility of the sphincter of the anus, the condition of the mucous membrane, the presence and degree of pain of the study. Then the finger is passed into the ampoule of the rectum, determining the state of its lumen (gaping, narrowing), the intestinal wall is sequentially examined over the entire surface and throughout the available extent, attention is paid to the condition of the prostate gland (in men) and the rectovaginal 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 ampullar portion of the rectum, fiber of the pelviorectal or posterior rectal space (paraproctitis, presacral), pelvic peritoneum (inflammatory process or tumor lesion), a 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 rectovaginal 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 ( rice. 3 ).

Instrumental R. and. carried out with the help of a rectal mirror, anoscope (see. Rectum ) or sigmoidoscope (see

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

Fundamentals of digital examination

A digital rectal examination is performed by probing the prostate with your fingers. To do this, a finger is inserted into the rectum of a man who turned to a urologist with complaints of pain and discomfort in the posterior canal and perineum. Rectal examination allows diagnosing for the appointment of effective treatment.

The considered method of diagnosis allows you to perform an examination without instrumental examinations, which prevents the risk of injury and pain when testing the prostate in other ways.

A digital rectal examination is as follows:

doctor and patient

The doctor interrogates the patient for 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 conducts a digital rectal examination. After that, the urologist can prescribe to the patient an additional, instrumental examination 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 the appointment of effective treatment.

Who is eligible for this examination?

Rectal examination is performed according to the testimony of a specialist with:

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;
discomfort during bowel movements;
to determine the method of therapy;
for prevention purposes (rectal massage);

Rectal massage is carried out not only for research, with the help of this procedure, you can take an analysis of prostatic juice.

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

What can be determined after a rectal examination

During digital diagnostics, it is possible to recognize the texture of the tissue of the glandular organ and the mucous membrane of the rectum, determine the tone of the anus, 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 the prostatic juice for bacteriological examination.

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

Inspection

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

lying on your side with bent knees pressed tightly to the chest - such an examination allows you to identify the pathology of the rectum and the presence of formations;
knee-elbow posture is recommended to determine the degree and form of tumors with trauma to the mucous membranes of the intestine;
a posture lying on the back with bent legs is proposed for examinations for inflammatory processes in the urinary and genital areas of the female body to detect peritonitis, abscess.

Rectal examination is carried out in several ways:

Palpation of the prostate

One-finger examination - the urologist lubricates the finger (index), which easily penetrates the rectum for probing. With such an examination, it is possible to diagnose the condition of the anal canal, detect neoplasms, examine the internal genital organs and the prostate. Using the inspection method with one finger, the sacrum with the coccyx is probed, since in some cases pain in the groin, at the bottom of the peritoneum, can be triggered by injury to the lower spinal column. After removing the finger, the mucus remaining on it is examined. Sometimes there are traces of pus, blood, other pathological secretions.
Two-finger examination - one finger penetrates the rectum, with the other finger pressure is made in the pubic zone. In this way, it is possible to recognize the pathological process, tumors of the upper section in the rectum or in organs located in the small pelvis. A two-finger examination can tell about the mobility of the walls of the rectum in relation to the female vagina.
Two-hand examination - this method has no difference from the two-finger examination. When the health condition of the male body is diagnosed, a digital examination is performed through the anus. The female body can be diagnosed by penetration into the vagina. This method is used when there is a suspicion of an oncological process on the anterior wall of the rectum.

Rectal massaging 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 the pharmacy network, but their use is possible only if the specialist permits.

Digital rectal testing is a much needed procedure that should not be ignored. For every proctologist, such an examination is an important component for diagnosing diseases. Finger diagnostics may have contraindications, which include severe pain, a sharp narrowing of the anal canal, infectious prostatitis, and acute course. In infectious pathologies, antibiotic therapy is first performed, and then a rectal examination is prescribed for further effective therapy.

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

Rectal examination(lat. rectum rectum) - special examination techniques to assess the condition of the rectum and its 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 you to resolve the issue of the possibility of carrying out the latter, to avoid serious complications with a sharp narrowing of the anal canal or the lumen of the rectum by a tumor, inflammatory infiltrate. Finger R. and makes it possible to assess the functional state of the muscles of the anus, to 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, recto-uterine or recto-vesical depression. 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 that is difficult to access for inspection 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 soreness until the pain syndrome is relieved with the help of an ointment with dikain, analgesics or narcotic drugs.

Rectal examination is carried out in various positions of the patient: lying on his side with legs bent at the hip and knee joints, in the knee-elbow position, in the supine position (on the gynecological chair) with the legs bent at the knee joints and brought to the stomach. Sometimes to assess the condition of the hard-to-reach upper rectum with digital rectal examination the patient is given a squatting position. If peritonitis or Douglas pouch abscess is suspected, the digital rectal examination it is necessary to carry out in the position of the patient on the back, because. only under this condition can a symptom of overhanging and soreness of the anterior semicircle of the rectal wall be detected.

Finger rectal examination a thorough examination of the anus should always be preceded by a thorough examination of the anus, which often reveals signs of the disease (external fistulas, thrombosis of external hemorrhoids, insufficient closure of the edges of the anus, growths of tumor-like tissue, maceration of the skin, etc.), after which the index finger of the right hand, on which put on a rubber glove, richly lubricated with petroleum jelly, carefully inserted into the anus ( rice. one ). Consistently feeling the walls of the anal canal, evaluate the elasticity, tone and extensibility of the sphincter of the anus, the condition of the mucous membrane, the presence and degree of pain of the study. Then the finger is passed into the ampoule of the rectum, determining the state of its lumen (gaping, narrowing), the intestinal wall is sequentially examined over the entire surface and throughout the available extent, attention is paid to the condition of the prostate gland (in men) and the rectovaginal 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 ampulla of the rectum, tissue of the pelviorectal or posterior rectal space (paraproctitis, presacral cyst), pelvic peritoneum (inflammatory process or tumor lesion), a 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 with the help of a rectal mirror, anoscope (see. Rectum) or sigmoidoscope (see Sigmoidoscopy).

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

In adhesive (adhesive) colostomy bags, remove the wrapping paper, position the center of the opening over the stoma and press evenly, making sure that the plate is smooth and free of wrinkles. Check the correct location (opening down) of the drainage hole of the bag and the position of the latch in the closed position (Fig. 5.10).

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

At a used closed colostomy bag, cut off the bottom 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 examinations 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 allows you to decide whether the latter is possible, to avoid serious complications with a sharp narrowing of the anal canal or rectal lumen by a tumor, inflammatory infiltrate. Digital rectal examination makes it possible to assess the functional state of the muscles of the anus, to 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, the condition of the pelvic peritoneum, recto-uterine or recto-vesical depression. Sometimes a 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 that is difficult to access for inspection with any type of instrumental rectal examination.

Contraindications:

A digital rectal examination is contraindicated in case of a sharp narrowing of the anus, as well as in case of severe pain until the pain syndrome is relieved with the help of an ointment with dikain, analgesics or narcotic drugs.

Execution technique

Rectal examination is carried out in various positions of the patient: lying on his side with legs bent at the hip and knee joints, in the knee-elbow position, in the supine position (on the gynecological chair) with the legs bent at the knee joints and brought to the stomach. Sometimes, to assess the condition of the hard-to-reach upper rectum during a digital rectal examination, the patient is given a squatting position. If peritonitis or Douglas pouch abscess is suspected, a digital rectal examination should be performed with the patient in the supine position, because only under this condition can a symptom of overhanging and soreness of the anterior semicircle of the rectal wall be detected.

A digital rectal examination should always be preceded by a thorough examination of the anus, which often reveals signs of the disease (external fistulas, thrombosis of external hemorrhoids, insufficient closure of the edges of the anus, growths of tumor-like tissue, maceration of the skin, etc.), after which the index finger of the right hand , which is wearing a rubber glove, richly lubricated with petroleum jelly, is carefully inserted into the anus. The patient is recommended to "strain", as during a bowel movement, and during the study to relax as much as possible.

Consistently feeling the walls of the anal canal, evaluate the elasticity, tone and extensibility of the sphincter of the anus, the condition of the mucous membrane, the presence and degree of pain of the study. Then the finger is passed into the ampoule of the rectum, determining the state of its lumen (gaping, narrowing), the intestinal wall is sequentially examined over the entire surface and throughout the available extent, attention is paid to the condition of the prostate gland (in men) and the rectovaginal 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.

CHAPTER 6. PUNCTION OF SEROUS CAVITIES

6.1. Abdominal puncture

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

Methodology: a puncture is made along the midline of the abdomen. The puncture point is chosen in the middle of the distance between the navel and the pubis. The bladder must first be emptied. The patient is seated on the operating or dressing table. The operating 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 hand and, placing the trocar perpendicular to the surface of the abdomen, pierces the abdominal wall, removes the stylet and directs a stream of fluid into the pelvis. To avoid a rapid drop in intraperitoneal pressure during fluid extraction, which can lead to collapse, the external opening of the trocar is periodically closed. In addition, the assistant pulls the stomach 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 puncturing the abdominal wall with a diameter of 3-4 mm with a pointed mandrin, 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 test 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 hats, masks. Hands are treated as before a surgical operation, put on sterile rubber gloves. It is necessary to ensure the 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 the intestines, bladder. The position of the patient is sitting, in a serious condition lying on the right side. As a premedication for 30 minutes. 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 in 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 make sure that there is free fluid in the abdominal cavity). After disinfection of the puncture site, infiltration anesthesia of the anterior abdominal wall, parietal peritoneum is performed. To prevent damage to the abdominal organs, it is advisable to flash the aponeurosis of the abdominal wall with a thick ligature, through which to stretch the soft tissues and create a free space between the abdominal wall and the underlying organs. The skin at the puncture site is displaced with the left hand, and the trocar is inserted with the right hand. In some cases, before the introduction of the trocar, a small skin incision is made with a scalpel. After the penetration of the trocar into the abdominal cavity, the manner is removed and the liquid begins to flow freely. They take a few ml of liquid for analysis and make smears, then a rubber tube is put on the trocar and the liquid flows into the pelvis. The liquid should be released slowly (1 liter for 5 minutes), for this purpose, a clamp is periodically applied to the rubber tube. When the liquid 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 the intestine, you should carefully press on the abdominal wall, while the intestine is displaced and the fluid flow is restored. collapse. To prevent this complication, during the removal of fluid, the assistant tightly tightens the stomach with a wide towel. After removing the liquid, 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 detect possible complications early.

Complications:

Phlegmon 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 the abdominal organs.

The release of fluid from the abdominal cavity through the puncture hole, which is associated with the risk of infiltration of the wound and the abdominal cavity.

Rectal examination I Rectal examination (lat. rectum)

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

In clinical practice apply manual 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 he complains of abdominal pain, dysfunction of the pelvic organs, and intestinal activity. It always precedes instrumental R. and., allows you to decide on the possibility of the latter, to avoid serious complications with a sharp narrowing of the anal canal or rectal lumen by a tumor, inflammatory infiltrate. Finger R. and makes it possible to assess the functional state of the muscles of the anus, to 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, recto-uterine or recto-vesical depression. 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 for inspection with any type of instrumental rectal examination.

Rectal examination is carried out in various positions of the patient: lying on his side with legs bent at the hip and knee joints, in the knee-elbow position, in the supine position (on the gynecological chair) with the legs bent at the knee joints and brought to the stomach. Sometimes for an assessment of a condition of hard-to-reach top departments of a rectum at digital R. and. the patient is given a squatting position. At suspicion on or abscess of Douglas space digital R. and. it is necessary to carry out in the position of the patient on the back, because. only under this condition can overhangs and anterior semicircles of the rectal wall be detected.

Finger R. and. a thorough examination of the anus should always be preceded, which often reveals signs of the disease (external fistulas, external hemorrhoids, insufficient closure of the edges of the anus, proliferation of tumor-like tissue, maceration of the skin, etc.), after which the index of the right hand, which is wearing a rubber a glove heavily lubricated with petroleum jelly is carefully inserted into ( rice. one ). Consistently feeling the walls of the anal canal, assess the elasticity and extensibility of the sphincter of the anus, the condition of the mucous membrane, the presence and degree of pain of the study. Then the finger is passed into the ampoule of the rectum, determining the state of its lumen (gaping, narrowing), the intestinal wall is sequentially examined over the entire surface and throughout the available extent, the condition of the prostate gland (in men) and the rectovaginal septum, cervix (in 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 ampulla of the rectum, fiber of the pelviorectal or posterior rectal space (, presacral), pelvic peritoneum (inflammatory process or tumor), a 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 ).

Bibliography: Aminev A.M. Guide to proctology, vol. 1-4, Kuibyshev, 1965-1978; Henry M.N. and Swash 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 rectovaginal 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; fingers of the left hand press on the anterior abdominal wall above the pubic symphysis.

II Rectal examination (exploratio rectalis)

the general name of 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 state of organs and tissues adjacent to it.

Rectal examination bimanual(e. r. bimanualis; syn. recto-abdominal 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.

Rectal examination digital(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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