Basic proctological examination
The Proctological Examination Procedure
Proctological examination of patients can be performed in different positions.
Possible poses: – knee-elbow position, i.e. on all fours; – knee-breast position, called the lithotomy position; – as the gynaecological examination is done; – left side-lying position;
The preferred position in the surgery is left-side up, perhaps the position that is most gentle on the patient’s pubic size, but it is also important to bear in mind that older patients, those with poor circulation or those who may be overweight may find it difficult to stand on all fours.
During the proctological examination, our patients can see the entire examination and any lesions found on the monitor in front of them.
View of the anus and surrounding skin
During a proctological examination, after taking a medical history and asking about symptoms, the anus and the surrounding skin are examined.
Many different proctological and dermatological diseases can already be seen at this stage.
For example, skin hernias, rectal fissures, abnormal external fistula openings, abscesses or thromboses around the rectum, condylomas, scars, deformities, etc. may be detected.
The patient is then asked to press.
This may reveal a purplish network of external haemorrhoids or, for example, a prolapse of mucosa or haemorrhoids.
Rectal digital examination (RDV, finger rectal examination)
This proctological examination is performed by inserting the second finger of the right hand.
The doctor wears a rubber glove, which he makes slippery on the outside with Vaseline before the examination.
The patient is warned beforehand that insertion of the finger may cause a sensation of defecation, a reaction which is perfectly normal.
The rectal digital examination can assess the tone of the sphincter.
The patient is asked to squeeze to obtain information about the musculature, especially if continence problems are a complaint.
Palpating the area around the prostate in men will give information about the size, consistency and possibly nodularity of the prostate.
In women, the cervix and the protrusion of the uterus towards the rectum can be palpated.
Anopapillomas, tumours, polyps, thromboses and other growths (e.g. condyloma) can be palpated by rotating the finger around the uterus.
It is important to emphasise that haemorrhoids are not palpable lesions, so a diagnosis of haemorrhoids cannot be made without an instrumental examination.
Instrumental tests
The next step is the introduction of anoscopy.
This 6-12 cm long instrument is used to examine diseases located in the lower rectum (haemorrhoids, fissures, anopapillomas, polyps, etc.) and to insert the instruments in case of a possible intervention.
The anoscopic examination is followed by rectoscopy.
The rectoscope is a 20 cm long rigid instrument that allows the last part of the colon to be examined by air.
During the examination, the condition of the intestinal wall can be assessed and a biopsy forceps is used to take a tissue sample from any lesions found.
During the proctological examination, rectoscopic examination is mandatory in all cases, even if the patient’s complaints are confirmed by the lesion found with the anoscope, since it is not known whether rectal tumours, polyps or inflammation may be found above this height.
The patient is warned at the beginning of the examination that he/she may feel tension due to the air inflow.
The test can be easily performed in 1-2 minutes.
Neither anoscopy nor rectoscopy requires any preparation on the part of the patient.
However, in the case of significant faecal contamination, our doctors will give the patient a laxative rectal suppository and repeat the examination after 20 minutes.
The patient is warned at the beginning of the test that they will feel tension due to the air inflow.
If there is pain, signal but do not react suddenly as the bowel wall may rupture.
After inserting the device, move outwards in a circular motion.
The condition of the intestinal wall can be well assessed, and material can be obtained from any lesions found for histological examination using a biopsy spoon.
The test can be performed in 1-2 minutes, and is almost painless.
These tests require no preparation.