Overview of Rectal Exam
Checking the rectum, or what is known as a rectal exam, is a simple yet crucial part of a routine health check-up. Many medical professionals believe it can provide a wealth of information about a person’s health. Though it’s not done on every patient nowadays, respected doctors often stress its importance during medical training.
This procedure is not always included in basic health check-ups these days, but it’s still extremely useful and probably not used as much as it could be. It turns out to be a helpful tool in diagnosing a variety of health conditions. These may include bleeding in the digestive tract, inflammatory bowel disease (a condition that causes inflammation in the digestive tract), hemorrhoids (swollen veins in the lower part of the rectum and anus), constipation, physical injuries, and neurological disorders (diseases of the brain and nerves).
Anatomy and Physiology of Rectal Exam
The rectum is the final part of your large intestine. It is about 12 cm long and is found along the inward curve of your lower spine, also known as the sacrum.
The upper two-thirds of the front part of the rectum is covered by a thin, delicate tissue called the peritoneum. For men, this peritoneum on the front of the rectum connects to the base of the bladder. For women, it forms a pocket filled with parts of the bowel, called the pouch of Douglas.
In the lower third of the rectum, depending if you are a male or a female, different organs are located. In males, it’s close to the base of the bladder, prostate, and seminal vesicles. In females, the vagina is located in front of the rectum, and the cervix and uterus can be felt if a finger is inserted into the rectum.
The anus is a short 3-4 cm tube that joins the rectum to the outside of the body. There are both voluntary and involuntary muscles that support the anus. These muscles help us control when we go to the bathroom, also known as defecation, and to hold in stools when necessary for continence.
Why do People Need Rectal Exam
You might find yourself needing a particular medical procedure if your doctor suspects you have a disease. This procedure can also be part of a check-up. The process could be a bit uncomfortable, but your doctor will explain why it’s essential and ensure they have your agreement before starting. You may need this procedure if you’ve noticed changes in your bowel movements, have blood in your stool, issues with bladder or bowel control, need an evaluation of the prostate, or an additional approach for checking the female reproductive area.
This procedure is especially useful if you are experiencing symptoms like painful defections, which might indicate hemorrhoids, cracks in the skin near your anus, or visible blood. Further, it is helpful for checking constipation to assess feeling, tightness, and contraction coordination. If you have bowel control problems, this procedure can help evaluate the strength of rectum muscles.
For children, this procedure is generally avoided. If it absolutely must be done, doctors use the smallest finger for the examination to ensure comfort.
As people age, the likelihood of having diseases that affect bowel function increases, so this procedure is commonly required for older adults. Lying on the left side during the examination might be uncomfortable for some elderly patients, so make sure to take your time and find a comfortable position that allows for the examination to be completed.
When a Person Should Avoid Rectal Exam
A digital rectal exam is a test where a doctor uses their finger to check the lower rectum for any possible problems. There are certain situations where this exam should not be done because it could potentially harm the patient.
One of these is if the patient has a weakened immune system, because there is a risk of introducing infection which can be very dangerous for the patient. This is especially important when the patient’s immune system is already struggling to protect the body from diseases.
There are also other conditions where the exam absolutely should not be done:
- If the patient has no anus.
- Imperforate anus – a birth defect where the rectum is blocked or missing.
- Prolapsed thrombosed internal hemorrhoids – painful, swollen veins in the lower part of the rectum.
- Stricture – narrowing of the rectum.
- Severe anal pain.
- If the patient does not want to have the exam.
There are also certain situations where the exam might not be recommended:
- Acute abdomen – severe stomach pain.
- Coagulopathy – a condition that affects the blood’s ability to clot.
- Major rectal trauma – severe damage to the rectum due to an accident or injury.
- Recent anal surgery.
- Recent heart attack.
- Heart diseases like valvular heart disease or prosthetic valves.
Equipment used for Rectal Exam
During a medical procedure, your doctor will use several tools to ensure everything goes smoothly. These tools include:
- Gloves: These offer a protective barrier for both the doctor and the patient to avoid any potential risk of infection.
- Water-soluble Lubricant: This is a special type of gel applied to various medical tools to make them slide more easily onto your body without causing any discomfort or pain.
- Lighting: Appropriate and focused light is vital for the surgeon to clearly see what they are working on.
- Soft Tissues: This term refers to the parts of the body like muscles, fat, and blood vessels that the doctor will be working on during the procedure.
Preparing for Rectal Exam
Before starting the procedure, the doctor will explain to the patient why it is being performed. It’s necessary to have another person, or a chaperone, in the room as well. The doctor will also let the patient know that the procedure might be a bit uncomfortable and they might feel like they need to go to the bathroom.
How is Rectal Exam performed
Here is how a doctor would conduct a rectal examination:
1. The doctor will have you lie on your side, with your knees and hips bent; your buttocks will be positioned towards the edge of the examination table.
2. The doctor will then gently separate your buttocks to reveal your anal area and look at the skin around the anus.
3. The doctor will put a water-based gel on their index finger for smooth insertion and would gently press that finger on the lower part of your anal area.
4. After this, the doctor would gently slide their finger into your anal canal, aligning their fingertip with your sacral curve, which is the curved part of your spine at the bottom.
5. To assess the tightness of your anal muscles, the doctor will ask you to try and squeeze their finger with these muscles.
6. The doctor will then rotate their finger, feeling the walls of your rectum through 180°.
7. The rotational movement is continued up to the 12 o’clock position to assess the anterior wall of the rectum. This positioning helps the doctor to examine the opposing walls of the rectum.
8. In men, the doctor will feel the prostate gland through the anterior wall of the rectum.
For women, the doctor may be able to feel the cervix and in some cases, a backward tilted uterus with the tip of their finger. The doctor will then check the rectal walls all around at 360°. On examining the prostate gland (only applicable for males):
– A normal prostate is around 3.5 cm wide and would protrude about 1 cm into the rectum. It should feel rubbery and firm, with a smooth surface and a noticeable indentation separating its left and right portions.
– The prostate should not feel tender or lumpy.
– In some cases, the doctor may massage the prostate gland which may cause a fluid discharge at the urethral opening.
– At the end of examination, the doctor will remove their finger and check the glove for discoloration of stool and the presence of blood.
Possible Complications of Rectal Exam
Many patients can have a variety of symptoms including discomfort and pain. This can be caused by the tearing of the skin around the anus, also referred to as perianal skin. Additionally, damage or scraping of the hemorrhoidal tissue – basically, the tissue related to hemorrhoids or swollen blood vessels around your anus – can also cause discomfort.
In some serious cases, these conditions could even lead to an infection in the body or bacteremia. Bacteremia is a condition where bacteria enter the bloodstream, which can cause various health issues if not treated promptly.
What Else Should I Know About Rectal Exam?
During a rectal examination, doctors check the outside and the inside of the rectum to diagnose any health issues. Here’s what they might find:
Outside checking (External Inspection):
- An anal fissure: a small tear in the lining of the anus.
- An anal fistula: an abnormal connection between the skin near the anus and the rectum.
- Genital warts: a sexually transmitted infection that causes warts in the genital area.
- External hemorrhoids: swollen blood vessels in the rectum or anus that are outside the anus.
- Pilonidal sinus: a small hole or tunnel in the skin, usually at the top of the buttocks.
- Skin disease: like seborrhoeic eczema (a red, scaly, itchy rash), skin cancer or natal cleft dermatitis (rash in the buttock crack).
- Skin tags: Small, harmless growths on the skin.
- Skin discoloration: usually associated with Crohn’s disease, a condition that affects the digestive system.
- Rectal prolapse: when the rectum drops down and comes out through the anus.
Inside checking (Internal Inspection):
- Internal hemorrhoids: swollen blood vessels within the rectum or anus.
- Rectal carcinoma: a cancerous growth in the rectum.
- Rectal polyps: small, non-cancerous growths on the lining of the rectum.
- Tenderness: could be due to prostate inflammation (prostatitis) or a sudden inflammation of the appendix (acute appendicitis).
- Malignant or inflammatory conditions: these could affect the lining of the abdomen (peritoneum) and might be detected by feeling the area.
Remember, if you’re experiencing any symptoms or health concerns, it’s important to consult a healthcare professional for a proper diagnosis and treatment.