EXAMINATION

Have patient in knee-chest or left lateral position with hips and knees flexed, or standing with hips flexed and upper body supported by examining table. Drape patient appropriately.

TECHNIQUE	FINDINGS
Wear gloves on both hands
Inspect and palpate sacrococcygeal and perianal area
Skin characteristics	EXPECTED:Smooth and uninterrupted.
	UNEXPECTED:Lumps, rashes, tenderness, inflammation, excoriation, pilonidal dimpling, or tufts of hair.
Inspect anus
Spread patient’s buttocks. Examine, using penlight or lamp if needed, with patient relaxed as well as with patient bearing down.
Skin characteristics	EXPECTED:Skin coarser and darker than on buttocks.
	UNEXPECTED:Skin lesions, skin tags or warts, external or internal hemorrhoids, fissures and fistulas, rectal prolapse, or polyps. Describe any irregularities and locate using clock referents (12 o’clock ventral midline/6 o’clock dorsal midline).
Inspect, palpate, assess sphincter tone
Put water-soluble lubricant on index or middle finger; press pad against anal opening, and ask patient to bear down to relax external sphincter. As relaxation occurs, slip tip of finger into anal canal, as shown in figure below. (Assure patient that although he or she may feel the urgency of a bowel movement, it will not occur.) Ask patient to tighten external sphincter around finger.	EXPECTED:Even sphincter tightening.
	UNEXPECTED:Patient discomfort. Lax or extremely tight sphincter, tenderness.
Palpate muscular anal ring
Rotate finger.	EXPECTED:Smooth, even with consistent pressure exerted.
	UNEXPECTED:Nodules or other irregularities.
Palpate lateral and posterior rectal walls
Insert finger farther, and rotate to palpate lateral, then posterior, rectal walls. (If helpful, perform bidigital palpation with thumb and finger by lightly pressing thumb against perianal tissue and bringing finger toward thumb.)	EXPECTED:Smooth, even, uninterrupted.
	UNEXPECTED:Nodules, masses, polyps, tenderness, or irregularities. (Internal hemorrhoids not ordinarily felt unless thrombosed.)
Males: Palpate posterior surface of prostate gland through anterior rectal wall
Rotate finger and palpate anterior rectal wall and posterior surface of prostate gland. (Alert patient that he may feel urge to urinate but will not.)
Consistency and characteristics of anterior rectal wall	EXPECTED:Smooth, even, uninterrupted.
	UNEXPECTED:Nodules, masses, polyps, tenderness, or irregularities.
Consistency, contour, characteristics of prostate	EXPECTED:Surface firm and smooth, lateral lobes symmetric, median sulcus palpable, seminal vesicles not palpable.
	UNEXPECTED:Rubberiness, bogginess, fluctuant softness, stony hard nodularity, tenderness, obliterated sulcus, or palpable seminal vesicles.
Mobility of prostate gland	EXPECTED: Slightly movable.
Size of prostate gland	EXPECTED:4 cm diameter with less than 1 cm protruding into rectum.
	UNEXPECTED:Protrusion greater than 1 cm (note distance of protrusion).
	UNEXPECTED:Discharge that appears at urethral meatus (collect specimen for microscopic examination).
Females: Palpate uterus through anterior rectal wall
Attempt to palpate uterus and cervix through anterior rectal wall.
Position	EXPECTED:Midline, retroflexed or retroverted.
	UNEXPECTED:Deviation to right or left.
Surface characteristics	EXPECTED:Smooth.
	UNEXPECTED:Irregular.
Have patient bear down, and palpate deeper
Ask patient to bear down while you reach farther into rectum. Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Like this: Like Loading... Related Related posts: The Healthy Female Evaluation Reporting and Recording Male Genitalia Eyes Stay updated, free articles. Join our Telegram channel Join Tags: Mosby's Physical Examination Handbook Mar 25, 2017 | Posted by admin in PHYSIOLOGY | Comments Off on Anus, Rectum, and Prostate Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access %d