Improving medical students

Rectal Exam Insights

Posted by medliorator on February 9, 2008

I always felt… that the most gentle and least humiliating way to do a rectal exam is with the patient curled up on his/her side, and covered except for the target orifice. it behooves one fully to explain exactly the reasons for such a transgression. So here are some:

  • In evaluating a patient with bowel obstruction, it’s useful to determine if there’s air in the rectal vault.
  • By revealing localized pain on the right, it can help in the diagnosis of appendicitis.
  • With a pelvic abscess from any source, it can determine the feasibility of trans-rectal drainage. (Yes, it’s possible to do it without a radiologist, and there’s still a place for it.) In fact, under some unusual circumstances, such an abscess, followed for “ripening,” can be drained digitally and yuckally, right there in the bed.
  • Rectal exam can stimulate the bowels to move, in a post-op patient (hopefully not in an instantaneous fashion.)
  • Among the most important: it predicts successful resection of rectal cancer with the ability to re-connect the colon without colostomy. (If I can feel the tumor on rectal exam, I won’t be able to resect with a margin safe for anastomosis.)
  • The exam helps to judge how extensive a rectal tumor is; how large, and how fixed in position. The need for pre-op radiation is determined, in part, this way.
  • When that very low stapled anastomosis becomes too tight (which they sometimes do), it can be permanently fixed with a single digital dilatation.
  • Some anal fistulae track up into areas that can be felt & mapped out by a rectal exam.
  • In addition to routine evaluation of the prostate, there are some circumstances wherein prostate massage is therapy.

That’d Be Up The Butt, Bob [Surgeonsblog]

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