Rectal examination: why it is important
A proctology exam is essential in the presence of symptoms due to intestinal problems.
Many people are frightened at the thought of a visit to the proctologist and tend to postpone it. Embarrassment, fear and misinformation can make you overlook the symptoms of diseases which sometimes can be very serious. Moreover, even easily treatable diseases can get worse and become chronic if left untreated.
Those who suffer from rectal disorders should therefore contact a specialist as soon as possible.
Rectal examination: preparation
Preparation for a proctological examination is very simple.
The rectal examination involves the inspection of the anorectal canal which must be as clean as possible. This is why the patient may be asked to have an enema the day before the exam and about 2 hours before the visit.
The enema removes faeces residues from the anorectal canal and allows it to be viewed correctly. Enemas are sold in vials ready for use in all pharmacies or drug stores.
Rectal examination: what it consists of
A rectal examination allows to diagnose various disorders of the anorectal area.
The examination is divided into several phases and it is not painful. The more relaxed the patient, the less discomfort he/she will feel. If the patient is relaxed it will also be easier for the doctor to inspect the area and to make an accurate diagnosis.
In case of problems which could make it difficult to continue, for example in the presence of acute and painful fissures, the doctor can perform only a few phases of the examination. Rectal exploration can be performed later, after resolving the symptoms.
For these reasons, we invite you to undergo a visit to the proctologist relaxed and without fear.
Specifically, the 5 phases of the rectal examination are:
- MEDICAL HISTORY: before starting the actual examination, the doctor records the patient’s medical history, an in-depth interview with the patient.
During this phase the specialist asks the patient:
- the description of the symptoms and disorders he/she suffers from
- when the symptoms appeared and how often they occur
- possible anorectal problems in the family history
- information on any previous therapy or surgery for this problem
- OBSERVATION: the specialist observes the perianal area to identify any externally visible problems.
The specialist asks the patient to lie down on the couch mainly in the so-called Sims position. The Sims position requires the patient to turn on his/her left side, bend his/her legs on the abdomen and bring his/her buttocks to the edge of the couch.
The doctor makes a first non-invasive inspection and identifies problems already visible on the outer skin. After the observation phase and based on the patient's symptoms, the specialist will assess whether it is possible to proceed with the next steps.
- PALPATION: the specialist places a finger on the perianal area to feel its consistency and to identify any anomalies.
During observation and palpation, the doctor may identify problems, such as inflamed fissures and haemorrhoids, which may make it difficult to continue the examination. In these cases, the specialist will suspend the inspection and postpone it to a later stage.
- RECTAL EXPLORATION: in this phase, the doctor gently inserts a well lubricated finger into the anal orifice. In this manner, he/she can better assess possible diseases and the ability to contract and relax the sphincter muscles. For this purpose, the doctor can ask the patient to contract the anorectal area as if he/she were evacuating.
In the case of symptoms due to sphincter problems, the specialist may request further tests such as an anorectal manometry and a transanal ultrasound.
- RECTOSCOPY AND ANOSCOPY: the last phase of the examination may consist in inspecting the anorectal canal with the aid of an anoscope and of a rectoscope.
With these instruments the proctologist can view the anal canal (anoscopy) and the lower part of the rectum (rectoscopy). During this phase the specialist might also perform biopsies or small outpatient treatments.
Thanks to the anoscopy, it is possible to verify the presence of internal haemorrhoids and the stage of the disease. The rectoscopy allows instead to verify the presence of tumours of the lower rectum.
An examination called High-Resolution Anoscopy (HRA) is also available for diagnosing precancerous lesions of the anus and of the lower rectum. This exam allows to accurately visualise lesions and to perform possible biopsies. For further information on HRA and traditional Rectoscopy and Anoscopy, click here.