A rectal exam is a simple procedure used by doctors to examine the rectum and other internal organs (Keifer, 2017). The steps to perform a rectal exam on an older patient include; first the patient has to change into a hospital gown then the doctor or nurse will choose a position that is comfortable for the patient such as the patient lying on their side, squatting on the examination table or bending over the exam table (Keifer, 2017). Afterwards, the doctor inserts a gloved, lubricated finger in the anus that allows them to feel for any abnormalities (Keifer, 2017). A rectal exam is done for both men and women during their physical exam and majority feel a minor discomfort during the procedure (Keifer, 2017). The rationale for performing rectal exams is to check for rectal tumors, colon cancer, prostate cancer, hemorrhoids and so much more (Keifer, 2017).
Some findings you can have while assessing the rectal sphincter include that there are no problems such as there are no enlarged organs as well as no abnormalities that can be felt (E. Gregory Thompson, 2019). On the other hand, the findings can be that there are organ enlargements and abnormalities such as growths can be felt (E. Gregory Thompson, 2019). For men, their prostrate can be enlarged which may be a sign of cancer and as for women, there might be tumors in the cervix, ovaries and uterus (E. Gregory Thompson, 2019). There can also be growths that are tumors in the lower rectum or at times breaks on the skin around the anus which are anal fissures and even problems in the bladder can be found from this exam (E. Gregory Thompson, 2019).
Though acute prostatitis and benign prostatic hypertrophy can bring pain and difficulty during urinating, they have differences which can be noted during the rectal examination (Watson, 2018). Prostatitis refers to the inflammation of the prostrate as a result of an injury or a bacteria that got into the prostrate during urination or sex (Watson, 2018). Prostatitis can be acute or chronic (Watson, 2018). Acute prostatitis develops quickly while the chronic version develops over a period of time (Watson, 2018). Benign Prostatic Hypertrophy (BPH) is the enlargement of the prostrate and as the prostrate continues to become large, it blocks the urethra hence passing urine becomes difficult (Watson, 2018). Another difference between the two is that prostatitis is likely to affect men who are 50 and below while BPH is most likely to affect men who are 50 and above (Watson, 2018).
The findings to expect on physical examination of acute prostatitis is a tender, enlarged or even boggy prostate (Dierfeldt, 2016). Then diagnosis is made based on the history such as whether the patient had symptoms such as how frequent you are urinating, urinary retention which can lead to other symptoms such as fevers and chills (Dierfeldt, 2016). The history together with the physical exam and at times with the help of urinalysis, can help in the diagnosis of acute prostatitis (Dierfeldt, 2016). As for BPH, before the rectal exam, the doctor will first ask you a series of questions if for instance he wants to know what symptoms you have (Deters, 2019). Afterwards, the doctor will perform a rectal exam to check your prostrate for enlargement (Deters, 2019). Afterwards the doctor will recommend further tests such as urinary flow test to confirm the enlargement of the prostate and rule out other conditions (Deters, 2019).
In conclusion, rectal examination is very important especially for older adults who are 50 and above. Regular rectal examination helps with detection of cancers such as rectum, prostrate, colon cancers and others which if detected early can be treated. Acute prostatitis is more common especially for men who are below 50 and can be treated easily with early detection. As for BPH, with regular physical examination can be found earlier on and also treated. It is therefore, important for everyone to get there rectal exam done whenever it is due.
Steps to examine and older adults would be to first lay them on the left lateral position. As an examiner, this would be the position of choice because elderly adults who are weak and may have difficulty withstanding would be physically easier for them. I also prefer this position because I like the ability to be able to position the patient to my comfort as well. I could adjust the bed to the correct height for examination. After performing hand hygiene I would DON gloves and spread buttocks wide apart to observe the perianal region. I would then look for abnormalities. Normally the anus is moist and hairless, with coarse, folded skin that is more pigmented than the perianal skin. The anal opening is tightly closed and no lesions are present. If you notice flabby skin sac’s those are hemorrhoids, small round openings would be a fistula, there could be inflammation, lesions, scars, rectal prolapse, and if you notice a tuft of hair or dimple at the tip of the coccyx may indicate pilonidal cyst (Jarvis & Eckhart, 2020).
Instruct the patient to perform a Valsalva maneuver. No break in the skin integrity or protrusion through the anal opening should be present. Describe any abnormality in a clock face term with 12 O’Clock position as the anterior point toward the symphysis pubis and the 6 O’Clock position towards the coccyx (Jarvis & Eckhardt, 2020). Apply lubricating jelly onto your index finger. Instruct the person that palpation is not painful but may have the feeling of needing to have a bowel movement (Jarvis & Eckhardt, 2020). Ask the male patient to take a deep breath in and hold it. Place the pad of your index finger gently against the anal verge. You will feel the sphincter tighten and then relax. As the sphincter relaxes have the patient exhale and flex the tip of your finger and slowly insert it into the anal canal in a direction towards the umbilicus. Rotate your examining finger to palpate the entire muscular ring. The canal should feel smooth and even. Use a bidigntal palpation with your thumb against the peril tissue and press your examining finger toward it. This maneuver highlights and swelling or tenderness and helps assess the bulbourethral glands. (Jarvis & Eckhardt, 2020)
The palpation of the prostate should yield a smooth, slightly movable, elastic, and non-tender surface measuring about 2.5-4 cm wide and should not protrude more than 1 cm into the rectum. Abnormalities would include an enlarged or atrophied gland, flat with no groove, nodular, hard or boggy, enlarged, firm, smooth, hard stone, or irregular shape. If someone has prostatitis they would present with symptoms of fever, chills, malaise, urinary frequency, urgency, dysuria, urethral discharge, dull, aching pain in the perineal and rectal area. The assessment would yield an exquisitely tender enlargement to acute inflammation, with a swollen slightly asymmetric gland (Jarvis & Eckhardt, 2020).
A patient with Benign Prostatic Hypertrophy (BPH) would present with urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, the sensation of incomplete emptying, and nocturia. The objective signs would include a symmetric contender enlargement. The prostate would feel smooth, rubbery, or firm (like the consistency of the nose), with the median sulcus obliterated. One thing to remember is that according to Mayo Clinic is that some other conditions can lead to some of the same symptoms. Such as urinary tract infections, urethral strictures, scaring in the bladder neck as a result of previous surgery, bladder/kidney stones, problems with the nerves that supply the bladder, or cancer of the prostate or bladder (Mayo Clinic, 2020).
It is very important to fully assess your patient which includes obtaining a good medical history and subjective data. There are a number of things that could be of concern when it comes to rectal assessment, prostates assessment, cervical assessment, and surrounding tissue. It is important to educate patients on the importance of their routine physicals with their providers. Educate patients on things to monitor at home and when it is recommended to seek medical attention.
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