Examination rectal

The examination rectal is a Medical examination being part of the proctologic Examen, at the time which a doctor or a nurse introduces a finger ganté and lubricated into the Rectum of the patient, via the Anus.

Description

Before carrying out the gesture, the patient must be informed gesture and of his practice but especially of his importance for the diagnosis.

The position of the patient depends on the practices of the doctor even if the dorsal décubitus (reclining position on the back), the bent legs and the fists under the buttocks are generally practiced. The examination can also be carried out in ahead leaning position, the elbows posed on the table of the examination, in décubitus side right or left (prone lengthened on the side), or on a gynaecological table of examination in gynaecological position.

The doctor introduces his index ganté and lubricated by Vaseline in order to carry out the examination.

Observation

The rectal examination will bring several types of information:

Ahead, the Prostate at the man: the normal prostate has a flexible, regular and bilobate consistency (right and left separated by a median furrow).

In the event of Prostatitis, the prostate is painful, even soft in the event of abscess (very rare situation).

In the event of benign Hypertrophy of the prostate, the latter can be increased by volume, to lose its median furrow but it preserves a regular and homogeneous aspect.

The majority of the cancer S develop in the posterior peripheral zone of the prostate and can thus be accessible to the rectal examination. In the event of cancer of the prostate, it can be noted a nodule will intra prostatic, an overflowing nodule the prostate or to the maximum a fixed aspect of the Pelvis in the event of prostatic extra invasion. In these cases, the prostate is irregular and stony. Attention, a normal rectal examination does not eliminate a cancer.

Behind and laterally, the Rectum: it is systematically necessary to note a possible lesion of the rectal wall.

the Anus: the muscular tone is to be sought, in particular at the patients reached of neurological disease.

the saddles: seek of a Fécalome, a Méléna (black saddles and liquids) or of a Rectorragie (Hémorroïde S or rectal lesion?).

the cul-de-sac the Douglas one, located ahead, above the prostate at the man. He corresponds to a cul-de-sac of the Péritoine: in the event of pelvic and abdominal pain, the pain with the palpation of the bottom of bag the Douglas one corresponds to an ignition péritonéale (Péritonite).

at the woman, at the time of the gynaecological examination: it can supplement the Examination vaginal or to join it (to touch bidigital) in order to examine the partition rectovaginale;

Indication

The rectal examination is indicated:

In urgency for the abdominal pains and the pelvic pains.
Within the framework of the tracking of the cancer of the prostate from 50 to 75 years, even as from 45 years for the patients with cancer risk such as afro-West-Indian and the patients having family antecedents of cancer of the prostate.
In the event of medical visits of routine in the search of possible lesions of the rectum.
In the event of disorders mictionnels being able to be related to a benign hypertrophy of the prostate.
In the event of search for a cancer of the prostate whatever the age.
Within the framework of the neurological examination (tonicity of the sphincter).
In alternative to the vaginal examination in the virgin.

Legislation

It is about a gesture diagnosis, therefore reserved for a doctor. Taking into account its nature, a rectal examination carried out at a person not agreeing is juridically comparable to a Viol.

Anecdote

F Fesmire was prize winner of the Prix Ig Nobel 2006 in medicine for its proposal for a stop of the hoquet by rectal massage.

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