5.1 Assessing Anus, Rectum and Prostate Flashcards
Anus/Rectum/Prostate
Genitourinary System (GU System) Internal Sphincter - Involuntarily controlled by autonomic nervous system External Sphincter - Under voluntary Control
Review of Systems (Bowel Routine)
- How often does the patient have bowel movements
- Is there history of constipation?
(At risk include older adults, women, inactive people, low calorie low fiber diet) - History of dyschezia (pain due to hemorrhoids, fissure, constipation)
Review of Systems (Stool Consistency/Color)
- Change in consistency of stool
(Diarrhea could mean infection, food poisoning, parasites) - Color of stool
Black - Blood from iron intake or GI Bleeding
Red - Blood in lower part of GI Tract
Clay Color - Hepatitis, liver/gallbladder disease - History of steatorrhea (excess fat in stool)
(Result of malabsorption associated with celiac disease, chron’s disease, and pancreatitis)
Review of Systems (Other Issues)
- Tests for cancer or digital rectum exam
- History of encopresis (stool inconsistence)
(Accidents after age 4 can be considered encopresis) - Difficulty urinating or change in urine patterns
Positions for Anus/Rectum/Prostate/Cervix Exam
- Left Lateral Position
- Standing Position (common for males)
- Lithotomy position (common for females)
Inspection
- Anus should be moist/hairless
- Coarse folded skin around opening
- Note inflammation/scarring/fissures (linear split)
Inspection (cont)
Anus should be tightly closed
- Valsalva maneuver can assess for anal tightness
(Hold their breath and bear down)
- There should be no breaks in skin or protrusions through anal canal.
(Abnormalities are described in clock-face terms
Palpation
- Always use lubrication and gloved hand
- Insert flexed finger towards umbilicus
(Do not go in at a right angle, this may cause pain)
Palpation (Cont)
Assess for tone by asking patient to tighten muscle
- Sphincter should close around finger
- Decreased/increased tenderness could mean anxiety or inflammation
Feel for masses
- Slightly moveable masses could mean a polyp
- Firm or hard mass could mean carcinoma
Palpation (cont)
Male Patients
- Check prostate to feel smooth and muscular
(Note any nodules, firmness, or bogginess)
- Gland should not protrude more than 1 cm into rectum
Female Patients
- Check cervix feels like a small, round mass
Stool Examination
Look at the color and consistency of the stool
Tests
- Guaiac Testing
- Fecal Immunochemical Test (FIT)
(FIT - liquid-based test that stores stool in hemoglobin-stabilizing buffer)
(FIT - more sensitive than guaiac testing)
Stool Examination
- Note any blood or stool color on glove
- Note jellylike mucus in stool (inflammation)
Anal Disorders
Anorectal Fistula
Abnormal passages from inner anus/rectum out of skin around the anus. May result from common inflammation of GI Tract
Fissures
Painful, longitudinal tears in superficial mucosa. Bowel movements may feel like passing shards of glass
Hemorrhoids
Swollen veins in lower rectum that are usually painless unless thrombosed (clotted). Usually contains clotted blood and appears blue/purple on skin
Rectal Disorders
Rectal Prolapse
Rectal mucous membrane protrudes through anus. Looks like a moist red donut
Rectal Polyps
Growths from rectal mucus membrane that requires biopsy to rule our cancer
Carcinomas
Malignant tumors in rectum. Asymptomatic and usually found with digital rectum exam
Prostate Disorders
Prostatitis
Acute inflammation that causes enlargement and tenderness of the gland. Prostate can feel boggy (soft/spongy) and patient may have fever and malaise (general discomfort)
Benign Prostate Hyperplasia (BPH)
Causes prostate enlargement and urinary frequency, straining, urgency. Common in older adults.
