Anus, rectum, and prostate

Question 1

What in the health history is essential to ask regarding anus, rectum, and prostate?

Answer 1

change in bowel habits, blood in stool, pain w/ defecation, rectal bleeding or tenderness, anal warts or fissures, weak urinary stream, changes in urinary habits, dysuria, hematuria

Question 2

What should you ask about any changes in bowel habits?

Answer 2

size or caliber of stools, diarrhea, constipation, color of stools, mucus presence

Question 3

If someone says yes to rectal bleeding, what else should you ask about?

Answer 3

family history of colonic polyps, cancer, IBD

Question 4

What can pencil-thin stools indicate?

Answer 4

colon cancer

Question 5

What can blood in stool indicate?

Answer 5

polyps, hemorrhoids, GI bleeding, or carcinoma

Question 6

What can mucus in stool indicate?

Answer 6

villous adenomas, intestinal infections, IBD, IBS

Question 7

What are some unhealthy stools?

Answer 7

yellow, green, quickly sinking or floating, pebble, loose, mucus, pencil-thin, pale, undigested, bright red, black

Question 8

If someone has pain with defecation, what should you ask?

Answer 8

itching, extreme tenderness in rectum or anus, presence of mucopurulent discharge, ulcers, repetitive anal intercourse, insertion of foreign body in rectum

Question 9

What’s the inflammation of the lining of the rectum with symptoms like anorectal pain, tenesmus, discharge and/or bleeding?

Answer 9

proctitis

Question 10

What could proctitis be caused by?

Answer 10

IBD, STIs, trauma from receptive anal intercourse, bacterial infections, radiation therapy

Question 11

What are anal fissures?

Answer 11

small tear in lining of the anus, commonly from passing large or hard stools and constipation and straining

Or… chrohn’s disease/IBD, anal cancer, HIV, TB, syphilis

Question 12

What are anal warts?

Answer 12

HPV or secondary syphilis, ask about any history!

Question 13

If a patient has anal foreign bodies, what do you need to ask?

Answer 13

why it’s there, consent, ask about batteries, designed for internal use, what kind of object?

Question 14

If a patient has a weak urinary stream, what should you ask about?

Answer 14

• urinary intermittency
• weak or strong flow of urine
• blood in urine
• frequency
• retention
• sudden onset of similar symptoms

Question 15

What does a sudden onset of urinary frequency, urgency, dysuria, perineal & low back pain, malaise, fever, or chills?

Answer 15

possible acute prostatitis

Question 16

When are symptoms with urinary issues particularly indicative of BPH?

Answer 16

men > 70 yrs

Question 17

What helps diagnose BPH?

Answer 17

american urological association symptom score

Question 18

What can blood in the urine be caused by?

Answer 18

BPH, urolithiasis, nephrolithiasis, UTIs, prostate, bladder or kidney cancer

Question 19

What are key components of anorectal and prostate exams?

Answer 19

• properly position patient (side = preferred)
• inspect sacrococcygeal and perianal areas
• look for lesions, ulcers, inflammation, rash, excoriations
• inspect anus (lesions, mass, skin breakdown)
• perform digitial

Question 20

How should you position a patient for a rectal exam?

Answer 20

ask patient to lie on left side w hips and knees partially flexed, drape appropriately