Rectal examination

Rectal examination and diagnostic manipulations that occur through a direct gut the purpose of studying it, and the surrounding organs and tissues.
Rectal examination is digital and instrumental (executed with rectal mirrors and proctoscope). Indications: diseases of the rectum (see) (infiltration walls, ulcers, reduce, or compression rectum tumors, exudate , and so on); pelvic fiber (see Paraproctitis), internal organs, located in the lower abdomen, in the pelvis.
Rectal research precedes the inspection of the anus. Patient is placed on a table at the side of the belly and his feet or give a knee-elbow position. During the inspection you can find hemorrhoids (sometimes they are seen better if you ask patient naturalesa), cracked rear passage, fistulas.
Then make a careful study of your finger in a glove; put your finger on, in addition, rubber fingertip, smeared vaseline oil.
In the absence of a special fingertip study can be made just in a rubber glove. Finger by rectal examination should enter when natureway, pushing backwards; pre rectum should be emptied (enema). Finger study can detect internal hemorrhoids, tumors, fractures, to determine the size and condition of the prostate.
A study using rectal mirrors produce, pre-lubricated his branches vaseline. The branches is introduced into the rectum (at a depth of 8-10 cm), the patient with the knee-elbow position. Move them apart and slowly removing, examine the lining of the rectum. A study using a proctoscope - see Sigmoidoscopy.

recto-abdominal research
Recto-abdominal examination.

Rectal exam in gynecology. In gynecological practice rectal examination is produced in the following cases: 1) in girls and women, and also at atresia and stenosis of the vagina, where it is impossible to produce vaginal examination; 2) in addition to the vaginal research in cancer of the uterus to establish the prevalence of tumor process (transition on the pelvic tumor tissue, lymph nodes, and the wall of the rectum); 3) in inflammatory diseases of internal genital organs to clarify the status of Sacro-uterine ligaments, pararectal cellular tissue, etc.; 4) when parametritah; 5) to clarify the nature tumors located in premonicion-uterine space (cancer of the ovaries).
More data can be obtained with the help of bimanual (recto-abdominal) study (Fig.), which allows you to clearly shoot the uterus, uterine appendages, and to make representation about the state of the ligaments of the uterus and pelvic peritoneum.
Cm. also Gynecological examination.

Rectal examination - examination of the rectum (rectum), consisting of examination of the anus, research rectum finger, with the help of anoscope, rectal mirrors, rectoscopy and x-ray studies.
During the inspection of the anus can see external hemorrhoids, anal papillae and fringe (see the anus), the edge of the low located cancer or tuberculosis ulcers, exterior openings pararectal cellular fistula, acute HPV, atheroma, etc. When the sphincter of marked leakage of intestinal contents, the surrounding skin irritation, rash, eczema, excoriation. To detect cracks, you must make the patient Naturita, with an inquirer two hands stretches and pulls the skin fold outdoor anal funnel.
The study finger necessarily all patients with complaints of illness of the anus or rectum. It is produced in the patient on the back with bent legs, on her side, in the knee-elbow position or sitting (as when urinating). In the latter case, particularly when natureway patient, finger doctor enters the rectum, 2-3 cm deeper than when examining the patient in the supine position.
For inspection of the rectum using tools surrounding the anus, the skin lubricated with vaseline. The collected anycap greased with vaseline, enter in a direct gut, stiletto removed. Examine the lining the lower part of the rectum.
Rectal mirror enter in a direct-colon in close. The branches are bred and inspect the lower part of the rectum is statically and when retrieving tool that can turn, make them rotational motion. Offered many options designs anuscope and rectal mirrors (Fig. 1 and 3). Rectoskopia - see Sigmoidoscopy.
X-ray examination of the rectum produce or after 18-24 hours. after taking barium contrast mass through the mouth, or with over - filling bowel contrast through suspension enema (the latter is preferable). Some details are better able to look after bowel evacuation from contrasting suspended by natural bowel movements, especially when you double-contrast barium suspension and air. Remaining on the surface of the mucous membrane slight traces contrast mass give the opportunity to contribute pathological education even in small sizes.
Research strength sphincter produced with the assistance of sincerometer Amineva (Fig. 2)consisting of olive with a rod and spring balance. Olive slightly smeared with vaseline and enter in a direct gut. When stretching for steelyard arrow moves along the scale of the steelyard. She stops after the extraction of olive from the rectum, and shows the strength of the sphincter in grams. At the first measurement in a quiet position investigated recognized the tone of the sphincter. When the second dimension of researched greatly reduces the sphincter. It turns out the maximum strength of this muscle. In women, the tone is equal to an average of 500 g, the maximum power - 800 g, in men respectively 600 and 900,

Rectal exam in gynecology shows how to Supplement data vaginal research, and to replace it when it is impossible (girls, girls, when aplasia, atresia of the vagina).
By rectal examination could quite clearly define the cervix, scars, changes in vaginal discharge, an accumulation of fluid in it (hematopathology and so on), to examine okolovrusno cellulose, Sacro-uterine ligaments. To install some changes in the intestine (infiltration walls, sometimes ulcerous defects or abnormal razreshenia), the narrowing and compression of swelling or fluid in okolovrusno tissue, etc., a Rectal examination is obligatory method of screening for cervical cancer, as it facilitates the detection of infiltrates in the parametrium.
For repeated observations of pregnant vaginal examination can be replaced rectal giving sufficient information for assessment of the degree of the opening of the cervix, the presentation of the fetus, safe amniotic bladder, and in some cases, and the locations of sutures and fontanelles. You can feel the concavity of the sacral bone, determining the degree of filling of the sacral depression predlagay part of the fetus. A rectal examination may be a method of systematic observation of the family act.
Before rectal study the bladder should be emptied. It is necessary to lay the patient in a horizontal position on the back: your upper body should be slightly raised, knees slightly bent, feet divorced, stomach relaxed. The patient needs to breathe freely and to avoid any tension of muscles.
Another patient with rectal examination - as when kamnereznye; the doctor is standing between his knees patient. Rectal exam produce the index finger right or left hand, dressed in a rubber glove, thickly smeared vaseline oil. Thumb investigating brush away backwards to prevent the pressure them on the external genitals (Fig. 4). In some cases, (for the study of the peculiarities of the rectovaginal septum) produce combined rectovaginal examination in which the index finger enter the vagina and medium - rectum (Fig.5): free hand examine the pelvic organs through the abdominal wall. In rare cases for the study of the gallbladder-uterine space in front of the vault of the vagina enter your thumb and rectum pointing. In some cases, rectovaginal examination produce the index fingers of both hands.

Fig. 1. Tools for inspection of the rectum: 1 - sphincterotomy; 2 - anycap; 3 - proctoscope small; 4 - proctoscope great.
Fig. 2. Scheme of sphincterotomy sincerometer Amineva.
Fig. 3. Different types pryamokishechnye mirrors.
Fig. 4. Rectal-brunetoochka study.
Fig. 5. Rectovaginal examination.