Assessment
of rectum and anus
Rectal examination-
involves inspection and palpation (digital examination). Extent of the
assessment of the rectum and anus depends on the rectal problems stated by the
client in the nursing history.
Equipment
·
clean gloves
·
Water-soluble lubricant
Digital examination can cause apprehension and
embarrassment: help the client relax by encouraging the client to take slow,
deep breaths (tension can cause spasms of the anal sphincters, making the
examination uncomfortable). Inform the
client about potential sensations such as feelings of defecation or passing
gas.
·
Perform hand hygiene,
apply gloves
·
Observe appropriate
infection control procedures for all rectal examinations.
·
Provide for client
privacy.
·
Drape the client appropriately
·
Inquire for any history :
bright blood in stools, tarry black stools, diarrhoea, constipation, abdominal
Pain, excessive
gas, haemorrhoids, or rectal pain
Family history of
colorectal cancer
Signs or symptoms of prostate enlargement
Position:
·
In adults, a left lateral
or Sims' position with the upper leg acutely flexed
·
For females, a dorsal
recumbent position with hips externally rotated and knees flexed or a lithotomy
position
·
For males, a standing
position while the client bends over the examining table
·
Sims:
Side-lying position with lowermost arm behind the body, uppermost leg flexed at
hip and knee, upper arm flexed at shoulder and elbow.
·
Lithotomy:
Back-lying position with feet supported in stirrups; the hips should be in line
with the edge of the table.
·
Dorsal
recumbent: Back-lying position with knees flexed
and hips externally rotated; small pillow under the head; soles of feet on the
surface.
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Inspect the anus and surrounding tissue for colour,
integrity, and skin lesions
Ask the client to bear down as though defecating.
Bearing down creates slight pressure on the skin that may accentuate rectal
fissures, rectal prolapse, polyps, or internal haemorrhoids.
Describe the location of all abnormal findings in
terms of a clock, with the 12 o'clock position
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Intact perianal skin; more pigmented than the skin
of the buttocks
Anal skin is more pigmented, coarser, and moister
than perianal skin and is usually hairless
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Presence of fissures (cracks), ulcers, excoriations,
inflammations, abscesses, protruding haemorrhoids (dilated veins seen as
reddened protrusions of the skin), lumps or tumours, fistula openings, or
rectal prolapse (varying degrees of protrusion of the rectal mucous membrane
through the anus)
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Palpate the rectum for anal sphincter tonicity, nodules,
masses, and tenderness.
* lubricate your gloved index finger, and instruct
the client to bear downward slowly insert your finger into the anus and into
the rectum in the direction of the umbilicus.
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Anal sphincter has good tone
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Hypertonicity of the anal sphincter (may occur in the
presence of an anal fissure)
Hypotonicity of anal sphincter (may occur after rectal
surgery or result from a neurologic deficiency)
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Never force digital insertion. if lesions are
painful or bleeding occurs.
Ask the client to tighten the anal sphincter around
your finger, and note the tone of the anal sphincter. Rotate the pad of the index finger along
the anal and the rectal walls, feeling for nodules, masses, and tenderness. On
withdrawing the finger from the rectum and anus, observe it for faeces.
document
findings in the client record using forms or checklists
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Rectal wall
is smooth and not tender
Brown colour
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Rectal wall
is tender and nodular
Presence of mucus, blood, or black tarry stool
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