the rectal sphincter
You are about to perform a rectal examination of an older adult.
What are the steps to examine this patient?
Explain your rationale.
What are some findings you can have while assessing the rectal sphincter?
Describe the differences during the rectal examination of acute prostatitis and benign prostatic hypertrophy.
What findings would be expected on physical examination of acute prostatitis and benign prostatic hypertrophy?
Your initial post should be at least 500 words, formatted and cited in proper current APA style with support from at least 3 academic sources.
Sample Solution
Performing a Rectal Examination on an Older Adult
Steps and Rationale
A rectal examination is a crucial component of a comprehensive physical assessment, particularly in older adults who are at increased risk for colorectal cancer and other anorectal conditions. Here are the steps involved and the rationale behind each:
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Prepare the Patient:
- Explain the procedure: Clearly explain the purpose of the examination, the steps involved, and the potential discomfort. Reassure the patient that the procedure is brief and routine.
- Position the patient: The left lateral position is commonly used. Ensure the patient is comfortable and relaxed.
- Expose the area: Gently expose the buttocks and anus.
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Inspect the Perianal Area:
- Observe for abnormalities: Inspect the perianal area for skin tags, hemorrhoids, fissures, fistulas, or signs of inflammation.
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Lubricate the Gloved Finger:
- Reduce friction: Apply a water-soluble lubricant to the index finger to minimize discomfort during insertion.
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Insert the Finger:
- Gently insert: Gently press the lubricated finger against the anal opening and wait for the sphincter to relax before inserting it into the rectum.
- Palpate the rectal wall: Systematically palpate the rectal wall for masses, strictures, or tenderness.
Full Answer Section
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Assess the Prostate (in Males):
- Palpate the prostate: In males, palpate the prostate gland through the anterior rectal wall. Assess its size, shape, consistency, and any tenderness.
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Test Stool for Occult Blood:
- Obtain a sample: If indicated, obtain a stool sample for occult blood testing.
Findings Related to the Rectal Sphincter
During a rectal examination, the healthcare provider can assess the tone and function of the anal sphincter. Abnormal findings may include:
- Sphincter weakness: A weak or relaxed sphincter may indicate neurological disorders or damage to the sphincter muscles.
- Sphincter spasm: Increased tone or spasm of the sphincter can be associated with conditions like anal fissures or inflammatory bowel disease.
- Incontinence: Difficulty controlling bowel movements may be due to sphincter weakness or other factors.
Differences Between Acute Prostatitis and Benign Prostatic Hypertrophy
- Acute prostatitis: The prostate gland is often enlarged, tender, and warm to the touch. Patients may experience fever, chills, urinary urgency, frequency, and dysuria.
- Benign prostatic hypertrophy (BPH): While the prostate gland is also enlarged, it is typically not tender. Patients often present with symptoms of lower urinary tract obstruction, such as difficulty starting or stopping urination, weak urine flow, and nocturia.
Findings on Physical Examination
- Acute prostatitis: In addition to the rectal examination findings, patients with acute prostatitis may have a fever, tachycardia, and a tender suprapubic area.
- Benign prostatic hypertrophy: Physical examination findings are often normal, except for an enlarged prostate gland on rectal examination.
Citations
- American Cancer Society. (2023). Colorectal Cancer Screening. https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/colorectal-cancer-screening-guidelines.html
- National Institutes of Health. (2023). Rectal Examination. https://www.ncbi.nlm.nih.gov/books/NBK537356/
- Thompson, J. R., & Bushnell, M. C. (2018). Physical Examination: A Guide for Medical Students and Residents. Elsevier.