Many people, due to suffering from anal diseases, return to Zhengzhou for an examination of their condition at an anal specialty clinic. Anal diseases encompass a wide variety of conditions, and during an anal examination, the doctor often uses their finger to palpate the anus. This method is clinically referred to as a digital rectal exam (DRE), which is a simple yet crucial diagnostic procedure. Let's take a closer look at this examination technique.
The method used in an anal examination involving a digital rectal exam is as follows: The examiner wears a finger cot on their right index finger and applies a lubricant (commonly soapy water, liquid paraffin, or petroleum jelly) to facilitate insertion into the anus and reduce patient discomfort. First, the skin around the anal margin is checked for any redness, swelling, tenderness, or hard lumps, which may indicate perianal abscesses. Tenderness along the anterior or posterior midline might suggest the possibility of an anal fissure, which can be further inspected by separating the anal opening to check for any anal canal tears. If there is an external ulcerated opening with a cord-like structure leading to the anus, it is usually indicative of a fistula.
After checking the area around the anal margin, the examiner gently massages the anal margin with the right index finger while instructing the patient to take deep breaths to reduce abdominal pressure and relax the sphincter muscle, then slowly inserts the finger into the rectum. Suddenly inserting the finger could cause the sphincter muscle to spasm due to sudden stimulation, making insertion difficult and causing pain.
During a digital rectal exam in the anal specialty clinic, several common conditions of the anal canal and rectum can be detected:
1. **Anal Fistula**: A cord-like structure can be felt, and sometimes a small hard lump or depression at the internal opening of the fistula.
2. **Rectal Polyps**: A soft, movable mass can be felt, and bloodstains are often found on the finger cot.
3. **Internal Hemorrhoids**: Generally, internal hemorrhoids are soft, and even if they are felt, their size and quantity cannot be determined. However, if a thrombus forms, a smooth hard lump can be felt.
4. **Rectal Cancer**: Uneven, hard masses can be felt on the intestinal wall, often with ulcers on the surface, a narrowed intestinal cavity, and pus, blood, and mucus often staining the finger cot.
5. **Perianal Abscess**: In pelvic rectal space abscesses and retrorectal space abscesses, tender masses can be felt inside the rectum, with a relatively smooth surface. Other space abscesses can be examined using a two-finger palpation technique, where the index finger is placed inside the rectum and the thumb on the perianal skin, allowing detection of deep anterior or posterior perianal abscesses, ischioanal abscesses, or perianal abscesses.
6. **Anal Papilloma**: A medium-firm, movable, pedunculated mass can be felt, with a clean finger cot.
Due to the significant importance of the digital rectal exam in anal examinations, every patient visiting the anal specialty clinic for the first time will have their anus palpated, often deeply and meticulously, to avoid missed or incorrect diagnoses. Patients may feel some discomfort, but cooperation is essential.