- 1.Assessment of Anus and RectumMaria Carmela L. Domocmat, RN,
MSNInstructor, Nursing Health AssessmentSchool of NursingNorthern
Luzon Adventist College
2. Objectives:At the end of the lecture the student will be
ableto:Specify the important anatomy and physiologyof the anus,
rectum, and prostate.Enumerate at least three
interviewtopics/questions.Identify normal assessment findings in
theanus, rectum, and prostate. 6/26/2011 Maria Carmela L. Domocmat,
RN, MSN 2 3. ANUS AND RECTUMAnatomy and PhysiologyTechniques of
ExaminationRelated Abnormalities 4. Anatomy andPhysiology6/26/2011
Maria Carmela L. Domocmat, RN, MSN 4 5. Female Male6/26/2011 Maria
Carmela L. Domocmat, RN, MSN 5 6. 6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 6 7. 6/26/2011 Maria Carmela L. Domocmat, RN, MSN
7 8. 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 8 9. 6/26/2011
Maria Carmela L. Domocmat, RN, MSN 9 10. CollectingSubjective
DataHistory of present health concernPast Health HistoryFamily
HistoryLifestyle and Health Practices 11. Collecting Subjective
DataProvide clues to clients overall healthand whether he is at
risk for diseasesand disorders of the anus, rectum, orprostate.
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 11 12. Collecting
Subjective DataA good time to teach client about the riskfactors
related to diseases, such ascolorectal or prostate cancer, and
aboutways to decrease those risks. 6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 12 13. Collecting Subjective DataNote: Can be
embarrassing to both the examiner and the client. It is important
to ease the clients anxiety as much as possible Ask questions in
straightforward manner, and let the client voice any concerns
throughout assessment. RN, MSN 6/26/2011Maria Carmela L. Domocmat,
13 14. Collecting Subjective DataNote: In some cultural groups,
only nurses of the same gender will be considered acceptable
assessors of intimate bodies. Clients comfort and privacy 6/26/2011
Maria Carmela L. Domocmat, RN, MSN 14 15. History of present
healthconcernCOLDSPABowel patterns: What is your usual bowel
pattern? Have you noticed any recent change in the pattern? Any
pain while passing a bowel movement? Do you experience Domocmat,
RN, MSN 6/26/2011Maria Carmela L. constipation? 15 16. History of
present healthconcern Do you experience constipation? Do you
experience diarrhea? Is the diarrhea associated with any nausea and
vomiting? Do you have trouble controlling your bowels? 6/26/2011
Maria Carmela L. Domocmat, RN, MSN 16 17. History of present
healthconcernStool What is the color of your stool? Hard or soft?
Have you noticed any blood on or in your stool? If so, how much?
Have you noticed any mucus in your stool?Itching and Pain Do you
experience any itching or pain in the rectal area? 6/26/2011 Maria
Carmela L. Domocmat, RN, MSN 17 18. History of present
healthconcernPattern of urination Do you have any difficulty
starting the urine stream? Or holding back urine? Is the flow weak?
What about frequent urination, especially at night? Or pain or
burning as you pass out urine? 6/26/2011 Maria Carmela L. Domocmat,
RN, MSN18 19. History of present healthconcernPattern of urination
Do you notice blood in your urine or semen or pain with
ejaculation? Is there frequent pain or stiffness in the lower back,
hips, or upper thighs? 6/26/2011 Maria Carmela L. Domocmat, RN,
MSN19 20. Past Health HistoryHave you ever had anal or rectal
traumaor surgery? Were you born with anycongenital deformities of
the anus orrectum? Have you had prostate surgery?Have you had
hemorrhoids or surgery forhemorrhoids? 6/26/2011Maria Carmela L.
Domocmat, RN, MSN 20 21. Past Health HistoryWhen was the last time
you had a stooltest to detect blood?Have you ever
hadproctosigmoidoscopy?When was the last time you had DRE bya
physician? 6/26/2011Maria Carmela L. Domocmat, RN, MSN 21 22. Past
Health HistoryHave you ever had blood taken for aprostate
screening, which measures thelevel of prostate-specific antigen
(PSA) in prostate-your blood? When was the test and whatwas the
result? 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 22 23. Family
HistoryIs there a history of polyps, colon, orrectal cancer, or
prostate cancer in yourfamily? 6/26/2011 Maria Carmela L. Domocmat,
RN, MSN 23 24. Lifestyle and HealthPracticesDo you use any
laxatives, stoolsofteners, enemas, or other
bowelmovement-movement-enhancing medications?Do you engage in anal
sex?Do you take any medications for yourprostate? 6/26/2011Maria
Carmela L. Domocmat, RN, MSN 24 25. Lifestyle and
HealthPracticesHow much high-fiber food and roughagehigh-do you
consume everyday? Do you eatfoods high in saturated fat?Do you
engage in regular exercise?Do you use calcium supplements?
6/26/2011Maria Carmela L. Domocmat, RN, MSN 25 26. Lifestyle and
HealthPracticesFor postmenopausal women: do you usehormone
replacement therapy?Has any anal or rectal problem affectedyour
normal activities of daily living(working and engaging in
recreation)? 6/26/2011Maria Carmela L. Domocmat, RN, MSN 26 27.
Important topics for healthpromotion and counselingScreening for
prostate cancerScreening for polyps and colorectalcancer 6/26/2011
Maria Carmela L. Domocmat, RN, MSN 27 28. Collecting ObjectiveData:
Techniques ofExamination 29. Preparing the client Client
positioning Standing Knee- Knee-chest Squatting Left lateral
Lithotomy 6/26/2011Maria Carmela L. Domocmat, RN, MSN 29 30.
Techniques ofExaminationInspection of Perineum andSacrococcygeal
Area 31. Positions forRectalExamination6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 31 32. Equipments needed Gloves Lubricant Guaiac
Testing Equipment Tissue 6/26/2011Maria Carmela L. Domocmat, RN,
MSN 32 33. Inspection of Perineum andSacrococcygeal AreaInspect the
buttocks and sacral region forlesions, swelling, inflammation,
andtenderness. 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 33 34.
Male Female6/26/2011 Maria Carmela L. Domocmat, RN, MSN 34 35.
Normal FindingsArea should be smooth and free oflesions, swelling,
inflammation, andtenderness.There should be no evidence of feces
ormucus on the perianal skin.No additional opening 6/26/2011Maria
Carmela L. Domocmat, RN, MSN 35 36. Palpation of
CoccygealAreaPalpate the coccygeal areaNormal FindingNo tenderness
6/26/2011Maria Carmela L. Domocmat, RN, MSN 36 37. Pilonidal Sinus
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 37 38. Inspection of
Anal MucosaSpread the buttocks apartwith both hands, exposingthe
anus.Examine the anus forcolor, appearance,lesions,
inflammation,rash, and masses.Instruct the client to bear down as
thoughmoving the bowels (Valsalva maneuver)(Valsalva 6/26/2011Maria
Carmela L. Domocmat, RN, MSN 38Watch video 39. Normal
FindingsDeeply pigmented,coarse, moist, andhairless.Free of
lesions,inflammation, rash,masses and additionalopenings. The
analopening should beclosed. 6/26/2011 Maria Carmela L. Domocmat,
RN, MSN 39 40. Normal FindingsThere should not beany tissue
protrusionNo leakage of fecesor mucus from theanus while
strainingNo tissue perfusion 6/26/2011 Maria Carmela L. Domocmat,
RN, MSN 40 41. Lets Watch:Examining the Anusand Anal Sphincter 42.
Abnormal FindingsImperforate AnusHemorrhoidSkin TagVenereal
WartsAnorectal Fistula HerpesAnal FissureGonococcal ProctitisRectal
Prolapse Carcinoma 43. ImperforateSkin Tag anus6/26/2011 Maria
Carmela L. Domocmat, RN, MSN 43 44.
Fistula-in-Fistula-in-AnorectalanofistulaFistula-In-Ano: External
opening of fistulus tractis apparent in photo above. Proximal
opening This patient presented with "just a little blood when I
wipe."would be at level of crypts, within the anal canal.When
anoscopy revealed no anal pathology, closer inspectionMaria Carmela
L. Domocmat, RN, MSNidentify this papular area. The woodenFistulas
are frequently associated with perirectal 6/26/2011 allowed the
physician to44abscesses, though none are present in this case. end
of a cotton-tipped applicator was inserted 3 cm confirming a
fistula, and the patient was referred for surgery. 45. Anal Fissure
Rectal Prolapse 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 45 46.
External hemorrhoid6/26/2011 Maria Carmela L. Domocmat, RN, MSN 46
47. Prolapsed InternalThrombosed HemorrhoidExternal
Hemorrhoid6/26/2011 Maria Carmela L. Domocmat, RN, MSN 47 48.
Condylomata Perianalacuminatumherpes(Venereal warts) Rectal HSV
infection with perianal ulcers 6/26/2011 Maria Carmela L. Domocmat,
RN, MSN48 49. Gonococcal proctitis 6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 49 50. Anal Carcinoma6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 50 51. Palpation of Anus andRectum 52. Palpation
of Anus andRectumReassure the clientthat sensations ofurination
anddefecation arecommon during therectal assessment. 6/26/2011
Maria Carmela L. Domocmat, RN, MSN 52 53. Palpation of Anus
andRectum 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 53 54.
Palpation of Anus andRectumWhile the client strains, place
glovedand lubricated finger at anal openingas sphincter
relaxesSlowly insert the flexed tip of yourfinger into the anal
sphincter pointingtoward clients umbilicus 6/26/2011Maria Carmela
L. Domocmat, RN, MSN 54 55. Digital Pressure is applied against
anal verge until the external sphincter is felt to yield6/26/2011
Maria Carmela L. Domocmat, RN, MSN 55 56. The gloved, lubricated
finger isslowlyflexed and introduced in the direction of the
umbilicus6/26/2011 Maria Carmela L. Domocmat, RN, MSN 56 57. Avoid
thisincorrect approach at a rightangle tothe sphincterIt causes
discomfort for the clientDoes not promote relaxation 6/26/2011Maria
Carmela L. Domocmat, RN, MSN 57 58. If the client tightens the
sphincter,remove your finger, reassure the client,and try again,
using a relaxationtechnique such as deep breathingFeel the
sphincter relax. Insert as far asit will go.Note anal sphincter
tone.6/26/2011Maria Carmela L. Domocmat, RN, MSN 58 59.
Subcutaneuos portion of the externalsphincter is palpated between
thumband index finger 6/26/2011 Maria Carmela L. Domocmat, RN, MSN
59 60. Digital exploration of the deepexternal sphincter6/26/2011
Maria Carmela L. Domocmat, RN, MSN 60 61. Palpation of the levator
animuscle 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 61 62.
Palpate the lateral,posterior, andanterior walls of therectum in
asequenced manner.The lateral walls feltby rotating thefinger along
thesides of the rectum 6/26/2011 Maria Carmela L. Domocmat, RN, MSN
62 63. Palpate fornodules,irregularity,masses, andtenderness.Ask
the client tobear down again(which may help topalpate
masses.)6/26/2011 Maria Carmela L. Domocmat, RN, MSN 63 64. Normal
FindingsSmoothNo mass, nodules,tendernessEven pressure on
fingerContinuous, smoothsurface with minimaldiscomfort to client
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 64 65. Normal
FindingsRectum should accommodatethe index finger.Sphincter
tightens evenlyaround finger with minimaldiscomfort to clientGood
sphincter tone at restand with bearing down. 6/26/2011 Maria
Carmela L. Domocmat, RN, MSN 65 66. Normal FindingsNo excessive
pain,tenderness, induration,irregularities, or nodulesin the rectum
or rectalwall.Anal canal isapproximately 2.5 cmlong. It is bordered
bythe external and internalsphincters, which arenormally firm
andsmooth 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 66 67. Lets
Watch:Palpating Posteriorand Lateral RectalWalls 68. Anoscopy
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 68 69. Abnormal
Findings Rectal polyps Pedunculated Sessile 70. Pedunculated
polyps6/26/2011 Maria Carmela L. Domocmat, RN, MSN 70 71. Sessile,
multilobulated polyp 6/26/2011Maria Carmela L. Domocmat, RN, MSN
71On biopsy, turned out to be a benign tubularadenoma. 72.
Prostatic andCowpers GlandPalpation 73. Palpation of Prostate
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 73 74. Palpate the
posteriorsurface of the prostategland.Note the size,
shape,consistency, sensitivityand mobility of theprostate.Note
whether themedian sulcus ispalpable.6/26/2011Maria Carmela L.
Domocmat, RN, MSN 74 75. Normal Findings Approximately 4 cm (1
inches) in diameter; projecting less than 1 cm into rectum. About
the size of a walnut. Rubbery consistency (like a pencil eraser).
Smooth, firm and nontender. 6/26/2011 Maria Carmela L. Domocmat,
RN, MSN 75 76. If prostate protrudes into the rectal lumen,
probably enlarged. Classified as grades 1 to 4: protruding less
than 3/8 inch or 1 cm into the rectal lumen to 1 inch or 3 cm into
the rectal lumen6/26/2011Maria Carmela L. Domocmat, RN, MSN 76 77.
Lets Watch:Palpating theAnterior Rectal Walland Prostate 78.
AbnormalitiesBenign Prostatic HypertrophyProstate Cancer 79. Benign
Prostatic Hypertrophy 6/26/2011 Maria Carmela L. Domocmat, RN, MSN
79 80. Prostrate Cancer: Single nodule 6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 80 81. Prostrate Cancer: Multiplenodules
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 81 82. Bidigital
Examination ofthe Bulbourethral GlandReassure the client that
sensations ofurination and defecation are commonduring the
prostatic assessment.Use a well-lubricated, gloved
indexwell-finger.Insert the gloved index finger and followthe steps
3 to 6 above 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 82 83.
Bidigital Examination ofthe Bulbourethral Gland Press your gloved
thumb into the perianal tissue while pressing your gloved index
finger toward it. Assess for tenderness, masses, or swelling
Release pressure of the thumb and index finger. Remove thumb from
the perianal tissue and advance your index finger.6/26/2011Maria
Carmela L. Domocmat, RN, MSN 83 84. Bidigital Examination ofthe
Bulbourethral GlandPhoto 6/26/2011 Maria Carmela L. Domocmat, RN,
MSN 84 85. Normal FindingBulbourethral Gland Nontender 6/26/2011
Maria Carmela L. Domocmat, RN, MSN 85 86. Seminal Vesicles
Palpation Attempt to palpate the seminal vesicles by extending your
index finger above the prostate gland. Assess for tenderness and
masses.6/26/2011 Maria Carmela L. Domocmat, RN, MSN 86 87. Normal
FindingsNormally, too softto be palpated.Proximal portionscan
sometimesbe palpated ascorrugatedstructures abovethe lateral to
themidpoint of thegland. 6/26/2011 Maria Carmela L. Domocmat, RN,
MSN 87 88. Lets Watch:Palpating the AnteriorRectal Wall
SeminalVesicle & CowpersGland 89. Slowly withdraw the finger;
inspect any fecal matter on your glove and test it for occult
blood.(if not previously performed).Offer the client tissues to
wipeoff any remaining lubricant.6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 89 90. Normal FindingsStoolBrownSoftNo mucus
6/26/2011 Maria Carmela L. Domocmat, RN, MSN 90 91. Fecal Occult
Blood Test Stool Guaiac Test 92. Stool Guaiac TestOther
names:Guaiac smear testFecal occult blood test - guaiac smearStool
occult blood test - guaiac smear 6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 92 93. Guaiac Testing Equipment 6/26/2011 Maria
Carmela L. Domocmat, RN, MSN 93 94. Stool Guaiac TestPurposeFinds
hidden (occult) blood in thestool. 6/26/2011Maria Carmela L.
Domocmat, RN, MSN 94 95. 6/26/2011 Maria Carmela L. Domocmat, RN,
MSN 95 96. stool guaiac testa small sample of stool is placed on
apaper card and a drop or two of testingsolution is added.A color
change is a sign of blood in thestool. 6/26/2011 Maria Carmela L.
Domocmat, RN, MSN 96 97. How to Prepare for theTestDo not eat red
meat, any blood-containing food,blood-cantaloupe, uncooked
broccoli, turnip, radish, orhorseradish for 3 days before the test.
These foods cansometimes interfere with the test. test.You may need
to stop taking medicines that caninterfere with the test. These
include vitamin C andnonsteroidal anti-inflammatory medicines
(NSAIDs)anti-such as ibuprofen and aspirin. 6/26/2011 Maria Carmela
L. Domocmat, RN, MSN97 98. 6/26/2011 Maria Carmela L. Domocmat, RN,
MSN 98 99. Positive guaiac test shown on right, as would be seen
for this patient.Negative result (on left) included for
comparison.http://meded.ucsd.edu/isp/2002/desai/images/LGB46.jpg6/26/2011Maria
Carmela L. Domocmat, RN, MSN 99 100. Normal FindingNegative. No
blood in the stool 6/26/2011 Maria Carmela L. Domocmat, RN, MSN 100
101. Documentation samplesNo perirectal lesions or fissures.
Externalsphincter tone intact. Rectal vault withoutmasses. Prostate
smooth and nontenderwith palpable median sulcus. (Or in
female,uterine cervix nontender.) Stool brown andhemoccult
negative. 6/26/2011Maria Carmela L. Domocmat, RN, MSN 101 102.
Documentation samplesPerirectal area inflamed; no
ulcerations,warts, or discharge. Cannot examineexternal sphincter,
rectal vault, orprostate because of spasm or externalsphincter and
marked inflammation andtenderness of anal canal. 6/26/2011Maria
Carmela L. Domocmat, RN, MSN 102 103. Documentation samplesNo
perirectal lesions or fissures. Externalsphincter tone intact.
Rectal vault withoutmasses. Left lateral prostate lobe with 1 x 1cm
firm hard nodule; right lateral lobesmooth; medial sulcus is
obscured. Stoolbrown and hemoccult negative. 6/26/2011Maria Carmela
L. Domocmat, RN, MSN 103 104. Sources:Weber, Janet & Kelley,
Jane. (2007). Health assessment in nursing (3rd ed). Philadephia,
ed). Philadephia, PA : Lippincott Williams &
Wilkins.Bickley,Bickley, Lynn S . (2004). Bates Pocket guideto
physical examination and history taking(4th ed). New York:
Lippincott Williams and ed).Wilkins. 6/26/2011Maria Carmela L.
Domocmat, RN, MSN 104 105. Have a blessed Day!6/26/2011 Maria
Carmela L. Domocmat, RN, MSN 105 106. Have a blessed Day!6/26/2011
Maria Carmela L. Domocmat, RN, MSN 106