Anal, Rectal and Prostate Assessment

Question 1

Health History Points (7)

Answer 1

1. usual bowel routine
2. changes in bowel habits
3. rectal bleeding/ blood in stool
4. medication use
5. rectal conditions
6. family history
7. self-care behavior’s

Question 2

Health History: Usual Bowel Routine

Answer 2

• frequency of defecation
• quality: colour, consistency
• does the patient eat breakfast regularly? drink
  coffee/ tea? –> increases colon motility and
  prompts bowel movement
• constipation
• pain with defecation

Question 3

Constipation

Answer 3

defined as 3 or less bowel movements in a 7 day period

Question 4

Dyschezia

Answer 4

pain with defecation

Question 5

Health History: Rectal Bleeding, Blood in Stool

Answer 5

bright red = gastrointestinal or localized bleeding later in the intestinal tract (hemorrhoids)

dark red/ black = gastrointestinal bleeding high up in the intestinal tract

Question 6

Physical Exam Points (1)

Answer 6

1. Inspection

Question 7

Inspection Points: The Perianal Area

Answer 7

a. The Anus - moist, hairless, coarse folded skin,
increased pigmentation

b. Sacrococcygeal area - smooth, even

c. Anal Opening - Valsalva maneuver produces no
break in skin integrity or protrusion

Question 8

Inspection of the Perianal Area: Abnormal Findings

Answer 8

a. Inflammation - lesions or scars
b. Linear Split - fissure
c. Flabby Skin Sac - hemorrhoid
d. Shiny Blue Skin Sac - thrombosed hemorrhoid

Question 9

Positioning Males vs. Females

Answer 9

Females:
a. lithotomy position (if inspecting vagina too)
b. left lateral (if only inspecting anus/ rectum)

Males:
a. left lateral
b. standing with toes pointed inwards (relaxes
regional muscles

ALWAYS choose gender affirming positions with the least exposure possible (other than area being inspected)

Question 10

Hemorrhoids

Answer 10

painless, flabby papules caused by varicose veins from increased venous pressure

Question 11

External Hemorroids

Answer 11

originates below the anorectal junction and is covered by anal skin
- when thrombosed, it contains clotted blood and
becomes painful, swollen, shiny blue, itches,
and bleeds with defecation
- when it resolves, it leaves a painless, flabby skin
around the anal orifice

Question 12

Internal Hemorrhoids

Answer 12

originate above the anorectal junction and is covered by mucous membranes
- only visible as a red mucosal mass when the patient performs a Valsalva maneuver

Question 13

Fecal Impaction

Answer 13

a complete colon blockage by hard, desiccated immovable stool in the rectum, which presents as constipation or overflow incontinence
- results from decreased bowel motility

Symptoms:
- abdominal cramping, pain
- severe bloating
- anorexia (if severe)
- urgency to defecate (internal sphincter is
constantly signaled, overflow incontinence)
- stool when passing gas

Question 14

Older Adult Considerations

Answer 14

1. Prostate gland enlarges (agres 40+ benign prostatic hypertrophy occurs)
   
   • might start compressing on the urethra –>
     difficulty voiding/ voiding completely –> UTis,
     bladder and kidney infections might occur
2. risk of prostate and colorectal cancers increase
   
   • risk factors involve being 50+ years old