Proctoscopy

Visual examination of the rectum and anal canal complements digital examination but should always be preceded by digital examination. The appearance of normal rectal mucosa is similar to buccal mucosa apart from the presence of prominent submucosal veins.

Examination sequence

□ Position the patient in the left lateral position with the buttocks at the edge of the couch, the knees drawn up to She chest and the heels clear of the perineum.

□ Separate the buttocks with the forefinger and thumb of one hand and with the other hand gently insert a well-lubricated proctoscope with its obturator through the anal canal into the rectum in the direction of the umbilicus.

□ Remove the obturator and examine the rectal mucosa carefully under good illumination, noting any abnormality seen.

□ Ask the patient to strain down as the instrument is slowly withdrawn to detect any degree of rectal prolapse and the severity of any haemorrhoids.

□ Carefully examine the anal canal for fissures, particularly if the patient has experienced pain during the procedure.

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Essentials of Human Physiology

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