Rectal Examination in an Older Adult

Purpose

A rectal examination is a valuable tool for evaluating a variety of conditions affecting the rectum, prostate gland, and surrounding structures. In older adults, rectal examinations are particularly important for screening for colorectal cancer and prostate cancer.

Steps

1. Preparation:

   • Explain the procedure to the patient and obtain informed consent.
   • Ensure the patient is in a comfortable position, either standing and slightly bent forward or lying on their side with their knees flexed.
   • Provide privacy and drape the patient appropriately.

2. External Inspection:

   • Inspect the perianal area for any abnormalities such as skin tags, hemorrhoids, fissures, or discharge.

3. Digital Rectal Examination (DRE):

   • Lubricate your gloved finger with lubricant jelly.
   • Introduce your finger slowly and gently into the rectum, aiming towards the umbilicus.
   • Assess the following:
     • Sphincter tone: The strength of the anal sphincter is important for continence. A weak sphincter may be associated with fecal incontinence.
     • Rectal wall: The rectal wall should be smooth and pliable. Any irregularities, masses, or tenderness may be indicative of pathology.
     • Prostate gland (in men): The prostate gland should be firm, smooth, and symmetrical. Enlargement, nodules, or tenderness may be suggestive of prostate cancer or benign prostatic hypertrophy (BPH).

4. Stool Occult Blood Test (SOBT):

   • If indicated, perform an FOBT using a guaiac card.

Rationale

A rectal examination provides valuable information about the function and health of the rectum, prostate gland, and surrounding structures. It is a relatively quick, non-invasive procedure that can detect a variety of abnormalities, including cancer, inflammation, and benign conditions.

Findings on Rectal Sphincter Examination

The rectal sphincter is a crucial component of continence, and its tone and function are important to assess during a rectal examination.

• Normal Sphincter Tone: The sphincter should provide a firm resistance to the examiner’s finger.

• Decreased Sphincter Tone: A weak sphincter may be associated with fecal incontinence. This could be due to neurological damage, muscle weakness, or injury to the sphincter.

• Increased Sphincter Tone: An overactive sphincter may cause constipation or difficulty passing stool. This could be due to anxiety, stress, or certain medications.

Differences in Rectal Examination Findings between Acute Prostatitis and Benign Prostatic Hypertrophy

Acute prostatitis and benign prostatic hypertrophy (BPH) are two common conditions that can affect the prostate gland. While they share some similarities, there are distinct differences in their rectal examination findings.

Acute Prostatitis

• Prostate Gland: The prostate gland may be enlarged, tender, and edematous.

• Discharge: There may be purulent discharge from the urethra.

• Fever: Patients with acute prostatitis may experience fever, chills, and malaise.

Benign Prostatic Hypertrophy (BPH)

• Prostate Gland: The prostate gland is enlarged, but not necessarily tender.

• Discharge: There is usually no discharge associated with BPH.

• Fever: Patients with BPH typically do not experience fever or other systemic symptoms.

Physical Examination Findings in Acute Prostatitis and Benign Prostatic Hypertrophy

In addition to the rectal examination findings, other physical examination findings may be present in patients with acute prostatitis and BPH.

Acute Prostatitis

• Suprapubic Tenderness: Palpation over the pubic bone may reveal tenderness.

• Urinary Symptoms: Patients may experience urinary frequency, urgency, and dysuria.

• Pelvic Pain: Pelvic pain or discomfort may be present.

Benign Prostatic Hypertrophy (BPH)

• Urinary Symptoms: Patients may experience urinary frequency, urgency, nocturia, and weak urine stream.

• Digital Rectal Examination: The prostate gland may be enlarged, but not necessarily tender.

• Urinalysis: Urinalysis may reveal microscopic hematuria.

It is important to note that these are just general guidelines, and the specific findings on physical examination will vary depending on the individual patient.