Rectal Examination – Older Adult. You are about to perform a rectal examination of an older adult. What are the steps to examine this patient? Explain your rationale. What are some findings you can have while assessing the rectal sphincter? Describe the differences during the rectal examination of acute prostatitis and benign prostatic hypertrophy. What findings would expect on physical examination of acute prostatitis and benign prostatic hypertrophy?
Steps to Follow
Here are some general steps and information related to a rectal examination:
Introduction and Explanation
Introduce yourself to the patient and explain the procedure in a clear and empathetic manner. Obtain informed consent, ensuring the patient’s understanding and comfort throughout the examination.
Positioning
Position the patient appropriately for a rectal examination, usually in the left lateral decubitus position with knees flexed towards the chest. Provide a modesty drape or cover for the patient’s comfort.
Inspection
Begin by visually inspecting the perianal area for any abnormalities such as rashes, lesions, hemorrhoids, or signs of inflammation.
Digital Rectal Examination (DRE)
Apply lubrication to your gloved index finger and gently insert it into the rectum. Assess the tone and strength of the anal sphincter and observe for any signs of tenderness, nodules, masses, or abnormal sensations during palpation of the rectal wall and prostate gland (in males).
Findings from the rectal sphincter Assessment
Some findings that can be assessed during the rectal examination of the sphincter include normal tone and strength, which may indicate intact function and muscle control. Abnormal findings can include decreased tone or flaccidity, which may suggest nerve damage or muscular dysfunction. Increased tone or spasm can be indicative of conditions like rectal fissures or inflammation.
Differences during the Rectal Examination of Acute Prostatitis and Benign Prostatic Hypertrophy
Acute prostatitis and benign prostatic hyperplasia (BPH) are two different conditions that can present with distinct findings during a rectal examination. Here are some differences between the two:
Rectal Examination Findings in Acute Prostatitis
- Palpation of the prostate gland may reveal a tender, warm, and enlarged prostate.
- The prostate gland may feel firm or boggy to touch.
- The patient may experience severe pain upon palpation or with pressure on the prostate.
- Inflammatory signs, such as warmth and tenderness, may extend beyond the prostate to the surrounding tissues.
Rectal Examination Findings in Benign Prostatic Hyperplasia (BPH)
- Palpation of the prostate gland may reveal an enlarged prostate, which feels smooth and rubbery.
- The prostate gland may be symmetrically enlarged and non-tender.
- The patient may have urinary symptoms such as weak urine stream, difficulty initiating or stopping urine flow, or a sensation of incomplete bladder emptying.
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