Colorectal examination: what it is
A colorectal examination is an essential diagnostic step if you have symptoms that may be attributed to intestinal problems or disorders in the anorectal area. Those suffering from anal fissures, haemorrhoids, incontinence or any symptom that is believed to be a colorectal disease must see a specialist as soon as possible.
Due to current social taboos many people are frightened at the thought of having a colorectal examination and tend to put it off, risking the condition to worsen.
Colorectal examination: what do I need to do
Due to the test including inspection of the anorectal canal, the patient may be asked to have an enema the day before the appointment and about 2 hours before the examination.
The enema allows any faecal material remaining in the bowel to be removed and therefore allows the specialist to have a proper view of the anorectal canal. Enemas are sold in small, ready-to-use containers that are available in all pharmacies.
However, in some cases an enema is not indicated since it could alter the results of the cytological examination so check with your doctor for complete instructions prior to exam.
Colorectal exam: what to expect
A proctological examination is performed in set stages that allow the clinician to identify existing problems around the anorectal area and if necessary, prescribe further testing.
The more relaxed the patient is, the less discomfort they will experience and the easier it will be for the physician to examine the area and provide a proper diagnosis.
At the start of the appointment, the clinician will identify any condition that might make it difficult for the patient to continue with the procedure (such as pain on palpation) and postpone the anorectal exam to another time, after the symptoms have been treated.
There is no need to be nervous or scared about going for an anorectal exam. Just try to relax.
The 5 stages of an anorectal exam are:
- MEDICAL HISTORY: before starting the actual examination, the physician will take a medical history, i.e. carry out an in-depth interview with the patient.
During this stage the specialist will ask the patient:
- to describe any symptoms or conditions he is suffering from
- when the symptoms started and how often they occur
- any family history of anorectal problems
- about any treatments or previous surgery for the problem
- OBSERVATION: following the medical history, the physician must first observe the area around the anus to identify any problems that can been seen externally. This way the specialist is able to perform an initial non-invasive assessment and identify any problems visible at this stage.
After the observation stage and depending on the patient’s symptoms, the specialist assesses whether it is possible to proceed with the next steps.
- PALPATION: during palpation the clinician lays a finger on the area around the anus to check how it feels to the touch and identify any problems.
Through observation and palpation, the physician may also identify haemorrhoids, anal fissures or other problems that might make further examination painful. In such cases, the proctologist will stop the exam and postpone it to after the pain symptoms have been treated.
- RECTAL EXPLORATION: after palpation, the physician performs a digital examination (DRE) by placing a well-lubricated finger into the anus.
During the rectal exploration, the specialist can better assess any diseases and verify how the sphincter muscles contract and relax. At this stage, the physician may ask the patient to contract the anorectal area as though they were straining to empty their bowels.
If there are any symptoms that might make the proctologist suspect improper functioning of the sphincters, he will request further tests such as anorectal manometry and/or Endo Anal Ultrasound.
- RECTOSCOPY AND ANOSCOPY: the last step involves a thorough examination of the anorectal area with the aid of a rectoscope. With the rectoscope, the specialist can view the anal canal and the lower part of the rectum. During these exams, it is also possible to perform a biopsy or relevant outpatient procedures for any problem in the anorectal area.
With anoscopy it is possible, for example, to identify internal haemorrhoids and make a diagnosis of the grade of the disease, while rectoscopy makes it possible to identify tumors in the lower rectum.
For the diagnosis of anal cancer and cancer in the lower rectum, there is also a special examination called High-Resolution Anoscopy (HRA). This exam allows the proctologist to view suspicious lesions with high precision and perform a biopsy immediately.
To learn more about High-Resolution Anoscopy and traditional Anoscopy, please consult the page Rectoscopy and Anoscopy.