Assessment of Anus, Rectum, and Prostate

Assessment of the anus, rectum, and prostate should be completed during a comprehensive assessment or as part of a focused assessment if your patient is experiencing issues with their anus, rectum, or prostate. Inspection and palpation are used to assess the anus; and the rectum and prostate are palpated through a digital rectal exam, or DRE, performed by the health care provider. As the nurse, you will act as a chaperone or assist with this part of the assessment.

Begin your assessment by inspecting the pilonidal area, which is the area at the base of the tailbone at the cleft of the buttocks, just where the buttocks begin to divide. The skin should appear smooth without lumps, hair, warts, rashes, excoriation, or dimpling. If a pilonidal cyst, or sinus is present, this could be due to a congenital anomaly or related to excessive or repeated pressure on the sacrococcygeal area.

Next, to inspect the perianal area and anus, spread apart the buttocks, and use a penlight for adequate visualization. The skin directly surrounding the anus is normally more coarse and darker in pigmentation than the rest of the surrounding skin. Unexpected findings include anal warts, which are related to infection with human papilloma virus, or HPV; and irritation, which may occur with fungal infections or pinworm. Other unexpected findings include lesions, polyps, fissures, and skin tags. You’ll also inspect for signs of constipation, such as a protrusion of a dry, hard stool, and the presence of external hemorrhoids, or swollen, inflamed veins.

Now, palpation is typically performed by the health care provider with assistance from the nurse. Starting with the perianal area, this location should be free from tenderness or lumps. If your patient reports pain or tenderness upon palpation, this may indicate a perianal abscess, or an infection of the anal tissue; an anal fistula, where an inflammatory tract forms at the anus and runs through the perianal skin; or pruritus ani, which is itching that could be caused by a fungal infection.

Next, the health care provider will perform a DRE. During a DRE, your patient should be able to tighten their external anal sphincter around the health care provider’s finger with ease and without pain. A weak sphincter can be related to neurological conditions, the effects of childbirth, or trauma to the anus; whereas extreme tightness of the sphincter can be associated with fissures, scarring, or inflammation.