Physical assessment - Anus, rectum, and prostate: Nursing

Assessment of the anus and rectum should be completed as part of a comprehensive assessment like during a routine physical exam, or as part of a focused exam if a client is experiencing issues like rectal pain or changes to bowel patterns. For clients with a prostate, a prostate assessment provides the nurse with information about sexual health and genitourinary function. Let’s review the process of completing an assessment of the anus, rectum and prostate.

Okay, the supplies needed for this examination include a penlight, water soluble lubricant, drapes, gloves, a good source of light, and fecal occult blood testing material, as needed.

Now, this exam can be uncomfortable, both physically and emotionally, or even embarrassing for some clients;

which is why it’s important to explain every step in order to promote trust and relaxation.

You should also let your client know that at any time the exam can be stopped or paused if they request.

For clients with a known history of sexual abuse or trauma, remember not rush your examination, and use a gentle touch.

You can assist your client into one of three positions for this examination: lying on their back with their knees to their chest, also known as lithotomy, lying on the left side with their hips and knees flexed, or standing and leaning over the examination table.

In clients assigned male at birth, the last two positions work best for the anus, rectum, and prostate assessment, whereas with those assigned female at birth, anal and rectal examination is usually performed during a female reproductive exam while they’re already in the lithotomy position. It’s important to note that transgender clients should be examined in the position best suited for their preferance and identified gender.

Prepare for the exam by ensuring your client is in a comfortable position. For all clients, it’s recommended to let them know you’re starting the examination by touching them in a neutral location, such as the leg or foot.

Keep in mind that cold temperatures can cause rigidity of the rectal and pelvic muscles, making it more difficult for the healthcare provider to perform some assessment techniques; so ensure your hands are warm, and that the temperature in the room is comfortable. Provide privacy by closing the door and curtains, properly draping your client, and only exposing areas of their body as needed to perform your examination.

Before getting started, explain the procedure to your client and be sure to answer any questions they have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

Locating the anatomical landmarks of the anus, rectum, and prostate will help guide the appropriate placement of your equipment and hands throughout your assessment. Now, the diamond shaped perineum is divided into two triangles, the urogenital triangle anteriorly and the anal triangle posteriorly.

Commonly used landmarks within the anal triangle include the anal canal, which is normally kept closed by rings of muscle known as the internal and external anal sphincters, and the perianal areas, which surround the anal canal in the perineum. Then there’s the pilonidal area, near the cleft of the buttocks.

Next there’s the rectum, which is positioned internal to and above the anus.

The rectum has three semilunar transverse folds, also known as Houston valves, the lowest of which can be palpated by the healthcare provider.

The prostate gland is located at the bottom of the bladder surrounding the urethra.

The posterior surface of the prostate gland is accessible by digital rectal examination, or DRE, through palpation of the anterior rectal wall.

Methods of examination for the anus are inspection and palpation. The rectum and prostate will be palpated through DRE performed by the healthcare provider. As the nurse, you will act as a chaperone or assist with this part of the assessment.

Okay, begin your assessment with inspection. First, start by inspecting the pilonidal area, where the skin should appear to be smooth without lumps, warts, rashes, excoriation, scars, or dimpling. Typically, hair grows in the perianal area, but should not be present in the pilonidal areas.

You should inspect for the presence of a pilonidal cyst, or sinus in the cleft of the buttocks, which could be a congenital anomaly or due to excessive or repeated pressure on the sacrococcygeal area.

Moving onto the perianal areas and anus, you’ll need to spread apart the buttocks, and use a penlight for adequate visualization of this area. The skin directly surrounding the anus is normally more coarse and darker in pigmentation than the rest of the surrounding skin.

Here, you’ll note any abnormal findings, such as lesions, polyps, fissures, and skin tags. Irritation in the perianal areas may occur with fungal infections or pinworm.

Next, you’ll inspect for signs of constipation, such as a protrusion of dry hard stool,

while also noting the presence of external hemorrhoids, or swollen, inflamed veins.