男性直肠检查

A male rectal exam is indicated for patients with lower urinary tract symptoms, urinary or fecal incontinence or retention, back pain, anorectal symptoms, abdominal complaints, trauma, unexplained anemia, weight loss, or bone pain. The exam helps assess the prostate and rectum for abnormalities that may explain these symptoms.

Three acceptable positions exist: Sims' position with the patient on his left side and right leg flexed; modified lithotomy position lying on his back with hips and knees bent; or standing position bending forward at the waist supported on elbows. The choice depends on patient comfort and clinical context.

The examiner can palpate the posterior surface of the prostate, including its apex, base, median sulcus, and lateral lobes through the rectal wall. The prostate normally measures approximately 4 cm by 3.5 cm and weighs 20-30 grams in young men. The rectum and anal sphincter tone are also assessed.

Physicians should use neutral, matter-of-fact language to reduce patient anxiety. Recommended words include examine, check, assess, insert, and appears healthy. Avoid intimate connotations like feel or touch, and overly medical terms like probe or palpate. Inform patients what you intend to do before performing each maneuver.

After inserting the lubricated finger past the external anal sphincter, palpate the prostate by directing your finger anteriorly toward the umbilicus. Locate the median sulcus between lateral lobes and follow it to the base. Use abduction, adduction, flexion, extension, supination, and pronation movements to examine each lobe, noting symmetry, consistency, nodularity, and tenderness.

Prepare latex-free gloves, lubricant pre-expressed on a paper towel, a cotton swab for neurologic assessment, tissue paper for patient cleanup, and a guaiac card with reagent for occult blood testing if indicated. Having all supplies ready in advance ensures a smooth, efficient examination.

Using a cotton swab, gently touch the perianal region in a dermatomal pattern and ask the patient to notify you when contact occurs. Test the anal reflex by gently scratching the skin surrounding the anus and observing the sphincter for contraction. This assessment is particularly important in patients with neurologic symptoms or lower back pain.