Sievering Surgical Clinic

Sieveringer St 9, A-1190 Vienna Tel: 328 8777

The Colorectal Unit


Physical Examination


General examination


Diagnosis of anorectal diseases require a carefull assesment of one or more of the follwing information:

  1. Medical history
  2. complete rectal examination
  3. abdominal & general examination
  4. Endoscopy
  5. CT-Colonoscopy
  6. Manometry
  7. Defaecography
  8. Endosonography



Physical examination

Nearly every person who visits the clinic with an anal complaints dreads the physical examination. They have often had repeated rectal examination and anoscopies, often by inexperienced examiners. It is essential to quell the fears of these individuals prior to performing any examination if any meaningful information is to be obtained.

Patients should be examined in the left lateral decubitus position as this is better tolerated, more comfortable and less demeaning than the prone jackknife or lithotomy position. When using the Sims, or left lateral decubitus position, it is important to position the patient properly in order to obtain a good view of the anal canal. The patient should be placed with the left side down with the buttocks slightly off the edge of the examining table with the left shoulder back and the right shoulder rolled forward so that the patient is more on his or her belly than on his back. Both knees should be brought up towards the chest and the feet pushed forward away from the examining area. This position will allow good exposure of the anal canal with minimal discomfort to the patient.

The buttocks should be gently spread and the external perineal area examined for any rashes, condylomata, or eczematous lesions. Satellite lesions associated with a candidal rash should be noted if present. Any gaping of the anal aperture should also be noted. The patient should then be asked to contract his or her external sphincter and the function of this noted. Any abscesses, fissures or fistulae should be carefully inspected for as should areas of tenderness. Once this has been done, a lubricated finger should be gently inserted into the anal canal while asking the patient to bear down as if he were pushing out a bowel movement. During the digital exam, the resting tone of the anal canal should be ascertained as well as the voluntary contraction of the puborectalis and external anal sphincter. Any rectal or perirectal masses should be noted as well as any areas of tenderness. It should be noted that internal hemorrhoids are generally not palpable on digital examination. Any palpable anorectal lesions need to be clearly identified.

After completing the digital examination, anoscopy is performed. A side viewing anoscope is ideal as end viewing anoscopes provide a view of the rectum not of the anal canal. The side viewing anoscope should be inserted with the open portion in the right anterior then right posterior and finally the left lateral position to look for hemorrhoidal bundles. Hemorrhoidal bundles will appear as bulging mucosa and anoderm within the open portion of the anoscope. Once this is completed, the patient should be asked to strain to determine if there is any hemorrhoidal prolapse.


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| 25.01.2011 | Read more | Print |