Rectal Wall Palpation
October 29th, 2020
Rectal Masses
Feel For
- A mass within the rectum.
Causes of Rectal Masses
- Haemorrhoid (thrombosed / prolapsed)
- Polyp / cancer
- Perianal abscess
- Prostatic enlargement - BPH, prostatitis, cancer
- Malpositioned pessary
Haemorrhoids
Haemorrhoids are cushions of anal vascular tissue that may bleed, prolapse, thrombose or cause pain / pruritis.
Look For
- Perianal or rectal mass - flesh / mucosal appearance
- Thrombosed mass - purple or blue, may be associated with overlying clot
- Blood
- Mucus discharge
Severity
- First degree - non-prolapsed
- Second degree - prolapse and reduce spontaneously
- Third degree - reduce with manual pressure
- Fourth degree - unable to be reduced
Causes of Haemorrhoids
Essentially idiopathic, though predisposition is associated with:- Straining while defaecating
- Raised intra-abdominal pressure
- Congenital
Rectal Wall Tenderness
Feel For
- Tenderness on palpation of the rectal mucosa.
Causes of Rectal Tenderness
- Proctitis - IBD, infectious proctitis, radiation proctitis
- Thrombosed haemorrhoid
- Rectal fissure
- Prostatitis
Blood on the Glove
Look For
- Bright red blood on the glove of the examining finger after digital rectal examination.
Causes of Rectal Blood
Perianal
- Haemorrhoids
- Anal tumour - squamous cell carcinoma, basal cell carcinoma, Paget's disease
- Fistula in ano
- Fissure in ano
Colorectal
- Colorectal cancer
- Colorectal polyp
- Colitis - IBD, infection, diverticulitis
- Radiation proctitis / colitis
- Angiodysplasia
- Trauma
Faecal Occult Blood
How to Assess
- Smear a sample of stool onto test paper (e.g. guaiac-based), add developer solution, and look for blue colour change.
Significance
- A positive result is suggestive of the presence of faecal blood not visible by the naked eye - further testing is suggested via faecal immunochemistry and/or endoscopy.
Perianal causes of bleeding generally cause visible perianal or rectal blood, and faecal occult blood testing is not required.
Causes of Faecal Occult Blood
Colorectal
- Colorectal cancer
- Colorectal polyp
- Colitis - IBD, infection, diverticulitis
- Radiation proctitis / colitis
- Angiodysplasia
- Trauma
Upper GI
- Ulcer - gastric / duodenal
- Gastritis
- Oesophagitis
- Varices - oesophageal / gastricPortal hypertension
- Cancer - gastric / oesophageal
- Coeliac disease
- Mallory-Weiss tear
- Intussusception
- Angiodysplasia
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