Anal examination
Appearance
Inspection
[edit | edit source]- Anal wink: the reflexive contraction of the external anal sphincter upon stroking of the skin around the anus
DRE
[edit | edit source]- Insert finger to the top of puborectalis sling posteriorly
- Sweep around sacrum palpation of the coccyx tip
- Feel levator muscles on posterolateral aspect of the rectal vault
- Prostate in men
- Anterior wall for women, looking for rectocoele
- Mass - location, relationship to rectal wall, size, fixed/mobile, soft/firm
- Squeeze
- Bear down - check for appropriate relaxation of anal sphincter complex
- Check anal canal circumferentially
Anoscopy
[edit | edit source]- Useful to check for haemorrhoids, anal dysplasia, intra-anal condyloma acuminata, or anal tags
- Swab purulent drainage for STIs
- 5% acetic acid and Lugol's iodine
- Colposcope can be used for high-resolution anoscopy
- See separate topic under 'anal neoplasm' for more detail