Rectal examination through the rectum. How is the inspection carried out? Preparing a woman for a gynecological examination

Enough a rare species examination is . Given rectal examination in gynecology, it is recommended to collect additional data during a vaginal examination, as well as when examination of the vagina is not possible.

Reasons for a rectal gynecological examination

• when examining girls, girls and women who did not live sexually (virgins)
• with gynatresia, aplasia and atresia of the vagina
• with serious inflammatory diseases organs of the reproductive system (to clarify the state of the sacro-uterine ligaments and parameters)
• with diagnosed cancer of the cervix or ovaries (to obtain information on the extent of the spread of tumor infiltration on the parameters and the wall of the rectum)
• with retrocervical endometriosis (to clarify the spread of the pathological process to the wall of the rectum)
• during childbirth

With a rectal examination through the anus, the doctor can very clearly determine the following parameters of organs and tissues:

• cervix
• scarring
• vaginal changes
• accumulation of fluid in the vagina (hematopyocolpos, etc.)
• perivaginal tissue and sacro-uterine ligaments

Also, in the process of rectal examination, it is possible to determine some changes in the intestine itself: ulcerative defects and pathological expansions, infiltration of the walls of the vagina, to diagnose compression and narrowing of the existing tumor or exudate in the perivaginal tissue. Examination by a gynecologist through the rectum is a mandatory method of examining a patient in the presence of cervical cancer, as it greatly facilitates the detection of infiltrates in the parameters.

In pregnant women

Separately, it is worth mentioning the gynecological examination through the rectum in women in labor during childbirth. Sometimes a doctor can use it instead of a vaginal examination to obtain information about the degree of dilatation of the cervix in a woman in labor, presentation of the fetus, integrity or rupture amniotic sac. The doctor can also feel the concavity sacrum, to determine the degree of filling of the sacral cavity with the presenting part of the fetus. Rectal examination can be both a single and a method of systematic observation during childbirth.

How is the examination by a gynecologist through the rectum

Before gynecological examination must be emptied through the rectum bladder and carry out cleansing enema. The examined patient is placed on his back in a horizontal position, while top part the torso should be slightly raised, the knees slightly bent, the stomach relaxed, and the legs apart. The patient is asked to completely relax the muscles and establish even breathing.

The gynecologist conducts an examination with the index finger of the right or left hand, dressed in rubber glove, or a fingertip, thickly greased vaseline oil. The thumb of the examining brush is retracted backwards to prevent pressure on the external genitalia. Sometimes, if it is necessary to study the features of the rectovaginal septum, a combined rectovaginal examination is performed, in which the index finger is inserted into the vagina, and middle finger into the rectum.

At the same time, with his free hand, the doctor examines pelvic organs through abdominal wall. AT rare cases to study the vesicouterine space, it is inserted into the anterior fornix of the vagina thumb, and in the rectum - forefinger. In some cases, an examination by a gynecologist through the rectum is performed index fingers both hands. After completing the rectal examination, the doctor pays attention to the presence and nature of the discharge remaining on the examining finger, blood, pus, mucus.

An examination by a gynecologist is a mandatory and regular procedure for every woman. Used as a preventive measure genitourinary system, and in order to identify serious deviations in it.

Gynecological examination helps to find out the state of the genitourinary system

Why is a gynecological examination necessary?

An important procedure for saving women's health is inspection .

At the doctor's appointment, a woman must be:

• in preventive purposes- at least 1 visit every 6-12 months (even if there are no complaints);
• during pregnancy (schedule of visits is individual) - at least once every 3–4 weeks for the first 2 trimesters, and starting from 7–8 months, visits to the doctor are carried out almost weekly;
• after childbirth - be sure to undergo an examination after 2-3 days, then after 1.5-2 months and, if there are no complaints, regularly once every six months or a year.

The procedure allows the doctor to evaluate the external and internal state vagina.

During a superficial examination, the specialist pays attention to:

• skin (degree of dryness or greasy epidermis);
• hairline (hair growth, the presence of lep);
• labia (seals, growths, bulges);
• color of the mucous membrane of the genitals.

During the examination, the doctor checks in detail the genital structures - the clitoris, the labia (internal), the urethra, the cervix, hymen(in the presence of).

Gynecological examination is mandatory biological material- smear on flora. This is done both for prevention and to identify the source of negative disorders in the genitourinary system.

Gynecological examination includes a smear on the flora

An experienced doctor with an external examination can immediately determine the existing pathological abnormalities:

• inflammation, eczema, ulcerative processes, warts, papillomas, warts, tumors;
• hypoestrogenism (pale lips, increased dryness of the uterine and vaginal mucosa);
• high levels of estrogen in the body (discoloration of the vulva, copious discharge from the vagina)
• pregnancy (bright red genitals, which is associated with increased blood flow to the pelvic organs and hormonal changes in the body);
• hyperandrogenism (the clitoris is enlarged and distant from urethra, the labia (internal) are poorly developed).

How to prepare for a gynecological examination?

Before going to the gynecologist, you need to properly prepare.

1. Exclude sexual intercourse 3 days before visiting the doctor.
2. Do not douche or use a deodorizing hygiene medium on the day of your visit to the doctor.
3. Perform genital hygiene plain water without strong pressure on the genitals.
4. The bladder and rectum must be empty before examination.

Careful preparation for gynecological procedure allows the doctor to assess the real state of the genitourinary system and get reliable results flora smear.

Before going to the gynecologist, perform genital hygiene

How is a gynecological examination carried out?

Examination at female doctor begins with a patient interview:

• complaints are being investigated pain when visiting the toilet, during sex, the presence of rashes, the nature of the discharge);
• the doctor asks about the menstrual cycle (at what age did they start, are there any failures, how many days, what profusion, the date of the last menstruation);
• collects data on reproductive function(the presence of pregnancies, childbirth, abortions, miscarriages);
• the sexual aspect is being studied (the presence of a sexual partner, the use of contraceptives);
• the doctor is interested in past diseases of the genitourinary system.

The next step is examination on the gynecological chair. It includes 2 stages - with the help of mirrors and bimanual (palpation with both hands). For each category of women (children, pregnant women, virgins, after childbirth), the procedure has its own differences.

During pregnancy

The doctor's visit starts at early dates gestation (first time in 8-12 weeks). At this time, an internal examination of the cervix, perineum with a mirror is carried out. The purpose of the procedure is to clarify general condition reproductive organ and exclusion of ectopic pregnancy. Be sure to take a smear on the flora ( bacteriological culture) and cytological smear(to detect malignant changes). To do this, you need to bring gynecological set(sold in any pharmacy).

In addition to manipulations on the gynecological chair, the doctor measures the weight and height of the patient, pressure, pulse, examines the position of the uterus and the width of the pelvis. The survey will include information about hereditary diseases, chronic pathologies and bad habits.

Starting from the 15th week, internal examinations on the chair are not carried out. Now, at each visit, the doctor measures the circumference of the patient's abdomen, the position of the uterine fundus, and listens to the baby's heartbeat with a stethoscope. Mandatory parameters are pressure, pulse and weight.

Until the 29th week, visits to the gynecologist are limited to 1 time in 3 weeks. Further trips to the doctor become more frequent - 1 visit in 14 days. Starting from 36 weeks - visits every 7 days. 10-15 days before the birth, the need for a gynecological examination again appears. It is important to check readiness birth canal through which the child will pass, as well as the state of the pharynx - the opening of the cervix.

For the entire period of gestation, a woman needs to lie on a gynecological chair at least 5-6 times. It all depends on the course of pregnancy and possible deviations.

After childbirth

natural childbirth and normal postpartum period suggest a visit to the doctor when the discharge takes on a natural character - it will not be plentiful and bloody. The purpose of the examination is to check the condition of the birth canal, the formation of the uterus - whether the organ has become in place, the degree of its contraction to normal sizes, examine the seams (if any), their healing.

The specialist examines the woman first with a mirror, then takes a swab. Then he palpates - puts 2 fingers into the vagina, and with the fingers of the second hand presses on the stomach closer to inguinal zone. This allows you to determine the density of tissues, check the appendages, find out if there are extraneous seals or scarring on the uterus and its neck,

Medical examination at school

For the first time, the genitals of girls are examined in the maternity hospital, then at 1 year and before entering the kindergarten. At school, visits to the gynecologist for the first time begin at the age of 12–14. Girls are examined exclusively pediatric gynecologist.

The examination process consists in a survey (complaints, first menstruation) and examination of the genital organs. The girls are located on the couch, where the doctor performs palpation through the rectum. With the second hand, the specialist presses on the peritoneum. In the absence of complaints about genital area such manipulation may not occur.

Before the examination, the pediatric gynecologist conducts a survey

In adolescents who do not lead sexual life, the smear is taken with a special thin device, which allows you not to injure the hymen. Examination of underage girls who already have intimate relationship, is carried out in the same way as the usual preventive visit adult women.

Virgin at the gynecologist

The examination of a virgin is carried out in the same way as in a little girl - through the anus. The doctor checks the condition of the external genitalia, palpates the abdomen, with a finger through anus palpates the uterus. The swab is taken thin instrument, inspection with a mirror is not carried out.

Virgin examination goes through the anus

Gynecological examination helps to identify pathological changes in the early stages of development, observe the course of pregnancy and regularly monitor the condition reproductive organs. For prevention purposes, a woman should visit a doctor at least once a year. If there are complaints, do not hesitate to visit a specialist - a timely examination can prevent dangerous diseases.

If you have a little girl growing up, then be prepared that you will have to take her to

gynecologist. Do not think that children do not have problems with the reproductive organs, they can occur even in infancy. So, the first examination takes place in the hospital. And the first visit to the gynecologist usually falls on the age of 1.5-3 years, at the time when the baby passes medical commission in front of the garden. The doctor only does external examination, checks if the labia has grown together, if there is any irritation or redness. It is also held in front of the school - at the age of 6-7 years.

But a full examination by a gynecologist should take place at the age when it begins. Usually this happens at 12-13 years old. Mom should properly prepare her daughter for this visit, you should not hide anything, the girl should know what awaits her. If the mother herself cannot overcome the psychological barrier and explain to her daughter what will happen in the doctor's office and why this is necessary, then it is better to turn to a qualified psychologist.

Some women are afraid to take their daughters to the doctor, worrying that the hymen may be broken in the gynecologist's chair. But girls are examined by a gynecologist through Of course, sometimes there are situations in which the doctor must conduct, but in his office there are special narrow mirrors for this, which he will use. The doctor himself is not interested in causing injury to the child, so he will act very carefully.

Also, do not think that a full examination by a gynecologist through the rectum is ineffective, so you should not take your child to the doctor before the onset of sexual activity. This is also a fairly common misconception. The doctor will be able to feel the size and location of the ovaries and uterus, its density and mobility. Also, a full one will help to notice various cysts, fibroids or inflammatory diseases in time. In some cases, only timely treatment can be warned various complications and avoid problems with reproductive health in future.

If your daughter is worried about itching, burning, pain or discharge, then this is an indication for an unscheduled visit to the doctor. You will also need to undergo an examination by a gynecologist through the rectum if the girl has an early onset. puberty. As a rule, this is fraught with violations menstrual cycle in adulthood. It is better to stop this process in time, for which the doctor may prescribe special drugs.

From the age of 14, visits to him should become regular, you need to visit him once a year. This will help to detect various diseases, learn the structural features of organs and notice various pathologies their development. Examination at the gynecologist through the rectum - not the best pleasant procedure but you can't call it painful. The doctor inserts the middle finger into the anus and determines the location and size of the examined organs.

The frequency of gynecological examinations is determined by the age, health status of the woman, the presence or planning of pregnancy. The doctor interrogates the patient, conducts an examination on the chair and takes swabs.

Features and methods of gynecological examination

A visit to the gynecologist is necessary measure disease prevention reproductive system. Early detection pathologies helps to carry out treatment in the early stages and prevent the development of complications that can cause infertility. Girls start visiting a doctor at the age of 13-15, the first gynecological examination should be carried out no later than 21 years.

Before visiting the doctor, you must hygiene procedures, while it is not recommended to use deodorizing agents, you should wash regular soap. One day before the scheduled examination, you can not douche, put tampons, have sexual contacts. Failure to follow these rules may distort the results of the study.

The best period to visit a gynecologist is the first week after the end of menstruation, but you can get an examination on any other day when there are urgent complaints. If a woman took antibiotics, then it is necessary to go to the clinic 1-2 weeks after the end of therapy. Anti-inflammatory drugs can change the composition of the microflora of the vagina.

Immediately before visiting the gynecologist, you should empty your bladder and, if possible, your intestines.

You need to bring the following with you to your doctor's appointment:

• clean socks or shoe covers;
• diaper;
• sterile gloves;
• disposable vaginal speculum (according to Cusco).

In a pharmacy, you can purchase a gynecological kit, which, in addition to the above items, includes tools for taking a smear (Eyre spatula, cytobrush), laboratory glasses for applying vaginal secretions. In most modern clinics, the necessary tools are present, and you do not need to bring them with you. It is necessary to clarify this when making an appointment with a gynecologist.

Inspection principles

Consultation and examination by a doctor is recommended for all girls who have begun menstruation and sexual relations. And also the reason for an appointment with the clinic can be menstrual irregularities, inflammatory, infectious diseases of the gynecological sphere, pregnancy planning.

Mirrors are used to examine the vagina and cervix. different size(1–6). The tool is selected individually for each woman, taking into account the ongoing manipulations. For examination of pregnant women, a tazomer and an obstetric stethoscope are used. For girls aged 12–17, only the external genitalia are examined or a rectal examination is performed.

Questioning the patient

First, the doctor collects an anamnesis, asks questions of interest to him, listens to complaints. These data will help to establish the correct diagnosis and prescribe treatment. Most often, the gynecologist asks at what age menstruation began, and how long ago the last ended critical days whether the menstrual cycle is regular, whether sexual relations are present, and when the first sexual contact occurred.

The women explain the reason for their visit: it could be preventive examination, symptoms of the disease, pregnancy planning or suspicion of a conception that has already happened, selection of contraceptives. The doctor's questions should be answered honestly, without embarrassment, as this will help to quickly establish a diagnosis and carry out treatment.

It is important to tell your doctor about the number of births, abortions or terminated pregnancies, previous diseases gynecological sphere, the presence of chronic ailments, allergies to medications, congenital pathologies.

General examination

After the interview, a general examination is carried out. The gynecologist evaluates the condition of the skin, hair, body weight, measures arterial pressure. characteristic external signs may indicate the presence hormonal disorders. For example, acne, increased growth body hair appears elevated level androgens in the blood. Against this background, the woman's health worsens, there are problems with conceiving a child.

hair loss, swelling of the face, excess weight may indicate a decrease in function thyroid gland, development diabetes. For this reason, the doctor may prescribe additional consultation endocrinologist, testing for the level of thyroid hormones.

Examination of the mammary glands

The next step is the examination of the mammary glands. To do this, the patient undresses to the waist and lies down on the couch. The doctor performs palpation of the chest in various positions. Such a procedure is necessary to identify seals, nodes. The doctor pays attention to the condition of the nipples, skin, swelling of the mammary glands, the presence of discharge.

During the examination, it may be revealed fibrocystic mastopathy, tumor. The ovaries (polycystic) are often involved in the pathological process. These diseases can cause dysfunction of the reproductive system, lead to infertility, deterioration of a woman's well-being, and menstrual irregularities. In this regard, the examination of the mammary glands is a mandatory event.

Examination on a gynecological chair

Gynecological examination begins with an assessment of the condition of the external genitalia. If a woman suffers from venereal diseases, infectious diseases, then the labia will be swollen, skin inflamed, red. With candidiasis, a characteristic whitish cheesy coating appears. External manifestations also include the formation of genital warts, rashes of a different nature.

The doctor evaluates the condition of the clitoris, large and small labia, the vestibule of the vagina, the skin of the perineum, can diagnose vaginal prolapse.

The next step is an intravaginal examination. For this procedure, the doctor uses a special metal or plastic mirror. The instrument is gently inserted into the vagina and expands its walls. Such manipulation is necessary to check the condition of the mucous membranes and cervix for erosion or other pathological processes. An intravaginal examination is not performed for girls who have not had sexual intercourse.

Then the gynecologist, using a special spatula, takes a secret from cervical canal, vaginal walls (smear). The material is sent to the laboratory for research on the subject of pathogenic microflora.

If cervical erosion is present, colposcopy is performed and a piece is taken damaged tissue for cytological examination. Thus, cancer cells. If there are no features in the material oncological process, cauterization of erosion is shown.

Bimanual study

After examination with a speculum, a manual examination is performed. The doctor inserts fingers into the vagina, with the second hand probes the uterus and appendages from the outside through the abdominal wall. At healthy woman procedure does not call pain, in inflammatory diseases.

Bimanual gynecological examination allows you to determine the depth of the vaginal vaults, to detect an increase in the size of the uterus, ovaries, fallopian tubes. How is myoma diagnosed? ectopic pregnancy, ovarian cysts, pregnancy, endometriosis and other pathologies. In some cases, it is possible to identify inflammation of the bladder or rectum, damage to the parauterine tissue, accumulation of exudate in the tissues.

Rectal examination

The rectal method is carried out by inserting the finger of one hand into the rectum, while the doctor palpates the patient's abdomen with the other hand. Such an examination is an alternative to intravaginal, the following situations serve as indications for the procedure:

• examination of girls under 17;
• atresia, vaginal stenosis;
• uterine cancer;
• assessment of the state of the sacro-uterine ligaments;
• parameters;
• ovarian tumors.

Rectal examination helps to assess the condition of the ligaments pelvic floor, the degree of prevalence of the inflammatory or oncological process.

Examination of virgins on a gynecological chair

When examining girls under 17 years old, the doctor determines the degree of sexual development: the growth of the mammary glands, pubic hair and armpits, . Physical data and sexual characteristics must correspond to the calendar age.

Girls who didn't have sexual contact, examination with a mirror is not carried out. The gynecologist checks only the condition of the external genitalia. If there are complaints, there is a suspicion of inflammatory process, then the examination is performed rectally.

The doctor gently inserts a finger into the rectum, and palpates with the other hand groin. This allows you to determine the size of the uterus, ovaries and appendages. The hymen is not violated.

If a vaginal examination is required, a special baby speculum is used. The tool has a special structure and minimally injures the hymen. A vaginoscopy of the vagina can also be performed using the introduction of an apparatus equipped with a video camera.

Additional Research

In some cases, to set correct diagnosis required instrumental research. The doctor gives a referral for ultrasound, hysteroscopy or laparoscopy. By using ultrasound determine the condition of the mammary glands, endometrium of the uterus, the size and shape of the ovaries, fallopian tubes. is prescribed for polycystic, ovarian apoplexy.

If a cancerous tumor is suspected, a biopsy is indicated, CT scan. CT provides clearer information about the condition reproductive organs. For symptoms endocrine disorders analysis of the level of hormones in the blood is required.

How often do you need to be examined

Examination of girls under 17–18 years of age should take place with the consent of the parents, only the condition of the external genitalia is diagnosed. If inflammatory diseases are concerned, a rectal examination may be performed.

Women suffering chronic ailments, an examination by a gynecologist is needed more often. The doctor selects a treatment regimen, monitors the course of the disease and the course of recovery. In case of infertility or at the stage of pregnancy planning, the doctor must monitor the condition of the woman, so the patient will have to appear in the clinic more often.

An examination by a gynecologist is a necessary measure for the prevention of pathologies in the organs of the reproductive system. Finding them on early stage helps to carry out treatment on time and prevent the development of complications.

Rectal examination is a diagnostic manipulation performed through the rectum in order to study it, as well as adjacent organs and tissues.

Rectal examination is digital and instrumental (performed with the help of a rectal mirror and a proctoscope). Indications: diseases of the rectum (see) (infiltration of the walls, ulcers, narrowing or compression of the rectum by a tumor, etc.); pelvic tissue (see), internal organs located in the lower parts abdominal cavity, in the pelvis.

Rectal examination is preceded by an examination of the area anus. The patient is placed on the table on his side with the legs brought to the stomach or given the knee-elbow position. On examination, you can find hemorrhoids(sometimes they are better seen if you ask the patient to strain), cracks in the anus,.

Then a careful examination is made with a gloved finger; in addition, a rubber fingertip lubricated with vaseline oil is put on the finger.

In the absence of a special fingertip, the study can be done simply with a rubber glove. A finger during rectal examination is recommended to be inserted with straining, pressing backwards; must first be emptied (enema). Finger examination can detect internal hemorrhoids, tumors, cracks, determine the size and condition.

A study using a rectal speculum is carried out by first lubricating its branches with petroleum jelly. Branches are introduced into the rectum (to a depth of 8-10 cm), the patient is in the knee-elbow position. They are moved apart and, slowly removing, inspect the mucous membrane of the rectum. Research using a proctoscope - see.

Recto-abdominal examination.

Rectal examination in. AT gynecological practice rectal examination is performed in the following cases: 1) in girls and girls, as well as with atresia and when it is impossible to produce vaginal examination; 2) in addition to a vaginal examination for uterine cancer to establish the prevalence of the tumor process (transition of the tumor to the pelvic tissue, The lymph nodes and rectal wall) 3) with inflammatory diseases of the internal genital organs to clarify the state of the sacro-uterine, pararectal tissue, etc.; 4) at ; 5) to clarify the nature of the tumor located in the rectal-uterine space (ovarian cancer).

Even more data can be obtained with the help of a bimanual (recto-abdominal) examination (Fig.), which allows you to clearly feel the uterus, uterine appendages, and also to get an idea of ​​the state of the ligaments of the uterus and pelvic peritoneum.

Rectal examination - an examination of the rectum (rectum), consisting of an examination of the anus, examination of the rectum with a finger, using an anusscope, rectal speculum, rectoscopy and x-ray examination.

When examining the anus, you can see external hemorrhoids, anal papillae and fringes (see. Anus), the edge of a low-lying cancerous tumor or tuberculous ulcers, external openings of pararectal fistulas, acute condylomas, atheromas, etc. In case of sphincter insufficiency, leakage of intestinal contents, irritation of the surrounding skin, diaper rash, eczema, excoriations are noted. To detect a crack, it is necessary to force the patient to strain, while the examiner stretches and straightens with both hands skin folds external anal funnel.

A finger examination is mandatory in all patients with complaints of a disease of the anus or rectum. It is performed in the position of the patient on his back with bent legs, on his side, in the knee-elbow position or sitting (as during defecation). In the latter case, especially when straining the patient, the doctor's finger penetrates the rectum 2-3 cm deeper than when examining the patient in the supine position.

To examine the rectum with instruments, the skin surrounding the anus is lubricated with petroleum jelly. The collected anusscope, lubricated with Vaseline, is inserted into the rectum, the stylet is removed. Examine the mucous membrane lower section rectum.

A rectal speculum is inserted into the rectum in a closed form. The branches are bred and the lower rectum is examined - statically and when the instrument is removed, which can be rotated slightly, to make rotational movements. Many design options for anusscopes and rectal speculums have been proposed (Figures 1 and 3). Rectoscopy - see Sigmoidoscopy.

Rice. 2. Scheme of sphincterometry with Aminev's sphincterometer.

Rice. 3. Different kinds rectal mirrors.

X-ray examination of the rectum produced or after 18-24 hours. after taking a barium contrast mass through the mouth, or with the help of irrigoscopy - filling the intestine with a contrast suspension through an enema (the latter is preferable). Some details can be better seen after emptying the intestines from a contrast suspension by natural defecation, especially with double contrast - barium suspension and air. Small traces of contrast mass remaining on the surface of the mucous membrane make it possible to contour pathological formations even small sizes.

The study of the strength of the sphincter is carried out using the Aminev sphincterometer (Fig. 2), consisting of an olive with a rod and a steelyard. The olive is lightly smeared with petroleum jelly and injected into the rectum. When sipping the steelyard, the arrow moves along the scale of the steelyard. She stops after removing the olive from the rectum and shows the strength of the sphincter in grams. At the first measurement in a calm position of the subject, the tone of the sphincter is recognized. On the second measurement, the subject strongly contracts the sphincter. It turns out the maximum strength of this muscle. In women, the tone is on average 500 g, the maximum strength is 800 g, in men, 600 and 900 g, respectively.

Rectal examination in gynecology is indicated both to supplement the data of a vaginal examination, and to replace it when it is impossible (in girls, girls, with aplasia, vaginal atresia).

With a rectal examination, it is possible to quite clearly determine the cervix, scars, changes in the vagina, the accumulation of fluid in it (hemopiocolpos, etc.), examine the perivaginal tissue, sacro-uterine ligaments. To establish some changes in the intestine itself (infiltration of the walls, sometimes ulcerative defects or pathological growths), narrowing and compression by a tumor or exudate in the perivaginal tissue, etc. Rectal examination is considered a mandatory method of examination for cervical cancer, as it facilitates the detection of infiltrates in the parameters .

For repeated observations of women in labor, a vaginal examination can be replaced by a rectal examination, which provides enough data to judge the degree of opening of the cervix, the presentation of the fetus, the integrity of the amniotic bladder, and in some cases the location of the sutures and fontanelles. You can also feel the concavity of the sacral bone, determining the degree of filling of the sacral cavity with the presenting part of the fetus. Rectal examination can be a method of systematic observation of the birth act.

Before a rectal examination, the bladder must be emptied. The patient must be placed in horizontal position on the back: the upper body should be slightly raised, the knees slightly bent, the legs apart, the stomach relaxed. The patient should breathe freely and avoid any muscle tension.

Another position of the patient during rectal examination - as in stone cutting; while the doctor stands between the knees of the patient. Rectal examination is performed with the index finger of the right or left hand, wearing a rubber glove, thickly lubricated with vaseline oil. The thumb of the examining brush is retracted backwards to prevent pressure on the external genital organs (Fig. 4). In some cases (to study the features of the rectovaginal septum), a combined rectovaginal examination is performed, in which the index finger is inserted into the vagina, and the middle finger into the rectum (Fig. 5): the pelvic organs are examined through the abdominal wall with the free hand. In rare cases, to study the vesicouterine space, the thumb is inserted into the anterior fornix of the vagina, and the index finger into the rectum. In some cases, rectovaginal examination is performed with the index fingers of both hands.

Rice. 4. Rectal-abdominal examination.
Rice. 5. Rectovaginal examination.