How is a rectal examination performed? The use of cleansing enemas on the water. Gynecological examination through the rectum during gestation

Rectal examination can be performed by different doctors as part of the treatment and diagnosis of their profile. The word inspection is purely conditional. This is a term. In relation to the research process itself, it would be more correct to say probing.

Research Features

Medical professionals who in their practice resort to this type of research:

• proctologist;
• urologist;
• gynecologist;
• surgeon.

Rectal examination goes through the following algorithm:

1. The patient takes one of three postures for research: on his side, on all fours, or in a gynecological chair with limbs pressed against his stomach.
2. The doctor puts on gloves, lubricates his finger with petroleum jelly and inserts it into the anus. To begin with, the insertion depth is up to 5 cm. If necessary, a deeper insertion (up to 10 cm) is possible.
3. Finger manipulations are carried out in accordance with the diagnostic algorithm.
4. If necessary, they may be asked to tighten the sphincter or relax.

Such an examination is completely painless, although most people find it unpleasant. In diseases of the rectum, slight pain and a small amount of blood. But with an exacerbation of inflammatory diseases (a situation where it can really hurt), the examination is not carried out.

No special preparations are required to prepare for such an inspection. It is enough to empty and wash. An enema is not required, since the rectum is cleared of feces quite well after emptying (if there are no certain diseases).

Thus, if there are no diseases, then when examining the rectal method, there should be no feces, no blood, no pus or mucus on the gloves. The presence of any of these elements indicates incorrect processes occurring in the intestines. In addition, when examining the organs of the urinary and reproductive systems through the use of the rectum, lumps and seals should not be felt.

As for discomfort, it should be remembered here that getting sick is uncomfortable in itself, and treatment and diagnosis are primarily focused not on comfort, but on the speedy and correct diagnosis and treatment. You can, of course, refuse treatment for the sake of comfort, but by definition, a sick organism will not have comfort.

Diagnostics at the proctologist

Consider the features of a rectal examination by a proctologist (a doctor who treats diseases of the rectum, colon, anus). This problem can occur in both women and men, since it is not associated with gender differences, but only with the digestive system, in particular, with the excretory branch of the digestive tract.

The main disease in the practice of a proctologist is hemorrhoids. This is a disease in which the veins of the rectum swell and anus. It is not possible to visually see these symptoms, but with the help of rectal diagnostics it is quite possible to diagnose the disease. At the last stage, when hemorrhoids begin to fall out, of course, such an inspection is not required, but on initial stages necessary to start treatment on time and prevent deterioration of the patient's condition.

Urologist

A urologist is a doctor who treats genitourinary system in men and urinary in women. Differences in terminology for men and women are due to the fact that in the former, unlike the latter, it is not possible to separate the functioning of the urinary and reproductive systems. Many bodies, if not working on two fronts, are at least connected. For example, the prostate, which is not an organ of urination, is located under bladder, enveloping urethra. In case of inflammation, the prostate begins to compress the urethra, which causes severe pain when urinating. In women, the urinary and reproductive systems are simply physiologically close, but a certain, although not so bright pronounced relationship, is also present.

Rectal digital examination men at the urologist implies a mandatory palpation of the prostate gland. The easiest way to do this is just in this way, through the rectum. Therefore, it is worth treating such a study with understanding and not thinking that the doctor is doing something wrong by sticking his finger into the hole for the exit of feces, while treating the urinary tract.

Gynecologist

Rectal examination of women is additional analysis when examined by a gynecologist and is prescribed as needed. Women's reproductive system located close enough to the intestines, and in some cases, inflammation and tumors located in the female genital organs can be detected during rectal examination.

The purpose of the examination by a gynecologist may be:

• the degree of cervical dilatation in pregnant women;
• scars and changes in the vagina;
• hematopyocolpos (accumulation of fluid in the vagina);
• parameters of the sacro-uterine ligaments and fiber of the paravaginal zone.

In some cases, when examining pregnant women rectal examination can help the doctor determine the position of the fetus (previa) or get information about the rupture amniotic sac. For women in childbirth, rectal examination can be both single and systematic in the process of childbirth.

During a gynecological rectal examination, it is necessary to carry out procedures with an enema and empty the bladder. This, in addition to the sanitary standards of gynecology, also helps the doctor to separate the problems of a gynecological nature, from, for example, the problems of urology or proctology.

This examination by a gynecologist has several fundamental differences from examinations by a proctologist and urologist. This is not surprising, because the proctologist directly examines the intestines and it is important for him to find out the location of tumors and abscesses of the intestine itself. The urologist, although he probes the rectum, but the examination of the prostate, one might say, is a point. The gynecologist's task is wider. The examination passes through the intestines, but other organs are probed. Moreover, these organs are not point, but extended. In some cases, such a study is carried out with two fingers (one finger is inserted into the anus, and the other into the vagina). In some cases, during research, pressure is applied to the abdomen or other actions necessary for a more accurate diagnosis.

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 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 detect hemorrhoids (sometimes they are visible better if you ask the patient to strain), anal fissures,.

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

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 determine the extent 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 using 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 ulcer, external openings of pararectal fistulas, acute condylomas, atheromas, etc. In case of insufficiency of the sphincter, leakage of intestinal contents is noted , irritation of the surrounding skin, diaper rash, eczema, excoriations. 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 inspected - 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. The insignificant traces of contrast mass remaining on the surface of the mucous membrane make it possible to contour pathological formations of even small sizes.

The study of the strength of the sphincter is performed 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.

A 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 (hematopyocolpos, etc.), examine the perivaginal tissue, sacro-uterine ligaments. Establish some changes in the intestine itself (infiltration of the walls, sometimes ulcerative defects or pathological expansions), 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 sacrum, 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: top part the torso should be slightly raised, knees slightly bent, legs apart, abdomen relaxed. The patient should breathe freely and avoid any muscle tension.

Another position of the patient during rectal examination - as in lithotomy; while the doctor stands between the knees of the patient. Rectal examination is performed with the index finger of the right or left hand, dressed in 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 free hand is examined 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, a rectovaginal examination is performed index fingers both hands.

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

The rectum plays important role in the functioning of the whole organism, so you need to monitor its smooth operation. FROM biological point view of the rectum is a small ending (12-20 cm) of the large intestine. Its function is to remove processed products from the human body. In this regard, doctors recommend regular examination of the rectum. This is done to identify possible pathologies internal organs. For more information on how a rectal examination is performed in women, will be discussed in this article.

With the appearance of any violations in the work of the intestine, you should immediately visit the proctologist's office. This also applies to suspicious symptoms relating to the lower abdomen, intestines and anus. If you complain about problems with the work of these organs, you should visit the clinic for a diagnostic examination.

The following complaints are most often addressed to the proctologist:

• regular false urges to go to the toilet;
• frequent constipation;
• flatulence or a feeling of tightness in the abdomen;
• purulent, mucous or bleeding from the anus;
• pain in the anus;
• constant feeling of incomplete bowel release.

On a note! It is recommended to undergo proctological examinations for women after childbirth and older than 40-45 years. This will prevent or detect early stage development of diseases such as hemorrhoids, polyps or cancer. With regular heavy sports, as well as when planning a pregnancy, women also need to get advice from a specialist.

Preparatory procedures

Before contacting a specialist, you need to properly prepare. If you are waiting for an initial consultation with a proctologist, then it will be enough to use a special microclyster to clean the rectum. If during the inspection other diagnostic procedures, for example, barium enema or anoscopy, then a more thorough cleaning of the intestine will be required. Consider the basic methods of preparing the body for examination.

The use of cleansing enemas on water

Approximately 24 hours before the proctological examination, it is necessary to completely change the diet. You can only eat liquid food. You also need to limit the amount of foods that can cause flatulence. These include flour products, cereals, fruits and vegetables. If the doctor has scheduled an examination in the morning or in the morning, then in the evening before the procedure it is necessary to make several water enemas (2-3) with a volume of 1.5 liters. Between enemas you need to take a break of 40-60 minutes.

The next morning, do 2 more of the same enemas. Use only warm water. If the examination was scheduled for the second half of the day, then 1-2 hours before the examination, a proctologist should put cleansing enemas. Make sure that the last enema done is no later than 2 hours before the examination. This method very labor intensive but effective. Doctors prescribe it as the main way to cleanse the rectum.

The use of microclysters

A fairly simple way to prepare for diagnosis. The patient is given a microclyster with "Adulax" or "Norgalax", which leads to irritation of the intestinal receptors, because of which the patient begins to feel the need to go to the toilet. This method of preparation is very comfortable for the patient, because he does not need to comply special diet and the process itself is very fast.

But conducting microclysters can push the development allergic reaction or inflammation in the gastrointestinal tract. To avoid unpleasant complications, patients suffering from ulcerative colitis or hemorrhoids, the method of cleaning the intestines with microclysters, unfortunately, is not suitable.

Taking pharmaceutical drugs

There are special preparations used in bowel cleansing. All of them are made on the basis of one substance - polyethylene glycol, which makes them safe for the health of patients of all age categories. Most often, Endofalk, Fortrans and other drugs are used for this purpose. Before use, the drug must be dissolved in a certain amount warm water(exact information is indicated on the package) and drink 1-2 hours before the examination by the proctologist. As a rule, a complete bowel cleansing takes place about a day after taking the medication.

Doctors recommend using this method of preparation before carrying out complex instrumental procedures, such as irrigoscopy, fibrocolonoscopy. The use of such drugs for the initial examination is not provided. To choose one or another cleaning method, a consultation with a doctor is required, who will conduct an examination. He knows exactly which preparatory procedure is best to choose.

On a note! It is forbidden to independently carry out a bowel cleansing procedure with heavy bleeding in the region of the rectum or pronounced painful sensations. Otherwise, you can harm the body and make it worse.

Research methods

Inspection of the rectum can consist of several stages. The first is history taking possible disease and a conversation with a proctologist. Second - visual inspection anal area. The third is the implementation of some methods of rectal examination, the main of which are described below.

Table. Methods of examination of the rectum.

On a note! At correct application all proctological methods will allow you to conduct a high-quality diagnostic examination and identify various pathologies in the area of ​​the perineum or anus. You just need to seek help from a doctor in time.

Are there any contraindications?

Conducting an instrumental examination will allow the proctologist to put accurate diagnosis, but despite this, there are certain contraindications to performing all types of diagnostics of the rectum. They must be taken into account and notified to the attending physician before the diagnosis.

These contraindications include:

• severe bleeding;
• pulmonary insufficiency;
• diseases of the circulatory system;
• development of paraproctitis or hemorrhoids;
• muscle spasm of the anus;
• pain in the rectal area.

An examination will help determine the cause of the pathology, after which the doctor will be able to prescribe the appropriate treatment to eliminate painful symptoms diseases. In such cases, the proctologist can also choose the most suitable way preparing for another instrumental examination rectum.

As soon as the doctor has all the test results in his hands, he, having made an accurate diagnosis, will be able to prescribe best method therapy. It will also allow you to assign preventive actions that will protect the patient from possible relapses diseases.

How to prevent the development of proctological diseases

To prevent the development of proctological diseases, you need to take some preventive measures:

The need for examination and treatment of the rectum may disappear on its own if you regularly follow the above recommendations. In addition, they help to strengthen immune system therefore, you will have to go to the doctor with any disease much less often.

Video - How is the examination by a proctologist

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 must be held no later than 21 years of age.

Before a visit to the doctor, it is necessary to perform hygiene procedures, while it is not recommended to use deodorants, you should wash yourself ordinary 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).

Available at the pharmacy gynecological set, which, in addition to these items, includes tools for taking a smear (Ayre 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, past illnesses 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, enhanced 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 can be found 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 fibroids diagnosed? ectopic pregnancy, ovarian cysts, pregnancy, endometriosis and other pathologies. In some cases, inflammation can be detected 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 the intravaginal one, the indications for the procedure are the following situations:

• 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 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, the endometrium of the uterus, the size and shape of the ovaries, fallopian tubes. is prescribed for polycystic, ovarian apoplexy.

If there is suspicion of cancerous tumor, 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 you're worried inflammatory diseases 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.