1. Anus, Rectum, and Prostate
Chapter 25

2. Structure and Function
Subjective Data—Health History Questions
Objective Data—The Physical Exam
Abnormal Findings

3. Structure and Function
Anus and Rectum
Anal canal
Sphincters
Anal columns
Anorectal junction
Anal valve
Anal crypt
Rectum
Valves of Houston
Peritoneal reflection

4. Anus and Rectum

5. Structure and Function (cont.)
Prostate
Prostate gland
Position in pelvis
Lobes and median sulcus
Seminal vesicles
Bulbourethral glands
Regional structures
Sigmoid colon

6. Anatomy of the Prostate Gland and Seminal Vesicles

7. Subjective Data— Health History Questions
Usual bowel routine
Change in bowel habits
Rectal bleeding or blood in the stool
Medications (laxatives, stool softeners, iron)
Rectal conditions (pruritus, hemorrhoids, fissure, fistula)
Family history
Self-care behaviors (diet of high-fiber foods, most recent examinations)
Usual bowel routine: Bowels move regularly? How often? Usual color? Hard or soft? Pain while passing a bowel movement?
Change in bowel habits: Any change in usual bowel habits? Loose stools or diarrhea? When did this start? Is the diarrhea associated with nausea and vomiting, abdominal pain, something you ate recently?
Rectal bleeding, blood in the stool: Ever had black or bloody stools? When did you first notice blood in the stools? What is the color, bright red or dark red-black? How much blood: spotting on the toilet paper or outright passing of blood with the stool? Do the bloody stools have a particular smell?
Medications: What medications do you take—prescription and over-the-counter? Laxatives or stool softeners? Which ones? How often? Iron pills? Do you ever use enemas to move your bowels? How often?
Rectal conditions: Any problems in rectal area: itching, pain or burning, hemorrhoids? How do you treat these? Any hemorrhoid preparations? Ever had a fissure, or fistula? How was this treated?
Family history: Any family history of polyps or cancer in colon or rectum, inflammatory bowel disease, prostate cancer?
Self-care behaviors: What is the usual amount of high-fiber foods in your daily diet: cereals, apples or other fruits, vegetables, whole-grain breads? How many glasses of water do you drink each day?

8. Objective Data—The Physical Exam
Preparation
Position
Equipment needed
Penlight
Lubricating jelly
Glove
Guaiac test container

9. Rectal Examination Positions

10. Objective Data—The Physical Exam (cont.)
Inspection of the Perianal Area
Skin
Anal opening
Sacrococcygeal area
Valsalva maneuver

11. Objective Data—The Physical Exam (cont.)
Palpation of the Anus and Rectum
Palpation technique
Canal wall
Perianal tissue
Rectal wall

12. Objective Data—The Physical Exam (cont.)
Palpation of the Anus and Rectum (cont.)
Prostate gland
Size
Shape
Surface
Consistency
Mobility
Sensitivity
Examination of stool for occult blood

13. Sample Charting

14. Sample Charting (cont.)

15. Abnormal Findings Anus and Perianal Region
Pilonidal cyst or sinus
Anorectal fistula
Fissure
Hemorrhoids
Rectal prolapse
Pruritus ani

16. Pilonidal cyst or sinus

17. Anorectal fistula

18. Fissure

19. Hemorrhoids

20. Pruritis Ani

21. Abnormal Findings Rectum
Abscess
Rectal polyp
Fecal impaction
Carcinoma

22. Rectal prolapse

23. Abnormal Findings Prostate Gland
Benign prostatic hypertrophy (BPH)
Prostatitis
Carcinoma
Abscess
Rectal polyp
Fecal impaction

24. Which of the positions illustrated above would be appropriate for this examination on an adult male patient?
Left lateral
Lithotomy
Standing
Correct answer: C. Standing.

25. Which of the positions illustrated above would be appropriate for this examination combined with the pelvic examination on an adult female patient?
Left lateral
Lithotomy
Standing
Correct Answer: B. Lithotomy