Anus, Rectum

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Anus, Rectum Prostate Assessment

• Week 9

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Structures of the Anus Rectum
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Anatomy of the Prostate Gland and Seminal Vesicles
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Anatomy of the Female Internal Genitalia
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A P Dev. Considerations

• Infant passes stools by reflex until 1½ - 2 yrs  
• Wave of peristalsis called gastrocolic reflex
• At puberty prostate ? rapidly ?2x previous size
• Prostate starts to enlarge during middle adult
  years Benign Prostatic Hypertrophy present in
  110 males at age 40 ?s with age
• Thought its due to hormonal imbalance leading to
  growth of benign adenomas, which gradually
  obstruct urethra urine output.

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Transcultural Considerations

• Prostate cancer more common in North America
  northwestern Europe, is rare in Central South
  America, Africa Asia
• Incidence rates 50 higher in Black-Americans
  than other racial groups
• Mortality rates 2x higher for blacks than whites
• Black-Americans highest incidence rates in world
  cause unknown inherited predisposition could
  account for 5 10 of prostate cancers dietary
  fat may also be factor.

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Subjective Data Collection

• Usual bowel routine
• Change in bowel habits
• Rectal bleeding, blood in the stool
• black or tarry stool called MELENA blood from
  higher in GI tract
• Rectal conditions
• Family history
• Self-care behaviours
• Medications.

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Objective DataThe Physical Exam
Anus, Rectum, and Prostate

• Preparation
• Position
• Equipment needed
• Penlight
• Lubricating jelly
• Glove
• Guaiac test container

Slide 25-5
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Inspection

• Perform rectal exam on all adults, particularly
  those in middle late years
• Position male (L) side or standing, female in
  lithotomy then move to (L) side drape
  appropriately
• Inspect perianal area
• Inspect sacrococcygeal area
• Ask client to perform Valsalva maneuver nothing
  should protrude
• Use clock face to describe location of lesion
  around anus

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Palpation

• Place pad of index finger gently against anal
  verge should feel anus tighten then relax
• Flex tip of finger slowly insert into anal
  canal in direction of umbilicus
• Rotate examining finger to palpate entire
  muscular ring - examine sphincter muscle tone
• Use thumb forefinger to palpate perianal tissue
  assess for swelling tenderness, assess
  bulbourethral glands
• Insert finger further to examine rectal wall -
  normally feels smooth with no nodularity .

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Palpation of the Anus Rectum
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Developmental Considerations of Aging Adult

• When aging person performs valsalva may note
  relaxation of perianal musculature decreased
  sphincter control
• Exam same as previously described.

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Abnormal FindingsAnus and Perianal Region
Anus, Rectum, and Prostate

• Pilonidal cyst or sinus
• Hemorrhoids

Slide 25-9
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Abnormal Findings Pilonidal Sinus Hemorrhoids
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Abnormal FindingsRectum
Anus, Rectum, and Prostate

• Rectal polyp
• Fecal impaction

Slide 25-10
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Polyps Impaction
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THE END