Rectal Examination of an Older Adult

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You are about to perform a rectal examination of an older adult.

  • What are the steps to examine this patient?
  • Explain your rationale.
  • What are some findings you can have while assessing the rectal sphincter?
  • Describe the differences during the rectal examination of acute prostatitis and benign prostatic hypertrophy.
  • What findings would expect on physical examination of acute prostatitis and benign prostatic hypertrophy?
  •  Your initial post should be at least 500 words, formatted and cited in proper current APA style with support from at least 3 academic sources.

rectal examination of an older adult

Performing a Rectal Examination of an Older Adult

Steps for Rectal Examination

  1. Patient Preparation:
    • Explain the Procedure: Before starting, explain the purpose and steps of the rectal examination to the patient. This helps alleviate anxiety and gain informed consent.
    • Positioning: The patient can be positioned in different ways, depending on comfort and preference. The left lateral (Sims) position with the knees drawn up to the chest, the standing position with the patient bent over, or the lithotomy position are commonly used in older adults.
    • Privacy and Dignity: Ensure the patient’s privacy by draping them adequately and maintaining a respectful demeanor.
  2. Inspection:
    • Visual Examination: Begin with an inspection of the perianal area for abnormalities like hemorrhoids, fissures, skin tags, inflammation, or rashes.
  3. Digital Rectal Examination (DRE):
    • Lubrication and Glove Use: Don gloves and apply a water-soluble lubricant to the index finger.
    • Digital Insertion: Gently insert the finger into the rectum. Instruct the patient to take a deep breath and relax to ease insertion.
    • Rectal Wall Palpation: Assess the tone of the rectal sphincter, any masses, and the texture of the rectal walls.
    • Prostate Examination (in males): Rotate the finger anteriorly towards the prostate gland and assess its size, shape, consistency, and tenderness.
  4. Documentation and Explanation: After completing the examination, document findings and explain them to the patient, especially if follow-up or treatment is needed.

Rationale for Rectal Examination

  • Screening for Colorectal Pathology: A rectal examination helps identify abnormalities in the lower gastrointestinal tract, such as rectal masses, tumors, or inflammation.
  • Prostate Health: In males, DRE is crucial for assessing the prostate for conditions like benign prostatic hypertrophy (BPH), prostatitis, or prostate cancer.
  • Assessment of Rectal Tone: In both genders, it evaluates the tone of the anal sphincter, which is important for identifying neurological or muscular issues such as incontinence.

Findings While Assessing the Rectal Sphincter

  • Normal Sphincter Tone: A normal sphincter should contract evenly and provide some resistance upon palpation.
  • Increased Sphincter Tone: This may indicate conditions like anxiety, anal fissures, or localized inflammation.
  • Decreased Sphincter Tone: Commonly observed in older adults or patients with neurological conditions such as spinal cord injury, multiple sclerosis, or after childbirth, indicating potential incontinence risk.

Differences Between Acute Prostatitis and Benign Prostatic Hypertrophy (BPH) in Rectal Examination

  • Acute Prostatitis:
    • Rectal Exam Findings: The prostate is often tender, warm, swollen, and soft or boggy to the touch.
    • Symptoms: The patient may report pain, especially during DRE, and may also have systemic symptoms such as fever, chills, dysuria (painful urination), and pelvic discomfort. Acute prostatitis is often associated with bacterial infections, with accompanying urinary symptoms like frequency and urgency.
  • Benign Prostatic Hypertrophy (BPH):
    • Rectal Exam Findings: The prostate feels enlarged but non-tender, smooth, and firm. It may feel symmetrically enlarged, often described as “rubbery.”
    • Symptoms: BPH primarily presents with lower urinary tract symptoms (LUTS) such as urinary hesitancy, weak stream, nocturia, and incomplete bladder emptying. It is a non-inflammatory condition related to aging and androgenic changes in the prostate.

Expected Findings on Physical Examination

  1. Acute Prostatitis:
    • Prostate: Tender, warm, swollen, and boggy upon palpation.
    • Perineal Discomfort: Pain may be referred to the perineum or back.
    • Systemic Signs: Fever, malaise, chills, and signs of systemic infection are common.
    • Urinary Symptoms: Dysuria, urinary frequency, urgency, and sometimes urinary retention.
  2. Benign Prostatic Hypertrophy (BPH):
    • Prostate: Enlarged, smooth, and firm with a rubbery consistency. The enlargement is symmetrical without tenderness.
    • Urinary Symptoms: Urinary retention, weak stream, nocturia, and frequent urination.
    • No Systemic Symptoms: BPH does not present with systemic signs of infection or inflammation.

Conclusion

A rectal examination in older adults serves as a critical diagnostic tool for assessing colorectal health, prostate conditions, and rectal tone. In male patients, DRE helps differentiate between conditions like acute prostatitis, which is associated with tenderness and infection, and BPH, where the prostate is enlarged but non-tender. Understanding these differences informs clinical management and guides treatment options.

References

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