Is it okay to skip the digital anal exam if you think it's too embarrassing or uncomfortable? Don't, because...

"Digital rectal examination is uncomfortable and embarrassing. Can it be skipped during the physical examination?"

Some friends think that digital rectal examination is a bit embarrassing, and feel that even if there is a disease in the relevant area, it can be detected by other methods, so there is no need to do this examination.

Rumor Analysis

This approach is not appropriate.

Digital rectal examination has its irreplaceable functions and advantages and is not recommended to be skipped.

There are many kinds of medical examinations that can help doctors diagnose diseases, but it must be admitted that some of them are not so comfortable and even embarrassing. Especially the digital rectal examination, many people even quietly ask to skip this somewhat embarrassing examination when doing a physical examination.

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But please don't forget that these tests have become routine items in hospital physical examinations because they are useful! For example, many friends only vaguely know that the digital rectal examination seems to be used to check for hemorrhoids and cancer, but the function of the digital rectal examination is far more than that. The digital rectal examination can identify many diseases of the anus, rectum and colon, and can intuitively distinguish certain digestive tract cancers from other diseases. Let's talk about it in detail below, and after reading it, you will realize the importance of this examination.

Differentiating between hemorrhoids and rectal cancer

Although hemorrhoids can form hemorrhoids, they are soft and will not form hard masses unless there is thrombosis. Thrombosis usually occurs outside the anus and can be easily identified with the naked eye. This is not the case with rectal cancer, which forms hard masses in the rectal cavity. During a digital rectal examination, doctors can directly feel the difference between rectal cancer and benign diseases. Therefore, as long as the fingers can reach the part, doctors can effectively distinguish between rectal cancer and benign diseases.

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Indirect detection of colon cancer

So, if the fingers cannot reach the places, does that mean digital rectal examination is powerless?

Not really.

Bleeding from colorectal cancer is caused by the presence of tumors. Regardless of whether you have a bowel movement or not, the tumor will bleed, and it will stay in the intestine for a while before being discharged, so the nature of the bleeding is old. It is worth mentioning that the location where colon cancer occurs is out of reach of fingers, but bleeding from colon cancer will remain on the finger cot used for examination. Therefore, for digital rectal examination, it is a very important step to observe whether the finger cot is stained with blood after the examination.

If there is blood on the finger cot, then the possibility of colon disease should be highly suspected, colon cancer is one of them, and some other diseases that cause colon bleeding can also cause "blood on the finger cot", which will also attract the attention of the doctor and arrange for more comprehensive examinations. Therefore, even if the fingers cannot reach the place, the digital rectal examination can also indirectly understand very important information.

Different diseases, different bleeding situations

The problem is, hemorrhoids and anal fissures can also cause bleeding, so how can digital rectal examination distinguish between colon diseases such as colon cancer and hemorrhoids and anal fissures?

It turns out that for benign diseases such as hemorrhoids and anal fissures, the bleeding will be discharged immediately, so the bleeding is "fresh blood". And usually the bleeding will only occur during defecation, and the bleeding will stop after defecation. This is because the rectal cavity pressure is high during defecation, and the pressure will drop immediately after defecation. More importantly, at the end of the digital rectal examination, hemorrhoids and anal fissures will not stain the finger cuff with blood, which makes it more valuable to observe the finger cuff after the examination. After all, once the finger cuff is found to be stained with blood, it means that there is a high possibility of new problems other than hemorrhoids and anal fissures.

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It is worth mentioning that the function of the colon and rectum is to store feces, so the characteristic is "large space". It is precisely because of this characteristic that colorectal cancer is difficult to detect in the early stage. After all, if the mass does not grow large enough, it is difficult to block the intestinal cavity and cause obvious symptoms. Therefore, if every hospitalized patient can perform a digital rectal examination according to the standard, more rectal cancers can be discovered as early as possible.

Deciding if an anal fissure requires surgery

Moreover, anal digital examination can also determine whether anal fissures require surgical treatment. Contrary to common sense and intuition, although anal fissures cause a "crack" in the anus, they do not make the anus more spacious, but instead cause anal stenosis. This is because there is a muscle called the "internal anal sphincter" around the anus. When anal fissures occur repeatedly, the ulcer surface (that is, the "crack") will stimulate the internal anal sphincter, causing the muscle to proliferate and thicken, eventually causing anal stenosis.

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Since the anus is narrowed, the stool will naturally become thinner, dryer, and difficult to defecate. To solve this problem, conservative treatment and surgical treatment can be adopted. After all, surgical treatment is a traumatic operation and needs to be done with caution. So how to judge whether surgery is needed? In fact, the standard is very simple, that is, to see if the patient's stool has become thinner. Of course, the doctor must perform a digital anal examination to determine whether there is anal stenosis. If the digital examination finds that the anal stenosis is obvious, then the effect of conservative treatment will not be very good, and surgery must be decisively chosen at this time.

Diagnosis of rectocele by digital examination

In addition to anal fissures, the diagnosis and further examination of rectocele also need to be performed based on the results of digital anal examination. Rectocele is a disease with a high incidence rate, but it is often ignored. As the name suggests, the rectum protrudes forward. When this happens, when defecating, although you try very hard, the stool goes in the wrong direction, and it is difficult to defecate despite trying hard.

The incidence of rectal prolapse is higher in women. The reason is very simple. The tissues around the rectum of men are relatively strong, while the vagina in front of the rectum of women is not strong enough. Especially during normal childbirth, the tissues between the rectum and the vagina will be damaged, which is more likely to cause rectal prolapse. In such cases, digital rectal examination can effectively detect abnormalities, but a series of examinations are required to confirm the final diagnosis.

In addition, for perianal abscesses, digital rectal examination can also determine the location of the abscess, which is also very helpful for doctors to judge the condition. After all, perianal abscesses may be located deep, and if they are not accurately judged before surgery, some minor troubles will be encountered during the operation.

In short, digital anal examination is a project that patients don't like and accept very much, but it is really useful. If your doctor recommends you to do a digital anal examination, please don't be shy or afraid, just listen to the doctor.

Looking in the mirror of rumors

In medicine, every test that has been tested and proven to be effective will be put into the doctor's "toolbox". If you really need to do a digital rectal examination, then you have to be patient for the time being... because the digital rectal examination will only cause a little discomfort, but the diseases that are missed may endanger your health.

Author: Sun Yifei, Director of the Medical Education History Research Office, Hebei Medical University

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association