Colorectal exam: what it is
A colorectal examination is an essential diagnostic step in case of symptoms that may be attributed to intestinal problems or disorders in the anorectal area. Those suffering from anal fissures, hemorrhoids, incontinence or any symptom that is believed to be a colorectal disease must see a specialist as soon as possible.
Many people, though, are frightened at the thought of having a colorectal examination and tend to put it off, risking that the condition could worsen.
Colorectal exam: preparation
Since the medical test includes inspection of the anorectal canal, the patient may be asked to have an enema the day before the appointment and about 2 hours before the examination.
The enema allows any fecal material remaining in the anorectal canal to be removed and thus allows the specialist to have a proper view of the area. Enemas are sold in small, ready-to-use containers that are available in all drug stores and pharmacies.
However, in specific cases an enema is not indicated since it could alter the results of the cytological examination so check with your doctor for complete instructions prior the exam.
Stages of a colorectal exam
A colorectal examination is performed in stages to allow the specialist to identify existing problems around the anorectal area and if necessary, prescribe further testing.
The more relaxed the patient is, the less discomfort he or she will experience and the easier it will be for the physician to examine the area and provide a proper diagnosis.
At the start of the exam, the physician can identify any condition that might make it difficult for the patient to continue with the exam (such as pain on palpation) and the physician may postpone the rectal examination to another time after the initial symptoms have been treated.
We encourage you not to be nervous or scared about going for a colorectal exam. Just try to relax.
The 5 stages of a rectal exam are:
- Medical history: before starting the actual examination, the physician will take a medical history, i.e. carry out an in-depth interview with the patient.
During this stage the specialist will ask the patient:
- to describe any symptoms or conditions he is suffering from
- when the symptoms started and how often they occur
- any family history of anorectal problems
- about any treatments or previous surgery for the problem
- Observation: following the medical history, the specialist must first observe the area around the anus to identify any problems that can be seen externally. This way the physician is able to perform an initial non-invasive assessment and identify any problems visible at this stage.
After the observation stage and depending on the patient’s symptoms, the specialist assesses whether it is possible to proceed with the next steps.
- Palpation: during palpation the specialist lays a finger on the area around the anus to check how it feels to the touch and identify any problems.
Through observation and later palpation, the physician may also identify anal fissures, hemorrhoids or other problems that might make further examination painful. In such cases, the specialist will stop the examination and postpone it until after the pain symptoms have been treated.
- Rectal exploration: after palpation, the physician performs a digital examination (DRE) by placing a well-lubricated finger into the anus.
During the rectal exploration, the specialist can better assess any diseases and verify how the sphincter muscles contract and relax. At this stage the physician may ask the patient to contract the anorectal area as though they were straining to empty their bowels.
If there are any symptoms that might make the specialist suspect improper functioning of the sphincters, he or she will request further tests such as anorectal manometry and/or Endo Anal Ultrasound.
- Rectoscopy and anoscopy: the last stage involves a thorough examination of the anorectal area with the aid of a rectoscope. With the rectoscope, the specialist can view the anal canal and the lower part of the rectum. During these examinations it is also possible to perform a biopsy or other outpatient procedures for any problem in the anorectal area.
With anoscopy it is possible, for example, to assess problems with internal hemorrhoids and make a diagnosis of the grade of the disease, while rectoscopy allows identifying tumors in the lower rectum.
For the diagnosis of cancer in the anus and in the lower rectum, there is also a special examination called High-Resolution Anoscopy (HRA). This test allows the physician to view suspicious lesions with high precision and perform a biopsy immediately.
For further information about High-Resolution Anoscopy and traditional Anoscopy, please consult the page Rectoscopy and Anoscopy.