Examination of the Rectum and Prostate

by Stephen Holt, MD, MS

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    00:00 Okay, so now we can proceed with the rectum exam and the prostate exam. "What I like to do Jeff when I'm getting ready to perform this exam with the patient is just to orient him on what I'm doing. First off, we'll perform an external exam taking a look at the anus itself and looking for hemorrhoids, that sort of thing." So this is just a model demonstrating the normal prostate versus a prostate that may be enlarged or have cancer in it. This is the normal size of the prostate and you can see that it has a left and a right lobe with a subtle fissure between the 2 sides. Someone with benign prostatic hypertrophy would have a dramatically enlarged prostate but would have approximately the same consistency compared with someone with prostate cancer may have an enlarged and very firm, very hard, metastatic tissue with inside of it. More subtle findings would be in this case this particular model has a normal prostate in the left but then a smaller, raised in size, rock-hard nodule buried within the prostate. So this is why we're doing exam in the kinds of things that we're looking for.

    00:59 The normal consistency of the prostate should feel kind of like the space between the back of your hand between your thumb and your first finger. It's soft, it's plushy, but still has some firmness to it compared with the knuckle of your thumb which is clearly very rock hard, and that's what a prostate cancer whether a small one or a large one would feel like. "Okay." "So with that, if you wouldn’t mind, Jeff, just facing towards the wall and putting your elbows down on the bed. And I'm going to start with external inspection here and you can use the backs of your hands to sort of separate the buttocks. Jeff, you're going to feel me touching the outside of your buttocks now." So separating here, we're looking at the anus itself and looking at if there's some extra tissue here at the upper part of the anus which will be consistent with some hemorrhoids that are not dilated at present. Also, you might see skin tags in that area and patient who has an active hemorrhoid would have a very swollen and oftentimes violaceous in appearance, painful, tender area in that area which I'm not seeing in this case. You'd also be looking for any evidence of genital warts or in this case anal warts, which we're not seeing either. So, having completed the external part of the exam, I'm now going to do the digital rectal exam. Of course, after doing the genital exam, I've already washed my hands and changed gloves, and now I'm going to put some lubrication jelly on my finger. So, generously lubricating my finger. "Okay now you're going to feel me again. I'm going to spread your buttocks here and I'm going to insert my digit into the anus, like so. And I'm feeling for any lesions within the rectal vault and now I'm palpating the prostate itself looking for the signs that I mentioned before. And that's it. I'm going to withdraw my finger. All set. You can now stand up again, Jeff." With any stool that I may found on my finger, I would then use a hemoccult slide to look and see if there's any evidence of blood in the stool. And that would conclude the rectal exam.

    About the Lecture

    The lecture Examination of the Rectum and Prostate by Stephen Holt, MD, MS is from the course Examination of the Male and Female Genitourinary System.

    Included Quiz Questions

    1. A hard, firm nodule
    2. Tenderness on palpation
    3. A boggy, soft tissue
    4. Soft tissue that is enlarged
    5. An indentation between the left and right lobes of the prostate
    1. External hemorrhoid
    2. Anal wart
    3. Anal cancer
    4. Skin tag
    5. Benign nevus

    Author of lecture Examination of the Rectum and Prostate

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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