Anus, Rectum and Prostate

Nursing 330

Governors State University

Shirley Comer

Relevant History

Usual bowel habits Change in habits Rectal bleeding Blood in stool Medication Hemorrhoids Pruritus Family hx Diet Hx colon disease Last rectal exam Last PSA (men)

Anus & Rectum Anatomy

Inspect Perianal Region

Anus– Normally moist and hairless (hair=pilonidal cyst?)– Coarse folded highly pigmented skin– Anal opening tightly closed– Hemorrhoids are shiny blue sacs– Fissure is a split in skin– Fistula is an opening to skin– Prolapsed is a red doughnut shaped tissue

Palpate Anus and Rectum

Use lubricant and glove Insert index finger into anus and rotate to

palpate rectal wall Anal sphincter may resist- touch and let relax

then insert finger Assess

– Decreased tone– Lesions, masses, hemorrhoids

Palpate Prostate Gland

In men only Located anteriorly Assess

– Size- 2.5 cm to 4 cm– Shape- heart shaped and smooth– Consistency- elastic, rubbery– Mobility- sl moveable– Sensitivity- nontender

Prostate exam

Benign Prostatic hypertrophy

Occurs in older men – no specific age Gland enlarges and remains smooth Impairs urination

– Must stand– Difficulty initiating a stream

May impair sexual function Any hard irregular nodules may indicate cancer

Pix enlargement

Fecal Exam

Inspect and feces on glove for blood or other discharge Test feces for Occult blood using hemacult slide Occult blood may indicate colon cancer Bright red bleed in indicates rectal bleeding Black tarry stools indicate upper GI tract bleeding Gray, tan or clay stool indicates absent bile Yellow or greasy stool indicates malabsorption of fat Jelly like mucus indicates inflammation Iron tablets = green/black sticky stool

Practice Exam Question

You 65 yo female pt just had a bowel movement with a few drops of bright red blood. You assess her rectum and find moderately large hemorrhoids but no masses or lesions. You notify the Primary HCP but what do you suspect causes the blood?

A. Colon cancer B. upper GI bleed C. Hemorrhoids D. iron tablets

Rationale

C is the correct answer. The hemorrhoids are the most likely source of the blood

A is a possibility and occult blood specimens should be ordered by PHCP

B is unlikely as Upper GI bleeds result in black tarry stool

D. iron tablets generally cause the stool to turn green/black and sticky