Post on 05-Jan-2016
Examining for rectal prolapse• Most NOT evident in lying position as rest• Ask patient to bear down – most still not
evident• Need to examine after straining on the
toilet for 1-2 minutes – lean forward – observe from behind – estimate in centimetres - ? full thickness circumferential, or partial mucosal only?
Ano-rectal digital examination• Resting tone (low = IAS problem)
• Squeeze pressure (low = EAS problem)
• Co-ordination
• Pubo-rectalis (pelvic floor function)
• Sensation (? Neurological dysfunction)
• Assessment stops here for MOST patients
Abdominal transit study• Patient takes 20
radio-opaque markers on 3 consecutive days
• Attends for plain abdominal X-ray on day 6
• 80% of markers should have been passed
• Can distinguish slow whole gut transit from rectal outlet delay
Assessment
• Most can be done by a nurse
• Takes time (we allow 1 hour in my clinic)
• Remember how embarrassed most patients will be
• Many patients have more than one cause (especially older people)
• If you find the cause, you often know how to treat
Website: www.bowelcontrol.org.uk