How to conduct anal finger examination?

It is worth noting that about 85% of the cases of delayed diagnosis of rectal cancer are due to the absence of anal finger examination, and some people touch the anus with their fingers, that is, anal finger examination, which is a simple and important anorectal examination method, because many anorectal diseases can only be found early through anal finger examination, for example, 80% of rectal cancer can be found during anal finger examination. It is worth noting that about 85% of the cases of delayed diagnosis of rectal cancer are due to the lack of anal finger examination, and some even lost the opportunity of surgery, which deserves the attention and vigilance of both doctors and patients. The examination method is: the examiner wears a finger cuff on his right index finger and applies a lubricant (usually soap, liquid paraffin or vaseline) to facilitate his insertion into the anus and reduce the discomfort of the patient. First check the skin around the edge of the anus. If there is redness, tenderness and lump, it often indicates perianal abscess. There is tenderness in the middle before and after, which often suggests that there may be anal fissure. You can further open the anus to see if there is anal fissure. There is a rupture outside the anal margin, and there is a cord under the skin leading to the anus, often an anal fistula. After the examination around the anal margin, gently massage the anal margin with the index finger of the right hand, and instruct the patient to take a deep breath to reduce abdominal pressure and relax the sphincter, and then slowly extend the index finger into the rectum; If you suddenly insert your finger into the anus, the sphincter will spasm due to sudden stimulation, which is not only difficult to insert, but also painful. The content and significance of anal digital diagnosis are as follows: 1. First of all, check the tightness of anal sphincter and anorectal ring. The anorectal ring consists of internal and external sphincter and the upper edge of puborectal muscle. Around the junction of anal canal and rectum, the internal and external sphincter are annular, while the puborectalis muscle only exists on the back and sides. Therefore, it is not easy to touch the front of anal canal during anal digital diagnosis. When the anal sphincter and anorectal ring are normal, the index finger can extend into the anus smoothly. If the index finger is difficult to pass or can't pass, the anus has different degrees of stenosis, and if the anal sphincter is too loose, anal incontinence may appear. 2. Check whether there is tenderness, pulsation and lump in and around the anorectal wall, and pay attention to the size, hardness and mobility of the lump. For tumors with higher position, anal digital diagnosis can be performed in squatting position or lithotomy position. These two positions can make the tumor move down, and rectal cancer can be detected at a higher position. If necessary, double needle examination of rectum and abdomen or double needle examination of rectum and vagina can provide valuable information on the scope of cancer invasion; 3. On the anterior wall of rectum, men can touch the prostate and women can touch the cervix, which should not be mistaken for pathological masses; 4. Pull out the finger after the inspection, depending on whether the finger sleeve is stained with blood or mucus, and make a smear check if necessary. Several common anorectal diseases that can be touched during anal digital examination: 1. Rectal cancer: uneven lump can be touched on the intestinal wall, the surface can be ulcerated, the intestinal cavity is often narrow, and the finger cuff is often stained with pus and mucus. 2. Rectal polyp: a soft and pushable lump can be felt, and blood is often stained on the finger sleeve. 3. Internal hemorrhoids: Generally, internal hemorrhoids are soft, and even if you touch them, you can't tell the size and quantity. However, if there is thrombosis, they can feel smooth induration. 4. Anal fistula: the umbilical cord can be felt, and sometimes there is a small induration or depression in the anal fistula. 5. Perirectal abscess: pelvic-rectal abscess and retrorectal abscess. A tender lump with a smooth surface can be felt in the rectum. Other interstitial abscesses can be palpated with thumb and forefinger, that is, the forefinger is placed in the rectum, and the thumb is placed on the perianal skin. Thumb and forefinger palpation can find deep anal abscess, ischial rectal abscess or perianal abscess. 6, anal papilloma: can touch the medium texture and can promote, long stem tumor, clean fingertips. Because finger examination plays such an important role, all doctors who perform surgical examination in the People's Physical Examination Center will touch the anus deeply and carefully to avoid missed diagnosis and misdiagnosis. Patients may feel uncomfortable, but please be sure to cooperate. Clinically, patients who don't realize the significance of finger examination not only refuse to cooperate, but also complain that they will never do this examination again. Fortunately, in recent years, more and more patients are aware of this, often take the initiative to ask for finger examination, and will come regularly.