Finger rectal examination

Digital examination is a mandatory part of a proctological examination, the diagnostic value of which is difficult to overestimate. Emphasizing the importance of this method, V. M. Mysh wrote: "The area of diagnostic possibilities of rectoscopy is limited to diseases of the intestine itself, whereas digital examination through the rectum is an exceptionally valuable and widely available method of examining both the intestine itself and a number of adjacent organs." The digital examination method is of particular importance in the diagnosis of rectal cancer.

It is known that the diagnosis of rectal cancer can be made based on a single digital examination in 80-85% of cases, and it is possible to determine the exophytic or endophytic growth of the tumor, the degree of its displacement, the distance from the anus, and the narrowing of the intestinal lumen. In addition to examining the rectum, the condition of adjacent organs is determined (the prostate gland in men, the cervix and the posterior surface of the uterus in women).

The results of digital rectal examination (DRE) are the basis for drawing up a plan for further examination of a patient with suspected chronic prostatitis. The method is valuable not only for its simplicity and accessibility, but also for its fairly high information content.

There are 3 positions in which a rectal examination of the prostate is performed:

1. on the right side with the knees drawn up to the stomach. This position is most convenient when examining elderly and weakened patients;
2. traditional, knee-elbow position;
3. in the position of the subject standing with the torso bent forward.

During palpation of the prostate, the index finger of the right hand (with a rubber glove or finger cot) is lubricated with Vaseline and inserted with a light movement into the anus, where the lower pole of the prostate gland is felt at a distance of 4-5 cm. Carefully sliding the finger over the surface of the prostate, its contours, size, shape, consistency, sensitivity, and the state of the interlobar groove are assessed.

The unchanged prostate is compared in size and shape to a small chestnut with its rounded top facing downwards. Usually, a finger can easily reach the upper border of the unenlarged prostate. Normally, two lobes of the prostate are distinguished by palpation, between which an interlobar groove is clearly expressed. The average size of each lobe is 14 x 20 mm, their surface is smooth, their consistency is elastic, and their borders are clear. The mucous membrane of the rectum over the lobes of the prostate is easily displaced.

Our own clinical experience and the opinions of numerous authors indicate that there is a relationship between the clinical stage of chronic prostatitis and changes in the prostate detected during digital rectal examination.

Stage I is characterized by an increase (sometimes significant) in size and swelling of the prostate gland, its pronounced soreness, and uniform, dense, elastic consistency. No areas of compaction or softening are defined at this stage. The boundaries of the gland may be unclear due to infiltration of the surrounding tissue.

For stage II of the disease, normalization of the prostate size, reduction of its pain, uneven consistency (alternating areas of compaction and softening) are more typical. Sometimes it is possible to palpate stones of the prostate gland, the boundaries of which are clearer at this stage. Due to the pronounced disruption of the structure and function of smooth muscle formations, the prostate gland can become flabby and atonic.

At stage III of chronic prostatitis the gland is reduced in size, usually painless; its consistency is dense; its borders are clear. The mucous membrane of the rectum above it is moderately mobile. After massage of the sclerosed gland, no secretion is released from it.

Even in a healthy person, finger pressure on the prostate is accompanied by unpleasant sensations radiating to the penis. In a patient with chronic prostatitis, the pain during palpation is significantly greater. The intensity of subjective sensations varies greatly among different people. All this must be taken into account by the doctor performing this diagnostic procedure.

Because of variations in the size, shape and consistency of the prostate, for a correct assessment of its condition it is necessary to compare these and other features of the left and right lobes, as well as the data obtained in the analysis of the secretion of the prostate gland. I. F. Yunda (1982) described the "sickle" symptom - sickle-shaped atrophy of the prostate. In androgen deficiency, the prostate takes the shape of a sickle, open upward, i.e. the upper segment of the prostate flattens and sinks, and the lower one in the form of a ridge, as it were, borders the formed depression from below. If the sunken part has a diameter of up to 2.5-3 cm - the "sickle" symptom is assessed as sharply positive (+++), i.e. the androgen function is reduced by about 3 times; up to 1.5 cm - positive (++) - the function is reduced by 1.5-2 times - if less - the initial "sickle" symptom (+) - a decrease in the reserve androgen function is observed.

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