Digital examination with the index finger

Digital examination with the index finger

With an adequately lubricated index finger, the soft tissues around the anus are palpated for induration, tenderness and subcutaneous lesions. The index finger is then introduced gently into the anal canal along its posterior aspect. At the apex of the canal, the sling of puborectalis is felt posteriorly; supralevator induration feels bony hard and is more easily appreciated if unilateral. The posterior surface of the prostate gland with its median sulcus can be palpated anteriorly in male patients; in female patients, the uterine cervix can be palpated. The presence of any distal intrarectal, intra-anal or extraluminal mass is recorded. Sphincter length, resting tone and voluntary squeeze are assessed. On withdrawal, the examining finger is inspected for the presence of mucus, blood or pus and to identify stool colour.

(b) (c) Figure 80.3 (a) The left lateral, (b) knee–elbow and (c) lithotomy positions for examination. (Redrawn with permission from Mann CV. Surgical treatment of haemorrhoids . London: Springer, 2002.)