EXAMINATION OF THE ANUS

EXAMINATION OF THE ANUS

Careful clinical examination will be diagnostic in the vast majority of patients complaining of anal symptoms, but it requires a relaxed patient who is informed of what the examination will entail, a private environment, a chaperone (for the security of both parties) and good light. Most commonly , the patient is examined in the left lateral (Sims) position with the buttocks overlying the edge of the examination couch and with the axis of the torso crossing, rather than parallel with, the edge of the couch. Alternatively , in younger patients, the prone jack-knife or knee–elbow positions may be used ( Figure 80.3 ). Some units with access to a gynaecology couch may place the patient supine with legs in stirrups. The examining couch should be of su ffi cient height to allow easy inspection and access for any necessary manoeuvres. Personal protective equipment should be worn.