Proctoscopy

Summary

Definition: proctoscopy is a visual examination of the lower rectum and anal canal using a short rigid tube with a light source, called a proctoscope. Haemorrhoids may be treated by injection or banding, and biopsies may be taken without pain if the lesion is above the dentate line.

Indications: detection of diseases of the rectum or anus, or investigation of rectal bleeding.

Procedure

PRE-PROCEDURE CONSIDERATIONS

1. ▪ Explain the procedure, including the reasons why you are doing it and the fact that it should cause only minor discomfort.

2. ▪ Check your equipment including light source.

3. ▪ Position the patient correctly in the left lateral position, hips flexed and buttocks extending over the edge of the examination couch.

4. ▪ Ensure adequate lighting.

5. ▪ Inspect the perianal skin for skin tags/lesions, fistula openings, fissures, perianal haematomas and rashes. Ask the patient to bear down and inspect for prolapse if symptoms are suggestive.

6. ▪ Perform a preliminary digital rectal examination to ensure nothing is blocking the rectum. (If this is too tender for the patient to tolerate, do not proceed to proctoscopy. Suspect a fissure or anorectal abscess, treat appropriately and review the patient after treatment, or arrange an urgent examination under anaesthetic if you suspect sinister pathology.)

PROCEDURE

1. ▪ Talk to the patient throughout, as their confidence and cooperation will be helpful.

2. ▪ Apply a generous quantity of lubricant to the tip of the proctoscope, holding the handle with your fingers gripping the handle and your thumb holding the introducer in place to keep the two parts of the instrument assembled.

3. ▪ Point the handle posteriorly.

4. […]