What physical exams should a doctor perform at 6-month check-ups for a 50-year-old male patient with Crohn's disease, chronic pelvic pain, and Benign Prostatic Hyperplasia (BPH)?

From the Guidelines

A comprehensive 6-month check-up for a 50-year-old male with Crohn's disease, chronic pelvic pain, and BPH should include several targeted physical examinations, prioritizing a digital rectal examination to evaluate prostate size, consistency, and tenderness, as well as assessments for Crohn's disease and chronic pelvic pain. The doctor should perform a complete abdominal examination to assess for tenderness, masses, or distention related to Crohn's disease, including careful palpation of all quadrants and listening for bowel sounds 1. A digital rectal examination is essential to evaluate prostate size, consistency, and tenderness, which helps monitor BPH progression and rule out prostate cancer, as recommended by the AUA guideline on management of benign prostatic hyperplasia 1. The physician should conduct a focused musculoskeletal and neurological examination of the pelvic region to identify potential sources of chronic pelvic pain, including assessment of the lower back, hips, and pelvic floor muscles. Vital signs including blood pressure, heart rate, temperature, and weight should be documented to track overall health and medication effects. The doctor should also perform a thorough skin examination to check for extraintestinal manifestations of Crohn's disease such as erythema nodosum or pyoderma gangrenosum, as suggested by the SFED recommendations for IBD endoscopy during the COVID-19 pandemic 1. These examinations are important because they help detect disease progression, medication side effects, and complications before they become severe, allowing for timely intervention and treatment adjustments, in line with the principles outlined in the AUA guideline on erectile dysfunction 1 and the WSES-AAST guidelines for anorectal emergencies 1. Additionally, the physician should consider the patient's medical history, including the presence of Crohn's disease, and perform a thorough anorectal examination, including a digital rectal examination, to assess for anorectal abscesses or other complications, as recommended by the WSES-AAST guidelines 1. The use of cross-sectional imaging, such as bowel ultrasonography or MRE, may also be considered to assess disease activity and complications in patients with Crohn's disease, as suggested by the SFED recommendations 1. Overall, a comprehensive physical examination, including a digital rectal examination and assessments for Crohn's disease and chronic pelvic pain, is essential for monitoring disease progression and guiding treatment in a 50-year-old male with Crohn's disease, chronic pelvic pain, and BPH.

From the Research

Physical Exams for 50-year-old Male with Crohn's Disease, Chronic Pelvic Pain, and BPH

At 6-month check-ups, the doctor should perform the following physical exams:

• Abdominal examination to check for tenderness, masses, or other abnormalities in the abdominal region 2
• Pelvic examination, including manual inspection (per rectum) of the pelvic floor to assess for any abnormalities or tenderness in the pelvic region 3, 4
• Musculoskeletal examination to assess the abdominal and lower extremities muscles for any pain or dysfunction 3
• Neurological examination to assess for any neurological symptoms or abnormalities, such as pain or numbness in the lower extremities 4
• Visceral examination to assess the organs in the abdominal and pelvic regions, including the liver, kidney, and bladder 4

Specific Exams for Chronic Pelvic Pain

The doctor may also perform the following exams to assess chronic pelvic pain:

• Manual therapy of the lumbopelvic hip complex and manual therapy per rectum to assess for any pain or dysfunction in the pelvic region 3
• Assessment of the musculus ischiocavernosus, puboanalis, pubococcygeus, iliococcygeus, coccygeus, and canalis pudentalis seu Alcocki to check for any pain or tenderness in these muscles 3

Exams for Crohn's Disease

The doctor may also perform the following exams to assess Crohn's disease:

• Endosonographic examination to evaluate inflammatory changes in the lower pelvic region and to detect any fistulas or abscesses 5
• Abdominal examination to check for any tenderness, masses, or other abnormalities in the abdominal region 2

Exams for BPH

The doctor may also perform the following exams to assess BPH:

• Digital rectal examination (DRE) to assess the size and consistency of the prostate gland 2
• Assessment of urinary symptoms, such as frequency, urgency, or weak stream 2