What is the proper description of a peri-rectal (perirectal) examination?

From the Guidelines

A proper perirectal examination involves a systematic assessment of the anal and rectal areas, including a digital rectal examination, to identify abnormalities and diagnose anorectal conditions, as suggested by the WSES-AAST guidelines 1. To perform a perirectal examination, the patient should be positioned in a comfortable and accessible position, such as the left lateral decubitus position with knees flexed toward the chest, lithotomy position, or prone with buttocks slightly elevated. The examination should begin with a visual inspection of the perianal area for external abnormalities, such as hemorrhoids, fissures, fistulas, or skin tags, as recommended by the guidelines 1. The digital rectal examination is a crucial part of the perirectal examination, and it should be performed by lubricating the index finger and slowly inserting it into the rectum, while assessing anal sphincter tone and palpating all quadrants of the rectum for any masses, tenderness, or irregularities 1. Key aspects of the examination include:

• Positioning the patient in a comfortable and accessible position
• Visual inspection of the perianal area for external abnormalities
• Digital rectal examination to assess anal sphincter tone and palpate the rectum
• Evaluation of the prostate gland in males
• Examination of the glove for blood, mucus, or stool characteristics after withdrawal The perirectal examination is essential for diagnosing anorectal conditions, assessing sphincter function, screening for rectal masses, and evaluating pelvic floor disorders, as emphasized by the guidelines 1. It is also important to note that the examination should be performed gently to minimize discomfort while obtaining comprehensive clinical information, and that laboratory and radiological studies may not be necessary for the diagnosis of an anorectal abscess, but can be useful in specific situations, as suggested by the guidelines 1.

From the Research

Peri-Rectal Examination Description

• A peri-rectal examination, also known as a perirectal examination, is a medical procedure used to assess the rectal area and surrounding tissues 2.
• The examination may involve a digital anal rectal examination (DARE), which is a mildly invasive procedure that can be used to detect anal cancer and other abnormalities 2.
• The purpose of a peri-rectal examination is to evaluate the rectal area for signs of infection, inflammation, or other conditions, such as perirectal abscesses or fistulas 3, 4, 5.
• The examination may be performed in conjunction with imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), to provide a more comprehensive assessment of the rectal area and surrounding tissues 3, 4, 5, 6.

Key Findings

• Perirectal abscesses are uncommon in colorectal cancer, but can make surgical resection and preoperative treatment difficult 4.
• CT scans can be used to diagnose perirectal abscesses, but may lack sensitivity, particularly in immunocompromised patients 6.
• DARE can be a useful tool for detecting anal cancer and other abnormalities, but its sensitivity and specificity are not well established 2.
• Peri-rectal examinations may be used in conjunction with other diagnostic tests, such as colonoscopy or biopsy, to provide a definitive diagnosis and guide treatment 3, 4.