A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye).
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Anal region/anal canal [redness?, swelling, nodule?, lobule?, prolapsed tissue?, prallelastic nodule perianally (usually pinhead- to plum-sized), bluish-red; at anal margin or in anal canal?, blood?, ulcer in anoderm (ulcer in anal mucosa area)?]
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Digital rectal examination (DRU): examination of the rectum (rectum) in relation to sphincter function (sphincter function):
- At rest and under pinch the sphincter ani internus muscle.
- When actively pinching, the puborectal sling, the sphincter ani externus muscle, as well as the pelvic floor and anal canal length.
Palpating the anal verge/after area (documentation of findings according to clock time position) Furthermore, the examination of adjacent organs with the finger by palpation [anorectal diseases such as tumors, anal or rectal prolapse (prolapse of the rectum) or rectoceles / ejection of the anterior wall of the rectum into the vagina].
- Inspection (viewing).
- Cancer screening
Examination findings and their differential diagnoses.
Findings | Differential diagnosis |
Redness |
|
Swelling | |
Node, lobule | |
Prolapsed tissue |
|
Weak sphincter tone |
|
Cramped sphincter muscles or painful palpation. |
|
Blood |
|
Pain |
|