Anal Discomfort (Anorectal Pain): Examination

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].

• Cancer screening

Examination findings and their differential diagnoses.