![]() ![]() This aspect is important particularly for distinguishing between perianal venous thromboses and prolapsed hemorrhoidal nodes, which is often difficult for examiners with little proctologic experience. By contrast, rectal diseases usually do not cause any pain, or only mild pain. PainĪs mentioned at the beginning, acute-onset pain indicates problems with the anoderm and in the perianal region, which are among the body’s most sensitive areas. Soiled underwear is a sensitive diagnostic tool in relation to seepage, incontinence, peranal bleeding, and pruritus ani. More severe problems include mucus secretion, which should always be asked about after cases of rectal and anal prolapse and incontinence however, a muciparous adenoma may also be present. A question about soiled underwear should therefore be included as a standard part of a proctologic patient history. Seepage is usually associated with pruritus ani (see below) and can be easily identified from moist underwear. Less worrying, although equally disturbing for the patient, is seepage, which may be evidence of incontinence or may occur with dermatological diseases such as perianal eczema. As chronic bleeding is often overlooked as such, clinical signs of anemia should be noted such as a pallid skin color and pale sclerae, as well as poor exercise tolerance. A distinction also needs to be made between blood deposits on feces (hemorrhoids, ulcer, rectal carcinoma), feces intermingled with blood (colitis, colon carcinoma), and purely peranal bleeding (diverticular bleeding, hemorrhoids). Light-colored blood is typically found with hemorrhoidal and fissural bleeding, as well as diverticular bleeding, whereas dark, coagulated blood is associated more with chronic inflammatory or neoplastic disease. However, there is often considerable overlap between the different types of bleeding, and this needs to be taken into account. In cases of bleeding, it is decisive to distinguish between acute bleeding (typical of perianal thrombosis, fissures, diverticula and hemorrhoids) and chronic bleeding (inflammatory and neoplastic conditions). Bleeding and seepageīleeding is always worrying for the patient, as it is associated with cancer and its intensity is usually overestimated. Targeted questions on the following areas should be put when the patient history is being taken: bleeding and seepage, pain, pruritus ani, and problems with continence or constipation. Taking a detailed and targeted patient history also gives the patient a sense of the physician’s competence and establishes the trust that is decisive for the subsequent clinical examination. These should include the following areas: bleeding and seepage, pain, pruritus ani, and problems with continence or constipation. In addition to allowing the patient to describe the symptoms freely, the history should also include targeted questions on various symptom complexes. For example, painful conditions, particularly with an acute onset, often affect the highly sensitive anoderm, and a diagnosis of anal fissure is likely if pain first occurs after defecation and has an intense and sharp quality. Many proctologic diseases show typical clinical findings that can be noted when the patient’s history is being taken and make it much easier to establish the diagnosis. Taking a detailed proctologic history is essential for establishing a trusting physician–patient relationship, and it is also the most important pillar of diagnosis. Additional examinations are reserved for specific problems and are discussed along with the relevant clinical pictures ( Fig. The latter includes a digital rectal examination and proctoscopy/rectoscopy. This first section explains the basic techniques used in a proctologic examination, which - as in any type of clinical picture - provide the basis for successful subsequent treatment.īasic proctologic diagnosis includes taking a detailed patient history, followed by clinical and machine-aided diagnostic work-up. The aim of this series of articles on proctology is to provide the necessary proctologic information, although limited to the most frequent disease pictures. However, relevant findings often remain hidden in routine flexible endoscopy examinations, as they can only be adequately assessed using rigid endoscopy. ![]() Many proctologic findings may be noted incidentally during routine colonoscopy. However, the diagnosis of proctologic diseases is relevant to all physicians working in endoscopy, who therefore need to ensure that they have the relevant basic knowledge and are able to confidently assess the most frequent clinical pictures. As a therapeutic discipline, proctology belongs primarily to the field of visceral surgery. ![]()
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