Proctological examination and rectal exam in the clinical diagnosis of anorectal symtoms

Abstract

Objective:to evaluate the information provided by the proctological examination, and in particular, the rectal exam in patients with anorectal symptoms.
Method: patients referred to a proctology polyclinic from January 2005 through December 2008 were included in the study. We recorded demographic data, main symptom for consultation and clinical diagnosis. We evaluated the diagnostic performance of perianal examination, rectal examination and anoscopy for each pathology. The information obtained through the different maneuvers was classified into three categories: 1) it provided enough information to establish the primary clinical diagnosis; 2) it provided diagnostic information, although not conclusive; and 0) it failed to provide diagnostic information.
Results: 606 patients were included (319 women, 52%), average age was 47 years old, (range 14 to 93 years old). The most frequent symptom was anal pain (33%), followed by rectal bleeding (19%) and procidentia (18%). We performed a primary clinical diagnosis in 94% of patients; perianal examination and anoscopy provided enough information for diagnosis in 54% and 51% of cases respectively, whereas the rectal examination did so in 10% of cases.
Conclusion: the study showed that a complete proctological examination enables a primary clinical diagnosis in most patients who consulted for anorectal symptoms. Over half of the pathological conditions may be evidenced by means of a correct examination and perianal palpation. Rectal exam was the maneuver that obtained the least diagnostic performance, only allowing for a primary clinical diagnosis in 10% of the consultations.