A rectal examination is a diagnostic tool in medical assessments, providing important information about a patient’s health. It is a common and valuable component of a comprehensive physical evaluation. This examination allows healthcare providers to assess various internal structures for potential concerns, offering insights not obtainable through other non-invasive methods.
Why a Rectal Exam is Performed in Females
Healthcare professionals perform a rectal exam in female patients for several reasons, often as part of a routine physical or gynecological assessment. It helps investigate symptoms like pelvic pain, changes in bowel habits, or rectal bleeding. The procedure aids in checking for conditions such as hemorrhoids, anal fissures, or inflammatory bowel disease. It also contributes to the early detection of certain cancers, including colorectal, uterine, or ovarian cancers.
Key Palpable Structures and Their Assessment
During a rectal examination, a healthcare provider can palpate several anatomical structures to assess their condition. Feeling these structures helps identify irregularities or signs of disease, guiding further diagnostic steps and treatment plans.
The rectum and anal canal are directly accessible. The provider assesses the tone of the anal sphincter muscles, asking the patient to squeeze and relax to check for strength and coordination. Internal hemorrhoids, fissures, polyps, or abnormal masses and tenderness can be felt along the rectal walls. The presence of blood or mucus on the examining glove upon withdrawal is also noted.
The coccyx and sacrum, located posteriorly, can be gently palpated through the rectal wall. Clinicians assess these bones for tenderness, instability, or misalignment, which can be relevant in cases of tailbone pain (coccydynia) or indicate musculoskeletal issues.
The uterus, particularly if retroverted (tilted backward), may be palpable through the anterior rectal wall. A provider assesses its size, shape, consistency, mobility, and any tenderness or abnormal masses like fibroids. An anteverted uterus, which tilts forward, is generally not easily palpable.
The cervix, the lower part of the uterus, can often be felt. Its size, shape, consistency, and any associated tenderness are evaluated. Assessing the cervix through the rectum can be useful when a vaginal examination is not feasible or to gain a different perspective.
The posterior vaginal wall lies anterior to the rectum and can be assessed for masses, thickening, or tenderness. This area is often evaluated as part of a rectovaginal examination, which helps differentiate between certain pelvic conditions like a rectocele or enterocele.
The pelvic floor muscles are assessed for tone, tenderness, and strength. The provider may ask the patient to contract and relax these muscles to evaluate their function and identify weakness, tension, or pain. This assessment is relevant for conditions like pelvic floor dysfunction or incontinence.
The adnexa, including the ovaries and fallopian tubes, are typically located higher in the pelvis. Healthy ovaries are generally not palpable during a routine rectal exam. However, enlarged or pathological ovaries, such as those with cysts or tumors, or other adnexal masses, might be detected. In postmenopausal individuals, a palpable ovary is often considered an abnormal finding.
Understanding the Examination Process
Patients undergoing a rectal exam can expect a clear explanation from their healthcare provider. Emptying the bladder beforehand is often advised for comfort. The patient will typically lie on their side with knees bent toward the chest.
During the exam, the provider uses a gloved, lubricated finger, gently inserting it into the rectum. Patients may feel pressure or the urge to have a bowel movement, but significant pain is uncommon. The procedure is quick, usually lasting only a few minutes, with minimal and temporary discomfort. The provider communicates throughout, and patients can ask questions or voice concerns.