Abstract
A careful clinical examination remains of crucial importance in a patient affected by coloproctological diseases. These conditions have a significant impact on the patients’ quality of life and, moreover, are often associated to personality disorders or real psychiatric conditions: some measures are therefore needed to minimize the impact of the visit and to establish immediately an effective relationship of mutual trust.
It is therefore clear that the choice of where and how to visit a coloproctology patient is very important to properly address the diagnostic-therapeutic approach. A full coloproctologic examination should always provide a series of well-defined phases, with the evaluation of several different aspects of the same disease. For many common diseases treated in a proctology clinic, a proper clinical examination can address, or not, the patient to a subsequent assessment by radiology or anorectal physiology testing.
Growing literature evidences support the surgeon in the diagnosis of colorectal diseases and have highlighted the importance of treating these conditions in a specialist colorectal context.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Becker A, Koltun L, Sayfan J (2006) Simple clinical examination predicts complexity of perianal fistula. Colorectal Dis 8:601–604
Cirocco WC, Reilly JC (1992) Challenging the predictive accuracy of Goodsall’s rule for anal fistulas. Dis Colon Rectum 35:537–542
Coremans G, Dockx S, Wyndaele J, Hendrickx A (2003) Do anal fistulas in Crohn’s disease behave differently and defy Goodsall’s rule more frequently than fistulas that are cryptoglandular in origin? Am J Gastroenterol 98:2732–2735
Deshpande AR, Block N, Barkin JS (2009) Taking a closer look at the rectal examination: beyond the basics. Am J Gastroenterol 104:246–247
Dobbene AC, Terra MP, Deutekom M, Gerhards MF, Bijnen AB, Felt-Bersma RJ, Janssen LW, Bossuyt PM, Stoker J (2007) Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis 22:783–790
Eckardt VF, Kanzler G (1993) How reliable is digital examination for the evaluation of anal sphincter tone? Int J Colorectal Dis 8:95–97
Gans SL, Pols MA, Stoker J, Boermeester MA (2015) Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg 32:23–31
Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729
GarcĂa-Olmo D, Pascual Migueláñez I (2010) A sonograph in the proctology clinic – an aid to the “learned finger”. Rev Esp Enferm Dig 102:1–6
Gebbensleben O, Hilger Y, Rohde H (2009) Patients’ views of medical positioning for proctologic examination. Clin Exp Gastroenterol 2:133–138
Goldstein ET (1996) Outcomes of anorectal disease in a health maintenance organization setting. The need for colorectal surgeons. Dis Colon Rectum 39:1193–1198
Grucela A, Salinas H, Khaitov S, Steinhagen RM, Gorfine SR, Chessin DB (2010) Prospective analysis of clinician accuracy in the diagnosis of benign anal pathology: comparison across specialties and years of experience. Dis Colon Rectum 53:47–52
Gunawardhana PA, Deen KI (2001) Comparison of hydrogen peroxide instillation with Goodsall’s rule for fistula-in-ano. ANZ J Surg 71:472–474
Hyman NH (1999) Impact of a colon and rectal surgeon on a general surgery residency training program. Dis Colon Rectum 42:249–251
Isherwood J, Ashkir Z, Panteleimonitis S, Kumar N, Hemingway D, Miller AS, Norwood MN, Yeung JM (2013) Teaching digital rectal examination to medical students using a structured workshop-a point in the right direction? J Surg Educ 70:254–257
Jimeno J, Vallverdú H, Tubella J, Sánchez-Pradell C, Comajuncosas J, Orbeal R, Hermoso J, Gris P, López-Negre JL, Urgellés J, Parés D (2012) Prospective analysis of clinician accuracy in the diagnosis of benign anorectal pathology: the value of clinical information. Rev Esp Enferm Dig 104:122–127
Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ (2005) Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable. Dis Colon Rectum 48:349–352
Jordán J, Roig JV, GarcĂa-Armengol J, GarcĂa-Granero E, Solana A, LledĂł S (2010) Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis 12:254–260
Karlbom U, Graf W, Nilsson S, Påhlman L (2004) The accuracy of clinical examination in the diagnosis of rectal intussusception. Dis Colon Rectum 47:1533–1538
Kashyap AS, Kohli DR, Raizon A, Olden KW (2013) A prospective study evaluating emotional disturbance in subjects undergoing defecating proctography. World J Gastroenterol 19:3990–3995
Kuehn HG, Gebbensleben O, Hilger Y, Rohde H (2009) Relationship between anal symptoms and anal findings. Int J Med Sci 6:77–84
Laurell H, Hansson LE, Gunnarsson U (2006) Why do surgeons miss malignancies in patients with acute abdominal pain? Anticancer Res 26:3675–3678
Longo WE (2003) The specialty of colon and rectal surgery: its impact on patient care and role in academic medicine. Yale J Biol Med 76:63–77
Maconi G, Gridavilla D, Viganò C, Sciurti R, Asthana AK, Furfaro F, Re F, Ardizzone S, Ba G (2014) Perianal disease is associated with psychiatric co-morbidity in Crohn’s disease in remission. Int J Colorectal Dis 29:1285–1290
Ratto C, Grillo E, Parello A, Costamagna G, Doglietto GB (2005) Endoanal ultrasound-guided surgery for anal fistula. Endoscopy 37:722–728
Roos AM, Abdool Z, Thakar R, Sultan AH (2012) Predicting anal sphincter defects: the value of clinical examination and manometry. Int Urogynecol J 23:755–763
Sharma A, Sharp DM, Walker LG, Monson JR (2008) Stress and burnout among colorectal surgeons and colorectal nurse specialists working in the National Health Service. Colorectal Dis 10:397–406
Siproudhis L, Ropert A, Vilotte J, Bretagne JF, Heresbach D, Raoul JL, Gosselin M (1993) How accurate is clinical examination in diagnosing and quantifying pelvirectal disorders? A prospective study in a group of 50 patients complaining of defecatory difficulties. Dis Colon Rectum 36:430–438
Sit M, Yilmaz EE, Canan F, Yildirim O, Cetin MM (2014a) Health-related quality of life in patients with anal fissure: effect of type D personality. Prz Gastroenterol 9:93–98
Sit M, Yilmaz EE, Canan F, Yıldırım O, Cetin MM (2014b) The impact of type D personality on health-related quality of life in patients with symptomatic haemorrhoids. Prz Gastroenterol 9:242–248
Sprangers MA, Taal BG, Aaronson NK, teVelde A (1995) Quality of life in colorectal cancer. Stoma vs. non-stoma patients. Dis Colon Rectum 38:361–369
Springall RG, Todd IP (1988) General practitioner referral of patients with lower gastrointestinal symptoms. J R Soc Med 81:87–88
Sygut A, Mik M, Trzcinski R, Dziki A (2010) How the location of the internal opening of anal fistulas affect the treatment results of primary transsphincteric fistulas. Langenbecks Arch Surg 395:1055–1059
Talley NJ (2008) How to do and interpret a rectal examination in gastroenterology. Am J Gastroenterol 103:820–822
Tantiphlachiva K, Rao P, Attaluri A, Rao SS (2010) Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol 8:955–960
Toyonaga T, Tanaka Y, Song JF, Katori R, Sogawa N, Kanyama H, Hatakeyama T, Matsushima M, Suzuki S, Mibu R, Tanaka M (2008) Comparison of accuracy of physical examination and endoanal ultrasonography for preoperative assessment in patients with acute and chronic anal fistula. Tech Coloproctol 12:217–223
Zbar AP (2009) David Henry Goodsall: reassessment of the rule. Tech Coloproctol 13:185–188
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this entry
Cite this entry
Ratto, C., Litta, F., Donisi, L., Parello, A. (2017). Visiting a Coloproctology Patient: Rules and Suggestions. In: Ratto, C., Parello, A., Donisi, L., Litta, F. (eds) Colon, Rectum and Anus: Anatomic, Physiologic and Diagnostic Bases for Disease Management. Coloproctology, vol 1. Springer, Cham. https://doi.org/10.1007/978-3-319-09807-4_14
Download citation
DOI: https://doi.org/10.1007/978-3-319-09807-4_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-09806-7
Online ISBN: 978-3-319-09807-4
eBook Packages: MedicineReference Module Medicine