Anus, Rectum, and Prostate
Chapter 23
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Health History: Risk Factors
Colorectal cancer
• Age: highest incidence—middle age/older
– About 90% of new cases—>50
• History:
– Personal: colorectal cancer, adenomatous polyps, or
inflammatory bowel disease
– Family: strong for colon cancer (member of family with
hereditary colorectal cancer) or polyps
• Lifestyle: smoking, excessive alcohol intake, and
sedentary lifestyle
• Diet: obesity; high-fat, low-fiber diet
• Gender: higher in males
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Health History: Risk Factors
Prostate cancer
• Age: older men; 75% new cases—males >65
• Family history: 1st degree relative with prostate
cancer
• Ethnicity: African-American men—highest
incidence, twice as high as white men
• Worldwide, highest prevalence in North America
and northwestern Europe
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Health History:
Present Health Status
• Have had a test examining stool/visual
exam of rectum/colon? If so, when?
Results?
• Men: Last prostate exam? Have had a
prostate-specific antigen (PSA) blood
test? When? Results?
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Health History: Family History
• Has anyone in family had colon or rectal
cancer? Polyps in rectum or colon?
Inflammatory bowel disease?
• Men: Anyone in family had prostate
cancer? If so, who? What age?
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Age Variations
• Older adults– increased prostate cancer
• Toddlers– usually will be bowel trained after 2 years. Not
abnormal to vary widely.
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Examination
Preparation
• Exam of rectum/anus done on all adults
• Examination gloves worn throughout exam
• Inspection and palpation
• Anal/rectal exam same for male/female clients
• Male—prostate exam with rectal exam
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Examination
• Positioning for rectal exam depends on
client’s gender/age
– Male—left lateral position, hips and knees
flexed; knee-chest position; or standing, hips
flexed, bending over exam table, feet pointed
together
– Female—lithotomy position (if exam with
genitalia exam) or left lateral position
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Common Problems and Conditions:
Anus and Rectum
Clinical findings- Pilonidal cyst
• Dimpled area, small opening with tuft of hair in
sacrococcygeal area
• Usually diagnosed in young adulthood,
occasionally at birth—depression in sacral area
• If infected, area red/tender, cyst palpable
• Cyst often drains a mucoid or purulent discharge
• May complain of pain/swelling at base of spine
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Common Problems and Conditions:
Anus and Rectum
Hemorrhoids
• Dilated veins (hemorrhoidal plexus)—
increased portal venous pressure
– Frequently caused by pregnancy, constipation,
chronic liver disease, and obesity
– Large numbers suffer condition without
seeking treatment
– Both genders affected equally
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Common Problems and Conditions:
Anus and Rectum
Hemorrhoids (cont’d)
• Clinical findings
– External hemorrhoids—outside external rectal
sphincter; flaps of tissue/skin
• If irritated/thrombosed, localized itching and
bleeding; blue or purple shiny masses at anus
– Internal hemorrhoids—-above interior
sphincter
• May be in rectum, not seen unless thrombosed,
prolapsed, or infected
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Common Problems and Conditions:
Anus and Rectum
• Clinical findings
– May/may not have symptom
– Most important symptom—rectal bleeding; if
have, better long-term outcomes
– Rectal bleeding—consistent with tumor at
early stage; more vascularized than advanced
lesion
– If tumor palpable, presents as an irregular
mass on rectal wall with nodular, raised edges
– Center of the mass often has an area of
depression
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