The data gathered during subjective assessment provide clues to the client’s overall health and whether he is at risk for diseases and disorders of the anus, rectum, or prostate.
History of present health concern
Bowel Patterns
What is your usual bowel pattern? Have you noticed any recent changes in the pattern? Any pain while passing a bowel movement?
Do you experience constipation?
Do you experience diarrhea? Is your diarrhea associated with any nausea or vomiting?
Do you have trouble controlling your bowels?
Itching and Pain
Do you experience any itching or pain in the rectal area?
Stool
What is the color of your stool? Hard or soft? Have you noticed any blood on or in your stool? If so, how much?
Have you noticed any mucus in your stool?
Past health history
Have you ever had anal or rectal trauma or surgery? Were you born with any congenital deformities of the anus or rectum? Have you had prostate surgery? Have you had hemorrhoids or surgery for hemorrhoids?
When was the last time you had a stool test to detect blood?
Have you ever had a proctosigmoidoscopy?
When was the last time you had a digital rectal examination (DRE) by a physician?
Have you ever had blood taken for a prostate screening, which measures the level of prostate-specific antigen in your blood? When was the test, and what was the result?
Family history
Is there a history of polyps, colon, rectal cancer, or prostate cancer in your family?
Lifestyle and health practices
Do you use any laxatives, stool softeners, enemas, or other bowel movement-enhancing medications?
Do you engage in anal sex?
Do you take any medications for your prostate?
How much high-fiber food and roughage do you consume every day? Do you eat foods high in saturated fats?
For postmenopausal women: Do you use hormone replacement therapy?
Has any anal or rectal problem affected your normal activities of daily living?
Anus and rectum
Inspection
Inspect the perianal area. Spread the client’s buttocks and inspect the anal opening and surrounding area.
Inspect the sacrococcygeal area. Inspect this area for any signs of swelling, redness, dimpling, or hair.
Palpation
Palpate the anus. Inform the client that you are going to perform the internal examination at this point. Lubricate your gloved index finger; ask the client to bear down. As the client bears down, place the pad of your index finger on the anal opening. When you feel the sphincter relax, insert your finger gently with the pad facing down.
Palpate the rectum. Insert your finger further into the rectum as far as possible. Next, turn your hand clockwise. This allows palpation of as much rectal surface as possible. Note tenderness, irregularities, nodules, and hardness.
Palpate the peritoneal cavity. This area may be palpated in men above the prostate gland in the area of the seminal vesicles on the anterior surface of the rectum. In women, this area may be palpated on the anterior rectal surface in the area of the rectouterine pouch Note tenderness or nodules.
Prostate gland
Palpation
In male clients, palpate the prostate. The prostate can be palpated on the anterior surface of the rectum by turning the hand fully counterclockwise so the pad of your index finger faces toward the client’s umbilicus. Note the size, shape, and consistency of the prostate, and identify any nodules or tenderness.
Inspect the stool. Withdraw your gloved finger. Inspect any fecal matter on your glove. Assess the color, and test the feces for occult blood. Provide the client with a towel to wipe the anorectal area.