Proctoscopy
Description
This procedure teaches you how to prepare for and correctly perform proctoscopy.
Simulation
The simulator tests your ability to prepare for and perform proctoscopy, including the necessary preliminary steps.
Video
The video guides you through a step-by-step demonstration on how to set up and perform proctoscopy of a male or female.
Anatomy
The anatomy provides a detailed cross section of the male and female pelvis, including a 360-degree rotating coronal image to illustrate the key structures of the examination.
Text
The text includes illustrations, key terms, and hyperlinks to external references. The example text below has been truncated.
- Indications, contraindications, and complications related to this procedure
- Correct tray set up
- Preparation and positioning of the patient
- How to prepare yourself as the operator
- Familiarity with the equipment
- Which structures to inspect and examine
- How to perform a digital rectal examination
- How to insert a proctoscope and inspect the ano-rectal mucosa
- How to remove the proctoscope
- Correct postprocedure considerations and documentation
Step 1: Preparation
1.1. Tray Preparation
Before embarking on this procedure, be sure to set up your tray with the necessary equipment and/or medication.
1.2. Patient Preparation
If a sigmoidoscopy is being done as well, an enema should be administered half an hour to two hours before the procedure. This may not be necessary if the patient has just had a bowel motion.
Place the patient in the lateral position. The buttocks should be at the edge of the bed with the hips and knees flexed at 90 degrees. Various other positions can be used; the left decubitus position is the most common.
1.3. Operator preparation
Take universal precautions.
Double glove the dominant hand as a digital rectal examination needs to be performed prior to the proctoscopy.
Step 2: Perform a digital rectal examination
Visually inspect the anus and perianal area.
Lubricate your finger and perform a digital rectal examination to assess the rectum for pain, masses and bleeding, the rectovaginal septum in females, and the prostate in males.
Remove the outer glove from your dominant hand and discard it into the disposable bag.
- If the patient does not tolerate the digital rectal examination due to pain,
do not attempt to perform the proctoscopy. The patient should have an examination under anesthesia; especially if a non benign lesion is suspected.
Step 3: Lubricate the proctoscope
With the obturator within the proctoscope, generously lubricate the tip of the obturator and the proctoscope.
Step 4: Introduce the proctoscope into the rectum
Ensure that the obturator is fully inserted into the proctoscope.
Hold the proctoscope so that the thumb or palm maintains pressure on the obturator during the introduction.
Separate the buttocks and gently insert the proctoscope into the rectum. Aim initially towards the umbilicus and then towards the sacrum.
Remove the obturator once the proctoscope has been fully inserted.
- If the obturator falls out during insertion, remove the entire proctoscope, reinsert the obturator into the scope and then attempt to reinsert the proctoscope into the rectum. This prevents pinching of the anal mucosa.
