Norm of Proctoscopy
The rectal lining is continuous, reddish, and free of lesions, abscesses, inflammation, ulcerations, and polyps. The anal lining appears grayish tan and smooth.
Usage of Proctoscopy
Melena or bleeding from the anorectal area, persistent diarrhea, changes in bowel habits, passage of pus and mucus, suspected chronic inflammatory bowel disease, bacteriologic and histologic studies, surveillance of known rectal disease or after rectal surgery, rectal pain, screening for suspected polyps or tumors, foreign-body removal, or adjunct to barium enema.
Description of Proctoscopy
A proctoscopy is the endoscopic, direct visual examination of the lining of the rectum and anal canal using a rigid, lighted proctoscope. Specimens for biopsy, cytologic evaluation, or culture may be taken during the procedure. Proctoscopy is usually performed with flexible sigmoidoscopy for clients demonstrating unexplained anemia, unexplained diarrhea, or the presence of blood in the stool.
Professional Considerations of Proctoscopy
Consent form IS required.
Bowel perforation, hemorrhage, peritonitis.
Severe necrotizing enterocolitis, toxic megacolon, painful anal lesions, or severe cardiac dysrhythmias.
- A tap-water, hypertonic phosphate, or saline enema may be prescribed. Clients with ulcerative colitis or acute diarrhea can be examined without an enema.
- Obtain drapes, gloves, 1%–2% lidocaine (Xylocaine), a proctoscope with an obturator, and a light source. If a biopsy is to be performed, obtain a specimen container of 10% formalin. If cytology slides are to be prepared, obtain cytology slides and a Coplin jar of 95% ethyl alcohol (ethanol). If cultures are to be performed, obtain sterile swabs with culture tube.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is placed in a left-lateral or knee-to-chest position and draped for comfort and privacy.
- The physician inserts a lubricated finger through the anus to assess for patency and the presence of obstruction.
- After patency is determined, the lubricated proctoscope with obturator is inserted fully into the rectum through the anus, and the obturator is removed.
- After a light is inserted, the physician carefully inspects the interior lining of the rectum and anal canal as the proctoscope is slowly withdrawn.
- If biopsy specimens are taken, the site may be anesthetized first with 1%–2% lidocaine or another local anesthetic.
- Any liquid drainage is removed with suction during the procedure.
- Send the specimens to the laboratory immediately.
- The client should lie flat for 10–15 minutes following the procedure.
- Monitor for signs of fatigue, abdominal pain or distention, fever, hypotension, or rectal bleeding.
- Bloody stools are normal for 1–2 days after a rectal biopsy.
- No enemas or barium studies for 1 week after rectal biopsy secondary to the increased risk of perforation.
Client and Family Teaching
- Client may be asked to follow a clear liquid diet for 2 days or fast for 8 hours.
- Try to defecate before the procedure.
- An urge to defecate may be felt during the procedure, and slow, controlled deep breathing may help to diminish this feeling.
Factors That Affect Results
- Residual barium from prior testing will impair visualization.
- The presence of stool in the rectum impairs visualization.
- Complications of proctoscopy include rectal perforation, minimal bleeding from lacerations, transient abdominal discomfort, and cardiac dysrhythmias.