(a) anorectal diseases 1, rectal cancer in the intestinal wall can be found in the uneven hard mass, its surface may have ulcers, the intestinal cavity is often narrowed in the shape of a ring, the finger sleeve is often stained with pus, blood and mucus. Some people believe that finger diagnosis is the same as direct vision, touch is equal to see, so there is “finger diagnosis eye” called (Figure 3-3). 2, rectal polyps can be found in soft and pushable round masses, often with a tip, finger stained with blood. Sometimes low rectal polyps can be hooked out of the anus by the finger. 3, internal hemorrhoids Simple internal hemorrhoids are soft and cannot be found, but if there is thrombosis or injection treatment, smooth hard nodes can be found. 4.Anal fistula A cord-like object can be found in the perianal area and connected to the external opening, and sometimes the internal opening of the anal fistula can be found at the anal fossa like a small hard knot. 5.Perianal rectal abscesses Pelvic rectal abscesses and posterior rectal gap abscesses can be found in the rectum as painful masses. Other interstitial abscesses can be examined by double-finger palpation with the thumb and index finger, i.e., with the index finger in the rectum and the thumb on the perianal skin, the thumb and index finger can be palpated to detect deep anterior and deep posterior anal canal abscesses or scirorectal interstitial abscesses or perianal abscesses. Fibrous fistulae are also easily palpated by two-finger examination. 6.Prolapse of the rectum The sphincter muscle is often relaxed or the pelvic floor muscle is weak during finger palpation. Rectal carcinoid tumor accounts for about 17% of gastrointestinal tract carcinoid tumors. The typical presentation is a single, sliding submucosal hard node with smooth and intact mucosa, 1-1.5cm in size and yellowish gray or brownish yellow in color. Only 2-4% are multifocal. The symptoms are blood in the stool and constipation, but they are mostly asymptomatic and are often found inadvertently during physical examination or as a result of examination for other diseases. Bates suggested that tumor size is related to malignancy: the malignancy rate is 1.7% for <1cm, 10% for 1-2cm, and 82% for >2cm. In addition, if the tumor reaches deep into the muscle layer, it is often malignant. Although these tumors are rare, there are more types of tumors, such as teratoma, osteoma, neuroma and others. Small asymptomatic retrorectal tumors are often found during finger diagnosis. When fingering a retrorectal mass, the rectal wall can be pushed forward or to one side, and the rectal mucosa is smooth. If it is a small sacrococcygeal teratoma, the mass is smooth and lobulated, with some mobile and some fixed. If it is a sacral chordoma protruding forward, it is hard and fixed in the sacrum, without pressure pain. 9, ulcerative colitis finger diagnosis rectal mucosa with granular sensation, sometimes can be touched on the rectal wall with pseudo-polyps. The finger sleeve is stained with pus, blood and mucus. 10, rectal mucosal prolapse rectal finger diagnosis can be palpated rectal jug abdominal mucosa folding accumulation, soft and smooth, moving up and down, there may be a circular groove between the part of internal prolapse and the intestinal wall. Some authors also reported that rectal palpation can only find sphincter relaxation and rectal mucosa accumulation, and some patients can palpate the loop. 11, anterior rectal protrusion A round or oval depressed weak area will be palpated on the dentate line of the anterior rectal wall during finger palpation, and the pouch will be palpated protruding into the vagina. The depression becomes more prominent when the patient strains to defecate, and even the posterior wall of the vagina can be pressed to the outside of the vaginal opening. 12. pelvic floor muscle spasm syndrome and puborectal muscle syndrome Rectal palpation reveals increased tension in the anal canal, sometimes it is more difficult to insert the finger into the anus and requires force to pass the anal canal. The anorectal ring is enlarged, and the anal canal is longer, up to 6 cm or more in length. The posterior part of the rectal potbelly becomes deeper into a sac. The posterior edge of the puborectalis muscle is contracted forward and upward when doing the anal lifting action, and its edge is sharp. The posterior edge of the puborectalis muscle contracted forward and upward instead of relaxing during the simulated defecation movement, and the pressure of the anal canal also increased. In some patients, even the pelvic muscles and gluteal muscles may also produce spasmodic contractions. The anal canal can be relaxed after stopping the defecation action. 13.Anal sphincter loss retardation There is obvious tightness on rectal palpation, but this tightness is different from puborectal muscle spasm and hypertrophy, the latter is the deeper the tension of the anal canal, while the internal sphincter loss retardation is the lower part of the anal canal tension, especially obvious at the anal opening, the pressure of the anal canal is increased, and even the fingertip has difficulty entering the anal canal. Rectal palpation can feel the thickening of the internal sphincter, and some patients have tenderness. The groove between the internal and external sphincter of the anal canal is often found to be deepened, and in severe cases, the internal sphincter may protrude beyond the anus when performing fecal movements. More dry fecal masses can be palpated in the upper part of the anal canal. 14, isolated rectal ulcer syndrome Most lesions are located at the anorectal junction, in the anterior rectal wall. On finger examination, a single thickened, hard and active rectal mucosa can be palpated, with pressure pain, and sometimes the hardened rectal mucosa is elevated at the edges and nodular or villi-like around. Polyp-like material may also be palpated. It is also misdiagnosed as polyps or cancer. Occasionally, annular strictures can be found in the lower rectum. (The central sulcus becomes shallow or disappears, and the gland may increase in length and width or both, and can be classified into 3 levels according to the degree of enlargement: the first level resembles the size of an egg, the second level resembles the size of a duck egg, and the third level resembles the size of a goose egg. 2.Prostate cancer: hard nodules like stones can be palpated. Acute prostatitis is a painful and swollen prostate that can be palpated. If there is a sense of fluctuation, it means that an abscess has been formed, and it is forbidden to massage the prostate body and examine the urethral instrument. The actual fact is that you can find a lot of people who are not able to get a lot of money from the internet. When doing rectal palpation, due to the high location of the seminal vesicles, they generally cannot be palpated. In case of infection, they may occasionally be found above the prostate gland, which is soft and cystic in texture, and attention should be paid to the presence of nodules, masses or tenderness. (C) General surgical diseases 1. Acute appendicitis If the appendix is in the pelvis, rectal palpation can reveal tenderness on the right side of the anterior rectal wall. If the inflammation has spread beyond the appendix, there is tenderness on both sides of the anterior rectal wall. If the appendix is high, the test result is mostly negative. 2, intestinal condyloma The finger condyloma often has mucus and blood stool, and sometimes the rectal palpation may feel the condyloma intestinal tube. 3, pelvic abscess often due to the consequences of pelvic inflammatory infection, mostly due to appendiceal perforation. Rectal palpation on the right side often reveals a palpable mass bulging into the rectal cavity, with increased temperature sensation and fluctuating sensation, while the opposite side is negative. 4, posterior peritoneal hematoma often has trauma mandarins. Finger palpation can reveal tenderness and fullness of the posterior abdominal wall. (iv) Gynecological diseases 1. rupture of ovarian follicle or corpus luteum Since it occurs mostly in young unmarried women, vaginal examination cannot be performed. Rectal palpation can reveal tenderness in the posterior wall of the uterus, tenderness in the fornix on one side, and pain when moving the uterine body. It is not difficult to diagnose based on menstrual history. 2, chronic adnexitis Rectal palpation often reveals enlarged, painful adnexa and cervical tenderness and cervical movement tenderness. 3, endometriosis During rectal palpation, a painless mass with smooth mucosa can be found in the rectal recess of the uterus. Combined with the medical history and the increase of abdominal pain during menstruation, and the increase of tumor size and pressure pain, the diagnosis can be made clearly.