For rectal cancer, many patients have to undergo anal resection and permanent colonic fistula (rerouting) due to late detection, which is really a chrysanthemum residue full of injuries and poor quality of life after surgery, your smile has yellowed, flowers fall on people’s broken intestines …… One of the terrible reasons for misdiagnosis of rectal cancer Failure to do rectal finger diagnosis According to relevant statistics, the misdiagnosis rate of rectal cancer is 30%. The reasons for misdiagnosis are many, one of the important reasons is that patients and doctors are not vigilant and do not do rectal examination. Statistics have confirmed that 85% of the delayed diagnosis of rectal cancer is due to the lack of early rectal finger examination. Low rectal cancer (located below the peritoneal reflex) accounts for 60%-75% of all rectal cancers in Chinese people, and for this group of patients, diagnosis can be confirmed by rectal finger examination; early rectal cancer has no obvious symptoms, and only when the cancer breaks down and forms ulcers and infection or obstruction, symptoms of rectal irritation, intestinal stenosis and tumor breakdown infection will appear one after another, such as change in stool habit, pus and blood stool, frequency of defecation, and so on, If anal examination is not done at this time, it is most likely to be misdiagnosed as bleeding internal hemorrhoids, bleeding polyps, bacterial dysentery, rectal inflammation, etc., and the consequences of delayed treatment are unthinkable. The anorectal examination is a method of diagnosing diseases by touching the patient’s anus and rectum with the doctor’s finger. Anorectal diagnosis plays a very important role in the diagnosis and treatment of anorectal diseases, and can be used to diagnose a variety of anal, rectal and pelvic floor diseases, especially about 80% of rectal cancers occurring in areas within the reach of the fingers, and is an important method for early detection of rectal cancer, and is also the most economical and practical examination method with strong intuition and reliability, which can provide an important basis for further treatment. What diseases can be detected by anorectal diagnosis? 1.Anal rectal diseases: such as rectal cancer, rectal polyps, internal hemorrhoids, anal fistula, perianal abscess, rectal prolapse, rectal carcinoid tumor, pelvic floor tumor, ulcerative colitis, rectal prolapse, rectal prolapse, pelvic floor muscle spasm syndrome and puborectal muscle syndrome, anal sphincter loss retardation, rectal isolated ulcer syndrome, etc. 2, urological diseases: such as prostatic hyperplasia, prostate cancer, prostatitis, etc. 3, general surgical diseases: such as acute appendicitis, intussusception, pelvic abscess, pelvic metastatic implantation tumor, etc. 4, gynecological diseases: such as ovarian follicular or corpus luteum rupture, chronic adnexitis, pelvic inflammatory disease, endometriosis, etc. How to practice the excellent “chrysanthemum one finger meditation”? The following detailed explanation 1, choose the appropriate position: commonly used positions are left lateral recumbency, knee-chest position and truncated position, as follows: 2, before the examination and the person being examined to do a good job of explaining, should not be in the case of patients are not mentally prepared to rashly carry out, to obtain the full cooperation of patients is the key factor in obtaining the correct diagnosis. 3.Before finger diagnosis, observe carefully whether there is redness, swelling, stained nature, fistula, external hemorrhoids, warts, ulcers, lumps and prolapse in the anus, so as to analyze and judge the nature of lesions and lay a good foundation for finger diagnosis. 4.Pay attention to several steps: ①Gently massage the anus after wearing gloves and applying paraffin oil with the right hand to check whether there is any anal pressure, fistula and external hemorrhoids, etc., and also check whether the sulcus between the anal sphincters is normal. ②Gently insert the fingers along the anal opening, do not enter suddenly to cause pain to the patient, and instruct the patient to breathe with an open mouth to reduce the abdominal pressure and anal tension. ③The examination process usually takes a clockwise or counterclockwise sequence, and the anal canal and rectum are examined completely for one week. During the examination, the tightness of the anal canal sphincter, the condition of the anal canal and rectal ring, the smoothness and integrity of the mucosa of the rectal wall, the presence of ulcers, masses and strictures, and the presence of tenderness and fluctuation of the rectal wall were tested. ④The anterior rectal wall is 4-5cm away from the anal verge, the prostate outside the rectal wall can be palpated in men, the cervix can be palpated in women, and the tailbone and sacrum can be palpated posteriorly, so as not to misdiagnose it as a pathological mass. ⑤ For female patients, do a double colectomy (anus and vagina) if necessary to further understand the nature and extent of the lesion. ⑥In the process of finger extraction, patients are instructed to do defecation to understand whether the anorectal angle is open, the degree of anal laxity, the size of rectal protrusion, and observe whether there is blood and mucus in the finger sleeve, etc. 5, for rectal cancer patients, “one finger meditation”: ① typical rectal cancer finger diagnosis performance, can touch the rectal mucosa destruction, manifested as hard mucosal ulcers and hard nodes, or the surface is uneven cauliflower-like masses, accompanied by pus, necrotic tissue and dark red blood, fishy smell, and feel the narrowing of the intestinal cavity. The finger sleeve is also stained with dark red blood. Accurate determination of the location (anterior, posterior, left and right of the rectum), size (upper and lower diameter, size of the circumference of the intestinal cavity), shape (ulcerated, elevated, infiltrated), hardness, whether it can be pushed and the relationship with the pelvic floor organs is extremely helpful in determining the stage of the tumor, choosing the treatment and judging the prognosis. Generally speaking, the prognosis of tumors located in the anterior rectal wall is relatively poor; ③ If the tumor can be pushed and has a certain degree of activity, it means that the depth of tumor infiltration is not deep and may be limited to the mucosal layer, submucosal layer or superficial muscular layer (stage I-II), which can generally be treated by surgery; if the tumor is fixed and immobile, or the potential gap between the tumor and the lateral wall of pelvis, sacrum, prostate and vagina disappears, it means that the tumor is very advanced. If the tumor is fixed, or the potential gap between the tumor and pelvic sidewall, sacrum, prostate and vagina disappears, it means the tumor is very advanced (stage III-IV), generally not suitable for surgery, and should be firstly treated with neoadjuvant radiotherapy before considering surgery. ④If the rectal bladder recess or rectal uterine recess disappears or hard nodes are palpated, it is generally considered that the tumor has peripheral invasion or implantation metastasis, and should also be firstly treated with neoadjuvant radiotherapy before considering surgery. ⑤ Accurately judge the distance between the tumor and the anal margin. Generally speaking, the closer the tumor is to the anal verge, the smaller the chance of anus preservation by surgery, and vice versa, the greater the chance of anus preservation. In my experience, generally speaking, if the tumor is ≥3cm away from the anal verge, it is feasible to preserve anus. (6) The relationship between accurate tumor and anal sphincter. If the inter-anal sphincter groove exists and the anorectal ring is intact, it means that the tumor has not invaded the anal sphincter, and the chance of anal preservation is large, and vice versa, the chance of anal preservation is small. Warm tip: Rectal cancer is very common, don’t ignore it as hemorrhoids. Early consultation and finger diagnosis will help you to have a strong smile without injury to your chrysanthemum!