Rectal cancer is scandalous! Low-grade rectal cancer may require a permanent lifelong stoma. However, rectal cancer can often be detected by a simple test, which is the rectal finger test, also called anal finger test. The most important feature of bowel cancer incidence in China compared to the West is that 75% of bowel cancers occur in the rectum, and 2/3 of them can be palpated by finger examination. Most bowel cancers develop from benign adenoma malignancy, which takes about 3-8 years to develop. Rectal finger examination is a screening tool. It is simple to operate and can roughly determine the presence and nature of lesions in the anus and rectum 7 to 10 cm from the anal verge. Rectal examination can detect tumors, inflammation, and various injuries. Therefore, rectal examinations should be performed during annual health checkups. What conditions require rectal examination? 1, defecation habit changes: such as no obvious cause for the increase in the number of stools, constipation and diarrhea alternately, the feeling of incomplete defecation, stool thinning or deformation. 2, change in stool characteristics: thinning of stool, blood and mucus in stool. 3.Anal pain: common in anal fissure, perianal abscess, perianal abscess should be detected early and excised early to drain the pus, general anti-infective drug treatment is ineffective. 4, anal pus, fluid: may be the symptoms of anal fistula, finger examination can be clearly diagnosed. Anal fistula cannot heal on its own and requires surgical treatment. 5. Hemorrhoids: mainly manifested as blood in the stool and prolapsed lumps, which are easily confused with rectal cancer clinically, and can be differentiated by anal finger examination. What is the value of anal finger examination? To diagnose rectal tumors To assess anal function and determine incontinence To understand the extent of hemorrhoids To assist in the diagnosis of appendicitis To examine pelvic organs such as the prostate (male) and uterus (female) How is the finger examination done? Washing your hands and wearing gloves should be done before the physical examination. In some cases, an antiseptic gel containing alcohol may be added. Dry your hands and put on medical gloves. The second step is to reassure the patient and ask him or her to lie on his or her side. The procedure is awkward, so it is important to remain professional and reassure the patient. After briefly informing the patient, ask the patient to remove his underwear and lie on his side (usually left side down) with his knees bent and hands on his chest (similar to a fetal position). The examination can also be done while the patient is standing, but lying on the side makes the patient more relaxed and the examination easier. Having a friend or family member with the patient can reduce anxiety. Lubricate the index finger To avoid patient discomfort or shock, warm the lubricant appropriately before applying it to the index finger. The lubricant is also cool at room temperature and may cause constriction of the anal canal, making the examination more difficult. The goal is to relax the anal canal tissue as much as possible to reduce discomfort or pain during finger insertion. In some cases, local anesthetic may be used to reduce discomfort, especially if the examiner’s fingers are thick or the patient’s anal sphincter is tight. Step 4 Insert the finger through the anus. After lubricating the finger, spread the buttocks and slowly insert the index finger. The patient may be allowed to breathe deeply during the examination to relax and avoid contracting the sphincter. Rotate the finger slightly to facilitate insertion. Before inserting the finger, the anus can be quickly examined for lesions such as hemorrhoids, warts, rashes, anal fistulas, perianal abscesses, or anal fissures. After the finger is fully inserted into the rectum, the patient is instructed to contract the anus to assess the anal canal pressure. Step 5 Palpation for abnormalities When the finger is inserted into the rectum, palpation is performed with the index finger to determine the presence of abnormalities, such as abnormal masses, hard nodes, and ulcers. Tenderness at the anterior and posterior median often suggests a possible anal fissure, and the anus can be further peeled open to see if there is a fissure in the anal canal. An anal fistula is often indicated by an ulcerated opening outside the anal verge with a subcutaneous cord leading into the anus. The index finger is rotated clockwise and counterclockwise to fully palpate the entire circumference of the rectum. The prostate can also be palpated through the rectal wall (in men). In the anterior rectal wall, the prostate can be palpated in men and the cervix in women and should not be mistaken for a pathologic mass; nor should a pathologic mass be mistaken for the prostate or uterus. Differentiating the two requires some clinical experience. The prostate is located anterior to the rectum and has two lobes as well as a central sulcus. The normal prostate is smooth to palpation and is not painful to touch. If tenderness is positive, benign hyperplasia, infection or tumor may be present. Palpation of the prostate may cause the patient to have an urge to urinate. Rectal cancer can be palpated as a hard mass with uneven or cauliflower-like surface, pus, necrotic tissue and dark red blood, which may be accompanied by intestinal stricture and finger stained with dark red blood. Rectal polyps are soft and pushable masses that can be palpated, and the finger sleeve may be blood-stained and bright red. Internal hemorrhoids are soft venous masses that are not easily palpable, but if there is thrombosis, smooth hard nodules can be palpated. Anal fistulas can be palpated as cords, and sometimes small hard nodules can be felt in the internal orifice of the fistula. Perianorectal abscesses such as pelvic rectal gap abscesses and posterior rectal gap abscesses may be palpable as a painful mass in the rectum and may be associated with fluctuating sensations. Anal fissures and infections are intensely painful to palpation on finger examination. It should be pointed out that the proportion of low rectal cancer in China is high, and most of them can be palpated on rectal finger examination, but those with high location may not be palpated. Therefore, those who cannot be touched do not necessarily do not have rectal cancer, and further examination should be done in a hospital with conditions. Step 6 After finishing the examination, slowly remove the index finger and check whether there is blood or mucus on the glove. Then wipe the lubricant around the patient’s anus and remove the gloves. Give the patient paper towels to clean himself again and dress. To remove the glove, place the index finger of the other hand on the inside of the dirty glove and pull in the direction of the finger to remove the glove. The examination itself will not cause bleeding. If the glove is blood-stained, it suggests possible hemorrhoids or other visceral disease.