Revision of the anatomy and physiology of the sigmoid colon, rectum and anus

A basic understanding of the potential complications for spinal injury patients in relation to bowel care.

Rectal examination is used as a diagnostic aid when there is:

An experienced nurse who has undergone appropriate training may perform a digital rectal examination as part of the assessment process for severe constipation (Royal College of Nursing 2000). This procedure assists the nurse practitioner in the decision-making process when choosing an appropriate laxative or enema (see ‘Enemas’, p. 129 and ‘Suppositories’, p. 321 for further information). The nurse practitioner may also use this procedure to remove faeces present in the lower rectum if appropriate.

The medical or nursing practitioner will put a disposable glove on the dominant hand and apply some lubricant to the fingertips. He or she will then insert one or two fingers into the patient’s rectum and perform the examination. On completing the examination, the practitioner will remove the glove by turning it inside out as he or she takes it off. A lubricated rectal speculum may be inserted by a medical practitioner and, using the light source, a visual examination carried out. An anal or rectal swab may also be taken for laboratory examination.

Digital rectal examinations (DREs) must be performed with caution on patients with a spinal injury at T6 or above. A DRE can stimulate the vasal nerve, causing the heart beat to slow and blood pressure to fall. The patient may demonstrate a flush over the upper body and experience a sense of impending doom. This is known as ‘autonomic dysreflexia’ and requires prompt medical attention.

It is important to note that this is an invasive and embarrassing procedure for the patient. Care and consideration should be taken by the practitioner at all stages of this procedure, remaining alert to potential issues that could arise, e.g. previous radiotherapy to this area, detection of a previously undiagnosed rectal carcinoma or a past history of abuse.