The Anal region
Examination of the Anus
Throughout history, the idea of good bowel function has been a mental image of good health, and practically every human malady has at some period been judged better or worse, depending on the answer to the question, “How are the bowels?”
Bowel concern begins at birth, and grows to real awareness in mature years when activities begin to slow down, but it is in the senior years that good health is “proved” by statements claiming “wonderful bowels.” This picture in our minds that good health and good bowel function are closely associated is based largely on facts reflecting age, activities and physical abilities and probably not even the space age will greatly re-shape this idea. Diseases of the rectum and anus have always been vexing problems, often producing great pain and always demanding great sympathy. When Louis XIV had his rectal operation in 1686, his many attendants were ordered to wear bottom bandages out of sympathetic respect. Happily, treatment of rectal diseases today is held in great esteem everywhere.
Finally, the social aspect of bowel function has a great impact on modern living. Universal demand has brought about the scientific advances of modern plumbing, privation and sanitation, as we now know them, and the lack of these advances more than anything else would make our urban world of today nearly impossible. To view the anus directly, uncover the anal region and assume a squatting position eight to ten inches above a mirror lying on the floor. This will give a clear view of the anal region,
Fig. 120. The anal region normally reveals only the small, indented, puckered anus in its closed position. It is impossible to voluntarily open the rectum, but it can be stretched open by oncoming bowel matter or instruments introduced from outside.
The normal anus is a small, puckered and indented opening. It remains closed because the anus cannot open itself except by having something forced through it. Straining will make the anus stand out slightly and appear a little larger than usual. Its color and hair distribution follow individual body characteristics.
1. Examine the skin surface of the anal opening without straining. Observe any large skin folds, any distended veins, or any sore irritated appearing spots. Observe also the existence of any generalized irritation of the entire anal region. These findings may be indications of disease as external hemorrhoids, mere skin flaps, or anal itching, technically known as pruritis.
2. Note the contour of the anus and surrounding skin when straining. Observe any mass protruding from the anus, any pus or blood from the anal opening, or from a pimple-like opening near the anal opening. These findings may in
dicate internal hemorrhoids of fistula formation.
3. Observe the skin forming the anus itself. Examine upon straining for any raw, split appearance in the folds of anal skin. Such a skin crack is possibly a fissure.
4. Note the texture of the skin of the anus and its surroundings. Look closely for any whitened, thickened, water-soaked appearing skin of the anus and surrounding skin. Also look to see if there is any clear, water-like discharge
