What examinations are performed in proctology?

Oct 15, 2025 Source: Cainiu Health

Dr. Li Jingxiang

Introduction

In general, proctological examinations focus on conditions involving the anus, rectum, and perianal area. Common procedures include visual inspection of the anus, digital rectal examination, anoscopy, colonoscopy, and anorectal manometry. Patients do not need to be overly anxious during the examination; simply follow the doctor's instructions regarding positioning. If abnormalities are detected, it is important to promptly follow medical advice for further treatment, avoiding delays in diagnosis and management due to fear of the examination.

Generally, proctological examinations focus on the anus, rectum, and perianal lesions, and commonly include visual inspection of the anus, digital rectal examination, anoscopy, colonoscopy, and anorectal manometry. Specific details are as follows:

Visual inspection of the anus: This is the most basic non-invasive examination, in which the doctor visually examines the anal region and surrounding skin. The patient assumes a knee-chest or lateral position while the doctor checks for signs such as redness, swelling, fissures, external hemorrhoids, fistula openings, or prolapsed tissues. The perianal skin is also examined for eczema, pigmentation, or abnormal discharge.

Digital rectal examination: A simple yet crucial palpation test. Wearing sterile gloves and applying lubricant, the doctor inserts the index finger into the patient's rectum. By touch, the physician evaluates whether there are masses, indurations, or tenderness along the rectal wall, assesses the tone of the anal sphincter, and may detect rectal polyps or internal hemorrhoid nodules.

Anoscopy: A direct endoscopic examination to visualize the lower rectum and anal canal, using either disposable or sterilized anal specula. With the patient in a knee-chest position, the doctor slowly inserts the anoscope into the anus and examines the mucosal lining for signs of congestion, edema, or erosion. This procedure helps identify the location, size, and number of internal hemorrhoids, as well as ulcers, polyps, or tumors.

Colonoscopy: A comprehensive evaluation of the entire colon and rectum using a flexible electronic colonoscope inserted from the anus to the ileocecal junction. Prior to the procedure, patients must take laxatives to cleanse the bowel. The doctor visually inspects the mucosal surface of the entire colorectum to detect inflammatory changes, polyps, tumors, and other abnormalities. Suspicious tissues can be biopsied, and small polyps can be removed during the procedure.

Anorectal manometry: A functional test assessing anorectal physiology. A pressure sensor is inserted into the rectum and anal canal to measure pressure changes at rest and during defecation maneuvers. This test helps evaluate the function of the anal sphincter muscles and aids in diagnosing functional disorders such as outlet obstruction constipation and fecal incontinence.

Patients need not feel overly anxious during these examinations; simply follow the doctor’s instructions regarding positioning. If abnormalities are detected, it is important to promptly follow medical advice for further treatment, avoiding delays caused by fear of the examination.

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