Diagnosis And Treatment of Hemorrhoids And Other Non Malignant Rectal Diseases
Diagnosis And Treatment of Hemorrhoids And Other Non Malignant Rectal Diseases
William Penn Agnew
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73 in place, thereby giving tbe operator the freedom of both hands. Introduce the speculum slowly, giving the muscles time to relax, bearing in mind that all movements about the rectum and anus mu?t be extremely easy and gentle. For the first inch the speculum should be directed, or pointed toward the navel of the patient, then toward the hollow of the sacrum. The proximal end of the slot of the speculum must be carried and kept above the external sphincter during the examination. It matters no...t what kind of a speculum is being used, the value of the instrument will Fig. 20. — Author's Rectal Speculum. greatly depend upon its power to hold this muscle out of the way. When examining above the internal sphincter, especially posteriorly, where the bottom or floor of the rectum forms a cul-de-sac, direct the patient to strain down a little. This effort will throw the mucous membrane out into the specu lum, and at the same time spread out and smooth its sur face. In looking through a speculum this cul-de-sac of the rectum sometimes appears as a vacancy behind the internal sphincter, and has been mistaken and treated as an ulcer 74 RECTAL EXAMINATION.
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