Unlike a trip to the hairdresser or GP, not many of us are familiar with what happens during a rectal examination when they visit their pelvic physiotherapist. We understand that a rectal examination is not the most comfortable experience and so hopefully this article can provide some answers to the questions you may have.
What exactly is a rectal examination?
A rectal examination is a type of pelvic floor assessment that allows your pelvic floor physiotherapist to assess externally and internally some important parts of your pelvic floor via an internal exam. During the procedure, a gloved and lubricated finger is inserted into the anal canal to assess the internal parts of the pelvic floor which are otherwise not able to be assessed externally or through other methods such as a vaginal exam.
This allows your pelvic floor physiotherapist to assess your pelvic floor muscles, hip muscles and anal sphincters to give us the whole picture as to what is causing or contributing to your symptoms.
Why and when would I need a rectal examination?
First of all, there will always be thorough history-taking and education and advice about what may be causing your symptoms and the relevant parts of your pelvic anatomy (including the pelvic floor, anal sphincters and any other relevant structures). A rectal exam may not occur during your first, second, or even third session. You and your pelvic floor physiotherapist may choose to address other areas of management first.
Conditions that often benefit greatly from a rectal examination include many bowel or anal conditions such as faecal incontinence or difficulty controlling one’s bowels, chronic constipation, anal pain syndromes such as levator ani syndrome, postnatal pelvic floor for those with anal sphincter injuries, and also (and often not thought of as much), those experiencing tailbone (coccyx) pain.
Here is a step-by-step guide of what happens during a rectal examination. Remember you and your physio may choose to assess around the pelvis and other areas first and a rectal examination doesn’t always happen on the first appointment.
Firstly, all steps will be clearly explained by your physiotherapist, and they will gain your consent. We can always modify or change parts of the consultation to make you more comfortable, and if you change your mind at any time during the examination, that’s OK too! While we understand it is not a comfortable examination, it should not be painful.
You will lie on your side like you are sitting in a chair with your lower half covered by a towel, and the physiotherapist will first look externally around your sacrum, tip of tailbone and anus (they may also “palpate”, or feel certain external structures). Your physiotherapist will then guide you through slow deep breaths into the abdomen to help your back passage and pelvic floor automatically relax.
Then when you are ready, your physio will gently insert a gloved and lubricated single finger into the anus. They may ask you to squeeze around your back passage as if stopping wind a few times. Then, they may assess other structures such as pelvic floor and hip muscles, or your tailbone by sweeping their finger over the areas. They may also ask you to contract and relax your pelvic floor, or hip or anal sphincter muscles to check their co-ordination, endurance or strength if needed.
At the end of the examination, all your findings will always be explained to you in detail, how they contribute to your symptoms, and then a treatment plan is discussed and agreed upon by you and your pelvic floor physiotherapist.
While a rectal exam can seem a little daunting, it can often provide incredibly valuable information on what is causing your symptoms, which is then used to guide your treatment.
Remember, everything that happens in the consultation is always up to you, you are in control at all times, and our clinicians will be guided by you, always.
If you have any questions about rectal pelvic floor exams, or bowel conditions, feel free to reach out as we are here to help.
Written by Tusanee Jierasak
