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The Dreaded Rectal Exam! (A Doctors Perspective)
Unlike the glamorous doctors portrayed in the likes of Scrubs or Grey’s Anatomy, being a doctor in the NHS if far from what you see on TV. I too was naive, distinctly picturing myself as one of those super-humans cast by Hollywood to save lives & charm nurses. Instead, the reality is that I’m more likely to be found behind a computer screen, bags under my eyes, dehydrated & disorientated – trying to avoid the Matron’s glare for not having prescribed the paracetamol she requested 20 minutes ago for her patient.
I’ve worked as a doctor for 2 years, in the role of a so-called ‘Junior Doctor’. In that time, I’ve worked in both hospitals & in the land of General Practice. In doing so, I’ve developed a distinct passion for men’s health. In particular, I found that I was able to make men feel comfortable talking about personal or embarrassing issues quite quickly, tackling the anxiety, stigma & reluctance from men to seek medical advice.
In turn, I’m going to cover a topic which personally – I’ve seen strike genuine fear & terror into the eyes of many men – the dreaded “rectal exam”. By doing so, I hope to explain why exactly we insist on performing such an unseemly act, but also what it’s like to be the one wearing the gloves.
Ok, so picture the scene: It’s 8pm & I’m about to start a 12 hour night shift in the hospital. In order to survive the night, I’ll need food, comfortable shoes & of course – plenty of lubricant. Why? Performing a rectal exam is inevitable. It’s an essential ‘routine’ examination that provides us with key clinical information, without requiring any special blood tests or scans. It’s simple, free & very fast – helping us decide the next step in the management plan.
So firstly, lets focus on the WHY? There are really only 2 reasons that we as doctors need to perform a rectal exam:
- There is a problem with the bowel: for example bleeding from the back passage, abdominal pain or a change in bowel habit. In these circumstances, I would want to assess if I an identify a cause for the bleeding/pain or perhaps feel any lumps or bumps.
- There is a problem with the prostate: The prostate gland is approximately the size of a walnut, located between the bladder & the penis. With age, it gets bigger & can obstruct the tube with enables urine to pass from the bladder to the penis [the urethra]. If this happens, it can cause hesitancy, poor flow or at worst – a total inability to pass urine.
So now that we’ve established the reasons why this examination is important, lets move onto the HOW…
Typically I’ll open with the line: “Ok Sir, so now I would just like to examine the back passage. This will involve me passing a single gloved finger into the back passage. It may be a little uncomfortable but it shouldn’t be painful – does that should OK?”.
Once I can confirm your consent, it’s essential that I ask for a chaperone to be present. This is typically a medical professional such as a nurse or a healthcare assistant, whom is simply there to observe my practice, given the intimate nature of the examination.
Next, I’ll stand behind the curtain/partition to allow you to undress & assume the appropriate position:- simply to lie on your left side, bringing your knees towards your chest. This simply helps open up the rectum – ensuring the prostate gland can easily be felt.
Meanwhile, I’ll wash my hands, down a pair of gloves & lubricate 1 finger. Once you indicate you’re ready for me to begin the examination, I gently insert my index finger, about 3-4cm within the rectum feeling all four walls of the bowel, to include the prostate gland which sits along the back wall of the rectum.
It total it lasts about 10-15 seconds.
So now what?
Based on what I find from the examination, I can then work out the next step in the management plan. For example :- If I found a haemorrhoid – then I could provide some reassurance & organise follow up with your GP. If I found an enlarged prostate, I would likely want to prescribe some medications & make a referral to a urology outpatient clinic. Or perhaps if I found a mass, I would want to order some scans.
Again, it’s important to emphasis that we perform this examination daily! Yet, people still ask, “Do you ever get embarrassed?” My answer is simple – No! Very little shocks me & it’s important that we as doctors make the patient the priority, ensuring they feel comfortable. We’ve seen it all before!
I hope this little insight has helped alleviate some of the fear that many of you men have surrounding this intimate examination. It’s nothing to be embarrassed about! At the end of the day, your health is key. After all, this examination only lasts 10 seconds, but has the potential to explain & enable us to treat your symptoms, ensuring you get the best quality of life possible.
For more information, please see NHS.health Or speak to your local GP.
Written By: Dr Sam HughesContinue reading →
Bowel Cancer Time Bomb As more Younger People Develop it!
Bowel cancers among under-50s in the UK have increased substantially due to poor diet and obesity – prompting calls to lower the screening age. Researchers have found that while incidents of bowel cancers in adults under 50 have increased over the latest available 10-year period, the levels for other age groups either dropped or remained the same. One study, published in the Lancet Gastroenterology and Hepatology journal, looked at colon and rectal cancer rates in developed countries such as the UK, New Zealand, Canada and Denmark.
In the most recent 10 years observed by the study – 2004-2014 – there were substantial increases, with incidents of colon cancer rising by 1.8 per cent and rectal cancer going up by 1.4 per cent on average each year for those in the UK. The study showed increases among those aged 30-39 for both colon and rectal cancer. The researchers found younger people born in the UK were now at higher risk of bowel cancer than older generations.
Across the same time period, the study found a decrease of 1.7 per cent in incidents of rectal cancer diagnosed in those aged 75 or over. Bowel cancer screening is currently offered on the NHS from the age of 50 in Scotland, 55 or 60 in different areas of England, 60 in Wales and 55 on the HSC in Northern Ireland. Public Health England announced last year it would be lowering the age to 50.
NHS advice suggests younger people with concerns can speak to their GP for advice. Dr Marzieh Araghi, the lead author of the study from the International Agency for Research on Cancer in Lyon, said: “Although the incidence of colorectal cancer in adults younger than 50 years remains much lower compared with that in older age groups, our findings are of concern and highlight the need for action to counteract the rising burden of the disease in younger people. “This rise in incidence among younger generations is likely to be driven in part by the changing prevalence of risk factors, such as obesity and poor diet.”
A second study, published in the GUT journal, found between 1990 and 2016 the number of younger people diagnosed with bowel cancer had risen at a steeper rate after 2004. Among 20 to 29-year-olds, bowel cancer incidents rose from 0.8 to 2.3 cases per 100,000 people between 1990 and 2016.
The sharpest rise was between 2004 and 2016 at an average of 7.9 per cent per year. For those aged between 40 and 49, bowel cancer rates fell by 0.8 per cent between 1990-2004 but then increased by an average of 1.6 per cent per year from 2004 to 2016.
TContinue reading →
Men An Unhealthy Lifestyle Can Lead To Dementia
Men, well we have been saying this for some while and now a large research programme by the World Health Organisation has found dementia affects some 50 million people worldwide and costs £632 billion annually to treat and in addition diagnoses are likely to triple by 2050.
To tackle this growing problem they have set out guidelines linked to overall health and wellbeing that were found to be most effective at reducing the risk of dementia.
Yes, it found that age was the strongest risk factor for dementia, but that it was not an inevitable consequence of ageing. It did find that lack of physical activity, smoking, an unhealthy diet and excessive alcohol consumption would significantly increase the threat of you getting dementia.
Medical conditions such as diabetes, high blood pressure, high cholesterol, obesity and depression also can have an affect upon developing dementia.Continue reading →
Kidneys – Let’s Debunk the Myths!
Ever think about your kidneys? Unless there’s something directly wrong with them, we don’t usually give them much thought. However, kidneys are incredibly important – they filter our blood to make urine and remove waste from our bodies. But they don’t always function correctly. Approximately 3 million people in the UK have kidney disease – that’s a lot of people.
However, there are many misconceptions surrounding symptoms, treatments and who is at risk and general awareness of the disease is poor. As a result of this lack of understanding, many people with kidney disease are in the dark when it comes to what to expect, with up to a third (1 million) going completely undiagnosed.
Dr Charlie Tomson, consultant nephrologist at Newcastle Hospitals and Kidney Research UK Trustee, filters the facts from the fiction, so you can focus on getting the best from your kidney health:
Myth: you will know if you have kidney disease
Think you will know when something is amiss? Think again. ‘Kidney disease, in some cases, is a silent killer,’ explains Dr Tomson. ‘This is because symptoms often don’t materialise until the disease is in its more severe stages. The human body is usually able to cope with a significant reduction in kidney function, and therefore, problems aren’t always spotted early on.’
Dr Tomson outlines the key warning signs to be aware of that can characterise kidney disease:
• Swollen ankles/ feet / hands
• Shortness of breath
• Blood in your urine
• An increased need to go to the toilet
• Back pain in the renal area
⚠️ If you are concerned about any of these symptoms seek medical advice as soon as possible.
Fact: there are multiple causes of kidney disease
Kidney disease has multiple causes, and often a combination of factors can lead to an individual developing it. ‘In some cases, long-term conditions which put a strain on the kidneys, such as poorly controlled blood pressure and diabetes, are the root cause,’ says Dr Tomson.
‘Other potential factors which can trigger kidney disease include large kidney stones, glomerulonephritis (kidney inflammation), and injury to the kidneys.’
Fact: kidney disease varies in severity
There are in fact five stages of kidney disease, which are determined by how quickly the kidneys clean the blood. ‘In stages 1 and 2, when kidney disease is caught early patients can go into remission after taking medication and amending their lifestyle choices,’ says Dr Tomson. ‘However, if a patient reaches stage 5 kidney disease, it usually means that they will need a transplant.’
‘Due to this, it’s really important to screen ‘at-risk’ people because treatment can delay the progression of kidney disease and even, in some instances, reverse its onset,’ he adds. ‘Many people with kidney disease are able to live a normal life, and just need to ensure they are managing their condition through regular check-ups, prescribed medication, a healthy diet and exercise.’
Myth: If you have kidney disease, you will need dialysisContinue reading →
Kidney disease can vary greatly in levels of severity. ‘Not everyone who is diagnosed will reach the stage in which they experience kidney failure and need dialysis,’ explains Dr Tomson. ‘Usually, our kidneys filter the blood, removing harmful waste products and excess fluid, and turning these into urine.’
‘However, if you experience kidney failure, your kidneys might not be able to do this effectively, and therefore, dialysis can assist with this process,’ he adds. ‘Thankfully, only a small proportion of those with kidney disease will reach this stage.’
Fact: kidney disease can be linked to diet
What you eat plays a vital role in kidney health. ‘Eating a healthy and balanced diet is important for all of us. However, when it comes to kidney disease, a good diet can have a huge impact on the disease and prevent complications,’ explains Dr Tomson.
‘Staying at a healthy weight and eating a diet low in salt and fat can help control your blood pressure, one of the main causes of kidney disease,’ he adds. ‘When kidney disease reaches its later stages, patients are likely to work closely with a dietitian to help manage their symptoms.’
Myth: only the elderly get kidney disease
You should take good care of your health at any age. ‘Kidney disease is commonly associated with getting older, however, it’s important to note that anyone at any age can get kidney disease,’ says Dr Tomson. ; Therefore, everyone should be aware of the signs and symptoms, eat a healthy diet and exercise regularly.’
Myth: you can cure kidney disease
Once kidney disease has reached a chronic stage, unfortunately there is no cure. ‘The aim of treatment is to help manage the disease by controlling symptoms, reducing complications and slowing progression,’ explains Dr Tomson.
‘Although most people who have kidney disease will need to take medicine to manage it, it’s essential that these people also exercise regularly, eat a healthy diet, reduce their salt intake and keep their blood sugar low. When kidney disease becomes chronic, dialysis or a kidney transplant can be the only options.’
Myth: urine infections cause kidney damage
If you have a urinary tract infection (UTI) while you should get it treated immediately, it does not necessarily mean you have anything more serious.
‘UTIs occur as the result of bacteria getting into the urinary system and multiplying,’ explains Dr Tomson. ‘This can lead to swelling, pain when passing urine, and urgency to go to the toilet. However, UTIs do not usually lead to lasting kidney damage if treated correctly.’
‘It is important to note that sometimes a UTI can be a sign of something underlying that can cause kidney damage, such as kidney stones.’ he adds.
Kidney Research UK is the leading UK charity committed to developing treatments, patient information and raising vital public awareness to help save lives.
Source: Net Doctor
10 Good Reasons To See Your Doctor. Number 5 – Yellowing Skin.
If you’ve ever seen a photo of a child who has turned orange from eating too many carrots, then you’ll know that what’s in our blood can sometimes show on our skin.
Vegetarians and those that love their greens tend to have an orange-ish hue to their complexion, but id someone notices that you are looking a bit yellow around the gills then visit your doctor.
When the liver isn’t working to full capacity, a banana-coloured substance called bilirubin accumulates in the blood, which shows up in the skin. It also makes the whites of your eyes look a bit golden!
Source: Benenden Be HealthyContinue reading →