Proctoscopy

Proctoscopy is usually an office examination that is less commonly performed these days because of the easy availability of flexible sigmoidoscopy. It is still useful for assessing the rectum, for determining the location of a lesion within the rectum, and for the follow-up of previously treated rectal lesions. Rigid proctoscopes can be metal or plastic. They come with an insufflating attachment with a bulb that is attached to an occluding plug that jams into the end of the scope and has a glass lens. Patient are given 2 fleet enemas and then placed either in steep head down position or in left lateral position. (the head down position allows the rectum to be distended more easily and the scoped passes straight in). The obturator is inserted, the anus is lubricated and the proctoscope is inserted into the vault of the rectum. It is important to follow the anorectal angle by pointing the scope posteriorly as soon as its tip is through the anus. The scope should pass with no resistance. The obturator is then removed, and the insufflator used to distend the rectum with air. The rectal walls are then inspected systematically, noting the three rectal valves, and the mucosa itself. Residual stool or liquid can be aspirated, and lesions can be biopsied. Proctoscopes are calibrated for length and come in three different sizes. The exam is generally well tolerated.