Rectal exam for appendicitis

When I was 9 or so, I got a terrible stomach ache, vomiting and all. Mommy called the doctor (in those days, they still made home calls and the state health insurance paid for it...). I remember the lady asking my mom for vaseline (which I knew about because mommy used it on little bro's thermometer when he was sick). I was really surprised by what followed - a finger up the butt palpating me from the inside.

I got a second rectal exam (same position, no surprise thus) from the surgeon at the clinic, which, in addition to various probings, confirmed I had appendicitis.

I was about 13 when I got sharp pains in the lower abdomen and in those days the doctors still made house calls. I had my pj pants lowered and had him press on my abdomen which hurt and made me feel sick. Then I was turned over and given a rectal exam which hurt and was told I had to go to hospital. In admitting I was examined again including another rectal exam and then admitted. As if this wasnt enough a while later the surgeon came and examined me again and then I was prepped for theatre

I was positioned on my side with my legs drawn part the way up for my exam

Around 14 had a lower stomach ache for a few days, went to my reg dr & he had me undress completely like he usually did, examined abdomen then had me roll over and position on my knees on the table without warning. He inserted his finger into my rectum, he had a large finger and I remember crying out in pain. I would have rather dealt with the abdomen pain as I can remember my rectum being sore for several days after

When I was a child, I once became very sick. Fever, vomiting, could not eat anything. The doctor came, examined me, palpated my tushy... Then at some point she talked to my mother and I distinguished the word "vaseline". She put on some latex glove and told me to adopt a kind of weird squatting position. Then she told me to push as though going potty.

I was naive and when the finger came up my butt it was a total surprise. Not that the penetration was unpleasant, at least until she started to push on the appendix (she was pushing locations inside and I was to say when it became painful). The finger slipped in easily, probably due to the position, the pushing and, I suppose, a large dose of vaseline.

Those of you who had suspected appendicitis, did you undergo that exam? I heard that nowadays it's replaced by some imagery.

A rectal exam is part of the evaluation for any abdominal pain or abdominal trauma.

What's funny is that my main remembrance of this exam is not the pain when the doctor pressed on the appendix, but the surprise at feeling the finger entering. She had not told me what she was going to do, though if I had been older I could have guessed (position, "pushing like going potty", asking for vaseline).

I had an emergency appendectomy several years ago. I remember running the usual gamut of tests while in the emergency room but I did not have a rectal exam. As you can imagine I was in quite an amount of agony and the responding staff seemed confident in the diagnosis so in this situation I was thankfully bypassed that procedure.

Technology has taken over. Physical examination has been supplanted by the likes of blood tests and imaging.

Curly, it's more direct than that. The doctor told me to say when it hurted, then pushed in several directions until I said ouch. Then she seemed sure of her diagnosis. I assume that it was the direction where the appendix usually lays.

I got the same exam from a surgeon at the hospital, but then I was not surprised anymore.

Rectal exams were done to see if pain was worse on the right side. This was highly suggestive of appendicitis. This is no longer done because it causes unnecessary pain to the patient. Imagining techniques such as CT or ultrasound are used instead.

Sure, why subject the patient to a moment of discomfort when you can get a $1000 test done.

A rectal exam is part of the evaluation of an acute abdomen in the absence of extenuating circumstances. I understand that imaging techniques are a huge advance in medicine and no one is happier than I am. Many times I wished for better diagnostic approaches before they came of age and CT/MRI/ultrasound etc are fabulous. But I'm probably betraying my "old school" training and ancient medical school graduation date when I say that I am also saddened that physical diagnostic techniques I was taught are pretty much disappearing. I work with medical students in community clinics at which I still volunteer and their physical diagnostic skills are, in the words of my former physical diagnosis class professor, "weighed on the balance and found wanting." Better they may be...modern testing methods...but it also goes a long way in explaining why medicine in the U.S.A costs many times what it does in any other country. Avoiding malpractice litigation drives a lot of this I believe. I know doctors from the U.K and, by and large, they seem more likely to know which end of a stethoscope goes in the ears than more recent U.S. graduates. I don't mean to offend any recent graduates...I do know some who have gone out of their way to improve upon the diagnostic skills they initially were taught. I just mean that it is deeply satisfying to do a good history and physical and make the diagnosis without a lot of additional, expensive tests.

~ Rayme

Rayme

It is both fortunate and unfortunate that equipment and technology is replacing know-how.

Fortunate because so few people today have any know-how.

Unfortunate because in the absence of high tech equipment, the majority of people will be lost and unable to perform their function.

I had to teach students recently that the cloth strip on the BP cuff is to attach the dial. You don't need three hands (one of them the patient) to take a BP.

One student needed instructions on how to hold the inflation bulb so you can inflate and turn the deflate knob without repositioning the bulb in the hand.

I had to teach students recently that the cloth strip on the BP cuff is to attach the dial. You don't need three hands (one of them the patient) to take a BP.

One student needed instructions on how to hold the inflation bulb so you can inflate and turn the deflate knob without repositioning the bulb in the hand.

I rest my case! 😁

I was just thinking today that soon there will be no one who remembers how to do anything anymore. No one fixes cars as a hobby, no one repairs clocks or watches. The internet is the perfect hobby, the perfect boyfriend, the ultimate partner, babysitter, coach, teacher, friend..... Going OUTSIDE for anything for the newer generations is a foreign concept, or soon will be. Kids sure don't go out and play anymore.

I'm glad Pecan nutjob posted his experience, because I had a similar experience as a 12 yr old kid. Had nearly completely forgotten about it. This was also many years ago, so perhaps more modern diagnostic techniques would have replaced it. I'd been having intermittent pain on my lower right side. So the doctor who ultimately became my surgeon inserted a well lubed finger into my anus and rectum. But he had me on all fours. He concentrated his finger movement and pressure where my appendix was, and there was no doubt sharp pain when he pressed there. I had my appendix removed a couple days later, and the pain never came back...guess his finger diagnosis was correct!

Liquidsky: To be fair the pain when the doctor pressed in the "right" direction was not unbearable. In fact, what I remember about that exam is the "surprise" effect: I had not been told what would happen, so the finger slipping in was a surprise. Not painful at all, she had me in a position that relaxes the anus, had told me to "push" and, it seems, had used tons of vaseline, but highly surprising. I had never thought it possible to shove a finger up there.

In fact I suspect that this episode inspired me for my (much later) teenage anal fantasies.

EnemaGuy: Ah, on all fours? In my case, weird squatting position that (I later understood when thinking about it, but on the moment I did not understand why she wanted me to sit that way) relaxed the anus. At the hospital the surgeon had me in exactly the same position. I suppose that's what medical school taught was the best way to examine a child my age.

What I found a bit annoying (and I still feel that way, for ethical reasons) is that neither my GP neither the surgeon explained what was going to happen. My GP could have easily said "I'm going to insert a finger up your anus, this won't hurt" but did not. Oh, yes, she talked to my mother before, she probably said "toucher rectal" but at that age I did not know what that meant.

Around 3 years ago over Christmas I developed right sided tummy pain . I went to my GP who carried out just an abdominal exam and said I had a urine infection . A few days later I was back in his office , struggling to walk as I was in so much pain. I didn't vomit once but had really bad nausea .This time he had me lay on the exam bed . He palpated the tummy and I complained when he went anywhere near the appendix area . He then asked me to pull my trousers and pants down and turn on my left side . I did as he requested and then he told me to relax as he was going to do a rectal exam . I heard him snap on his gloves and then I felt his finger go up my rectum .

He felt around for a minute and removed his finger . He asked me to dress as he washed his hands . He then wrote me a letter to go to the hospital. Within a few hours I was in theatre getting my appendix removed .

Come on. I know perfectly well how to use a DRE to diagnose appendicitis. The point is that every surgeon wants a gold standard diagnostic test to prevent unnecessary surgery. It could be something else! Why not try to find out what it is?

Liquidsky: Sure. Keep in mind that the first doctor I saw was a general practicioner on home call, so she did not have access to imaging equipment. She basically just took a plastic glove out of her bag and, I think, asked my mom for vaseline.

@enemaguy434, I had a similar experience when I was in college. On more than one occasion, when I was complaining about abdominal pain, but no nausea, one of my uncles, who was a general surgeon, paid me a visit. He had me on all fours and performed the DRE to check for appendicitis. As is turned out, I never did have appendicitis, never did have surgery, but I do remember that exam vividly to this day.

Come on. I know perfectly well how to use a DRE to diagnose appendicitis. The point is that every surgeon wants a gold standard diagnostic test to prevent unnecessary surgery. It could be something else! Why not try to find out what it is?

I don't think the point was that you don't know, it's about medicine's over reliance on technology at the cost of simple, free diagnostic techniques. LRQ rebound tenderness with nausea, fever and high white count? You really don't need a CT scan, just head for the OR.

I've seen other things than an acute appy found at laparotomy. Mesenteric adenitise which is non surgical can present as an acute abdomen.

When I was a child there was none of these coelioscopic techniques so it was laparotomy and thus a looooong recovery if only because of the muscles. I would have been pissed if the surgeon had said "ew, it was not appendicitis". ;-) So hooray for coelioscopy and better diagnosis techniques.

Liquidsky, Of course you know how to do a DRE and evaluate for appendicitis. I too have seen mesenteric adenitis and as I said in my earlier note, am truly grateful for the advanced imaging we have nowadays. I think my rant was more in the line of general pissing and moaning about where technology is taking us and the clinical skills that just don't seem as relevant as they used to. A little humanity is gained (diagnostic accuracy) and a little is lost (use of our cognitive skills).

~ Rayme

Rayme^^^That's the thing--not everyone sees this in those terms ...mores the pity as generally one relies upon a physicians knowhow & skill in determining diagnosis...personally I think both still have relevance & should remain so.

DRE's as hopefully most would know is one of the most basic & simple forms with detection...coupled with modern imaging generally eradicates problems for both physician/surgeon & patient...Technology in conjunction with a hands on approach would best satisfy any doubts I would think.

My first rectal exam was for expected appendicitis. My sister had had her appendix out not too long before, so when I started having bad stomach pains and difficulty with my bowels, my folks brought me into the ER. The doctor palpated my stomach, and I was running a low grade fever. Then he had me turn onto my left side and raise my right knee. In went his finger, feeling every part of my rectum.

He determined that it was probably not appendicitis, but simple severe constipation. He prescribed suppositories and told my folks to bring me back if I got worse. My Dad gave me the first suppository (I had never had one to my knowledge) and taught me how to put them in myself. That was actually more embarrassing than thee exam!

Eventually, with great difficulty, I evacuated my bowels. The irony is that 40 years later, I still have my appendix.