Rectal exam for appendicitis

Rayme I can't agree more. So many young docs are unable to perform basic physical exams. In addition I concur with the notion that if you don't know what the patient has by the end of the history you're in trouble.

When I was 12, I had had severe stomach pains for about 6 hours. My dad finally took me to the doctors house at about 7 in the evening. He did a quick rectal and said I needed an enema and that would take care of it. 5 hours later I was in emergency surgery having my appendix out....

When I was 15 I went to the ER with pain in the abdomen. The intern and residents all had their turn giving me a rectal exam. They decided it was not not my appendix and I still have it.

Yes, most anything abdominal today is diagnosed by CT, with or without contrast. I went through diagnosis and testing for colon cancer without even a DRE or any enema. No BaE, just drank several cups of barium, til it started coming out the south end, then the CT. My recent AAA repair and follow up was by CT with IV contrast. I think the days of BaE's are about over.

My 1957 exam before my appendectomy included many Docs doing DRE's on me and a pre-op enema at home before heading for the hospital.

When I was around 12 or 13 I was having really bad abdominal pain. My mom took me to my aunts house for her to look at me. She was an RN and mom frequently asked her opinion on medical matters. She took my vitals and examined my abdomen. Then she told me to roll over onto my side so she could do a rectal exam. I was nervous and embarrassed but did as she said. She pulled down my underwear and told me to bring my knees up to my stomach. Then she said to relax and I felt her finger slowly entering my anus. She moved it around a bit and then pulled it out. She said that there was no blood and that was a good sign. When she was finished she told my mom that I was constipated and the pain was caused by gas. Next came a series of enemas, but that's for another story.

I had a friend who developed severe abdominal pain while at boarding school They thought he might have appendicitis but kept him for observation. That evening they gave him an enema and the abdominal pain disappeared.

Herrdoktor

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.

Well, hardly anyone can saddle up and bridle a horse anymore, or keep a musket in good order or make their own ink or work a mimeograph and so on ... things just change and technology moves on. There is only so much any one person can learn to do in their lifetime.

It's technologies that are on the verge of or that have just become obsolete, that people get nostalgic about.

I've since then been told that rectal exams are no longer done for diagnosis appendicitis, due to the availability of high-precision ultrasound. When did this change?

Aren't they even used for quick screening before asking for the ultrasound? (my first rectal exam happened at home, where our G.P. would not have had ultrasound available)

At age 11 I was showing signs of an inflamed appendix. At the Ped's office I got a DRE on my back. He Rx'd some antibiotics and they worked. About 6 months later it came back and the Ped made a house call where he did another DRE on me and concluded that I needed surgery.

He told my mom to give me an enema before taking me to Children's ER. Once I was in the ER, about 7 residents and interns repeated the DRE's. So did the surgeon. He told my mom that he'd get them to give me a pre-op enema in the ER. She quickly told him I had already had one at home. He said OK and they gave me a Demerol injection in the behind. In a few minutes I couldn't care less what they did to me.

Years later, as a medical sales rep I was allowed to spend a weekend in a local ER to observe all that they deal with. A boy about 17 came in with lower, right quadrant gut pain. An attending and a resident examined him as I watched. They did belly rebound checks (which were positive), white cell counts and concluded that he needed to be sent to the OR. Afterward, the resident said, "I guess I did everything alright, didn't I?" I said "You could have done a DRE to see if he had pain when you pushed on the right side of the rectum." They both said, "Yeah that would also work." (If that patient had been a female, they would not have allowed me in the examining room).

Just over three years ago I was diagnosed with appendicitis. I went back and forth to Drs for almost two weeks in agony. I wasn't vomiting but had the lower right quadrant pain and the rebound pain. Not once on my visits to my GP was I given a rectal exam.

The 4th and final time of going to A & E I was given a gown, iv antibiotics and admitted. I was NIL by mouth immediately and placed on a fluid drip. I was sent for a CT scan and given numerous abdo exams and blood tests. Not once was I given a rectal exam.

Nikki

Back in the mid-80's I was experiencing some abdominal discomfort along with cramps and light headedness. I went for a day and even went to a social event one evening. After returning from that I finally told my wife to take me to the ER.

Once there they proceeded to give me an abdominal x-ray. After that was developed an ER doctor came in and said it was negative for appendicitis, but had me turn on my LH side in the SIMS position and did a thorough DRE while probing as high as he could. He would ask if I was experiencing any pain to which I answered negative. They finally sent me home with the diagnosis of likely gastric upset from unknown causes.

The next day I was feeling better and went back to work.

I was 14 then I had my appendix out. No waiting for me. Our doctor felt my abdomen, took my rectal temp and the next thing I knew, i was in the hospital. I really don't remember too much about the pre-op enema, but I sure do recall all those rectal temperatures afterward!

I had my appendix taken out about 15 years ago. Went to the doctor with bad stomach cramps, feeling really bad. The nurse listened to my belly with a stethoscope, she left the room right away then the doctor showed up a few seconds later and had a listen. He said my bowels were not making any noise (shut down I am guessing?) He then asked me to lower my pants and he was going to do a DRE, up his finger went and he pressed this way and that way asking if I felt any pain. I didn't really feel any pain from that at all. He told me he thought it was my appendicitis.

I then had to go to another place and get some blood work done to see if my white blood count was up to confirm. Sitting in the waiting room for several hours feeling worse and worse. And it came back as yes the count was up. Off to the hospital I went, They started an IV and that doctor pushed on my belly and confirmed what the first doctor said, no ultrasounds no enemas nothing like that.

A few hours later I was in the operating room and the doc was showing this camera and explaining how he was going to go in and pull it out of my belly button. (laparoscopic) Still I was in a lot of pain but still had an interest in what was going on and wished I could have watched. Next thing I knew I woke up, I felt awful from the meds that put me under that was the worst. But I knew rite away that the pain from the appendicitis was gone.

As a youngster of I think 13-14 my mother was thinking appendicitis, but after a blood test the Doc didnt think so. After a DRE and an x-ray I was scheduled for a barium enema. That was the ultimate embarrassment for a young teen boy.

Thankfully Mom stayed in the waiting room --- the end result was nothing to report and I didnt seem to have anymore bad cramping after that B.E.--- even to this day, didnt know what caused the cramps.

I had an emergency appendectomy when I was 15. I just remember being doubled over on account of the abdominal pain. When the doctor saw me, he just did a quick abdominal exam, palpating my right side, asking if it hurt when he pressed down. (And boy did it ever!) I was quickly rushed to the nearest hospital OR. But that exam was enough for him to make the diagnosis--no DRE in this case.

I remember I was 11 and had severe abdominal pain. In the ER they had me take off all my clothes and put on a gown. Then a parade of interns and residents came by to feel my abdomen and do rectal exams. The first time was a real shocker. It turned out I did not have an appendicitis.

It seems to be an aspect of being evaluated for appendicitis. Thankfully, I didn't have that but it was necessary to rule it out when I felt really sick and experienced considerable abdominal discomfort. At that moment, the trip to the ER while scary was needed and resulted in my being fully disrobed and subjected to a DRE. All things considered, it was better than surgery and not too terrible even though I didn't fully understand how doing a rectal told the doctor anything about my appendix.

When I was in college, I suffered from chronic lower abdominal pain. On those occasions when it became worrisome, my uncle who was a surgeon came over to check me out. After asking the usual questions, he checked for rebound tenderness in the lower right quadrant and then performed a DRE. He told me that with a hot hot appendix, I would have hit the ceiling when he probed. Fortunately, on each occasions the exam proved negative for appendicitis, but I have not so found memories of those occasions.

When I had my emergency appy done about 4 years ago now I did not get a rectal. They put me in a gown, the doc came in pressed for rebound tenderness. Then the nurses came in and pulled me off the ceiling and then the x-ray folks wheeled me down, did my scan and took me back to the ER, started an IV then took me down to surgery I believe. And that's pretty much all I remember until I woke up and called Doc. But no rectal for this girl, at least not on that trip. When I had colitis yes they did, and I was so very not happy about that either, lol. Trust me on that.

Mashie

Modern medicine with all kinds of diagnostic tools is safe and painless, but for a medfet like me, so boring as well. Would have enjoyed a docs visit may be in 80s when diagnosis used to depend more on Doctor's clinical skills and everything would depend on her judgement. Feel, we miss those days

No rectal for me when they suspected appendicitis. They did abdominal palpation and appendix test, then they did a ct scan. Negative, i had a cyst.

I could understand perhaps many years ago it was a diagnostic tool to rule out diverticulitis, bowel obstruction, etc. Although if you think about it the colon follows to the patient's left side if you follow from the rectum, which is the opposite of where the typical pain is for appendicitis, so to me it doesn't sound like a very reliable diagnostic tool (but if there is a MD or other knowledgeable person here let me know otherwise).

Definitely though with advances in X ray, CT, MRI, ultrasound, there are so many more diagnostic tools that can confirm or deny appendicitis. Plus from a time stand point a DRE simply delays getting tests done that can actually confirm a diagnosis.

Glad as a paramedic I won't have to do this lol.

In the UK ultrasound is used often to assess for appendicitis, but we were told by the person scanning if they see it then it's appendicitis but not seeing doesn't exclude appendicitis. And the way we were told by the dr that symptoms with high inflammatory markers in blood test was more important then scanning.

Here MRI scanners in emergency situations are not readily available and if younger patients it's best to avoid CT if possible due to high radiation.

Speaking only from personal experience, no rectal exam was performed and whilst we went for an ultrasound scan I got the impression based on symptoms and bloods they had already decided it was appendicitis. The ultrasound scan was more to rule out other causes.

Again any one with actual medical knowledge please wade in and correct me.

When in 1989 I went to the ER because I was in so much pain that the ER called my Gastro Doctor in and that first thing he did to me was a DRE, then after that he had blood taken to see if white count was up. He then told me he wanted to admit me to the hospital, then in the morning he would do a Cat-scan on me. I really didn't want to stay at the hospital so I promised him I would come back the next day for the Cat-scan so he let me go home after he gave me something for the pain.

I came back the next day for my Cat-scan and when he told me I had a hot appendix that I needed emergency surgery. I had to call my step dad and tell him not to pick me up that I was being operated on in a few hours for a appendicitis and that I would call Mom later and her know how it went when I woke up.

Boy when I started coming around the surgery where they had cut me really hurt me a lot. Well that is what happened, was in hospital for 5 days afterwards. 😃

I have seen it done before.

I didn't have a rectal exam before my appendectomy. They just did an abdominal, urine and blodd test and made an ultrasound exam.

I had my appendix taken out about 13 years ago when I was mid 30's. I went to the ER in the middle of the night in severe pain. The nurse had me put a gown on (with underwear) and took my vitals. Little bit later the doctor came in, asked me some questions, looked at my stomach, palpated my stomach for maybe 5 seconds, and told me it was my appendix and that it needed to come out. No imaging, no rectal. A couple of hours later I was in surgery. My appendix ended up rupturing at the beginning of the surgery.

About 14 years ago I was in my early 30's when I went to the ER in the middle of the night for abdominal pain. The doctor asked a few questions, pushed on my belly in a couple of places, then told me I needed to have my appendix out ASAP. No rectal exam, ultrasound, or any kind of imaging needed.

I've had plenty of rectal exams but none for appendicitis. A few years ago when I complained about abdominal pain I didn't get a rectal exam. I was sent for an abdominal ultrasound. They didn't find anything and I still have my appendix.

This was the reason for my first rectal exam back when I was 12, which I've written about here many times previously. Similarly to some others here, the doctor, a well-meaning yet awkward fellow--never really in clear English explained to me what he was about to do. He just told me he was going to do a “rectal exam" and said I needed to lower my pants and underpants for it.

If memory serves he wasn't even sure how he wanted to position initially. At first he told me to lie on my back (was he going to do it diaper style?), before changing his mind and telling me to get into what I now know is Sims position. Then I felt something thick and gooey penetrating my bottom. He would ask, “Does it hurt?”, and I didn't really know what to say--it was certainly uncomfortable and humiliating, if not quite painful. Then he would penetrate further and ask the same question all over again. You have to understand I had no idea that he was inserting a gloved finger into my rectum. For all I knew, it was some kind of tube. I can't believe how in the dark he left me, but this was 37 years ago.

In early 2000 I also was suspected of having appendicitis and the campus doctor (I had recently started graduate school) sent me to the ER across the street. I wouldn't call this time worse because I knew what a rectal exam was by this time, but it was still quite unpleasant. The resident was smug and they did it right next to someone else who was lying on a gurney, though he admittedly didn't seem very conscious. Neither time was it appendicitis, incidentally.