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Patients' views of medical positioning for proctologic examination.

Gebbensleben O, Hilger Y, Rohde H - Clin Exp Gastroenterol (2009)

Bottom Line: Randomized patients favored the knee-chest position more after experiencing it compared to those without experience (P < 0.03).Individual answers to the question 'which position do you find most embarrassing?' did not depend on sex or age at first examination or when their last examination was performed.The medical profession is authorized to use the proctological positioning that allows the most reliable anal diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Park-Klinik Berlin-Weissensee, Innere Abteilung, Berlin, Germany;

ABSTRACT

Background: It is unknown which proctological position is most embarrassing to patients.

Methods: Individuals consecutively referred to our outpatient clinic in order to determine the causes of anal and/or abdominal complaints were randomized to complete an unvalidated six-item questionnaire which asked for their preferred proctologic positioning either before or after a proctological examination in knee-chest position followed by inspection of the anal verge, digital examination of the anal canal, and anoscopy. A third group of patients referred for gastroscopy was asked to complete the questionnaire before being gastroscoped.

Results: One hundred seventy-eight individuals of both genders aged 16-80 years who consecutively entered our outpatient clinic were enrolled. One third in each group had never experienced any of the offered medical positionings. Most patients favored the Sims' position if they had the choice. Randomized patients favored the knee-chest position more after experiencing it compared to those without experience (P < 0.03). Patients favored the positions they had recently experienced irrespective of the other positions offered in the questionnaire (P < 0.05). Individual answers to the question 'which position do you find most embarrassing?' did not depend on sex or age at first examination or when their last examination was performed. The majority of patients (55.2%-71.4%) held that no type of proctological positioning was most embarrassing to them.

Conclusions: The medical profession is authorized to use the proctological positioning that allows the most reliable anal diagnoses.

No MeSH data available.


Related in: MedlinePlus

The 42-year-old man is in knee–chest position, head left. He complained of anal itch, bleeding, and pain. Hairs are seen at the buttocks in the uneverted anal region.
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f1a-ceg-2-133: The 42-year-old man is in knee–chest position, head left. He complained of anal itch, bleeding, and pain. Hairs are seen at the buttocks in the uneverted anal region.

Mentions: This may differ according to the position used. The left lateral Sims’ position is more comfortable and patients achieve it easily and quickly by themselves; thus the investigating physician saves time by not having to position the patient.3–5 A fundamental drawback of the knee–chest position might be that hemorrhoids could be found less frequently because of the sloping position of the patient; the large intestine may be pulled down towards the patients’ head so that the hemorrhoids may be unable to protrude.1,2 However, it may provide a better field of view on anal and perianal surface than broadly used left lateral Sims’ position, as the buttocks fall to each side, and finger tips of both hands of the investigator are free for gentle eversion of the anal skin, which may assist in more differentiated, and therefore more reliable diagnoses in good lighting1,6 (Figures 1–4).


Patients' views of medical positioning for proctologic examination.

Gebbensleben O, Hilger Y, Rohde H - Clin Exp Gastroenterol (2009)

The 42-year-old man is in knee–chest position, head left. He complained of anal itch, bleeding, and pain. Hairs are seen at the buttocks in the uneverted anal region.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108641&req=5

f1a-ceg-2-133: The 42-year-old man is in knee–chest position, head left. He complained of anal itch, bleeding, and pain. Hairs are seen at the buttocks in the uneverted anal region.
Mentions: This may differ according to the position used. The left lateral Sims’ position is more comfortable and patients achieve it easily and quickly by themselves; thus the investigating physician saves time by not having to position the patient.3–5 A fundamental drawback of the knee–chest position might be that hemorrhoids could be found less frequently because of the sloping position of the patient; the large intestine may be pulled down towards the patients’ head so that the hemorrhoids may be unable to protrude.1,2 However, it may provide a better field of view on anal and perianal surface than broadly used left lateral Sims’ position, as the buttocks fall to each side, and finger tips of both hands of the investigator are free for gentle eversion of the anal skin, which may assist in more differentiated, and therefore more reliable diagnoses in good lighting1,6 (Figures 1–4).

Bottom Line: Randomized patients favored the knee-chest position more after experiencing it compared to those without experience (P < 0.03).Individual answers to the question 'which position do you find most embarrassing?' did not depend on sex or age at first examination or when their last examination was performed.The medical profession is authorized to use the proctological positioning that allows the most reliable anal diagnoses.

View Article: PubMed Central - PubMed

Affiliation: Park-Klinik Berlin-Weissensee, Innere Abteilung, Berlin, Germany;

ABSTRACT

Background: It is unknown which proctological position is most embarrassing to patients.

Methods: Individuals consecutively referred to our outpatient clinic in order to determine the causes of anal and/or abdominal complaints were randomized to complete an unvalidated six-item questionnaire which asked for their preferred proctologic positioning either before or after a proctological examination in knee-chest position followed by inspection of the anal verge, digital examination of the anal canal, and anoscopy. A third group of patients referred for gastroscopy was asked to complete the questionnaire before being gastroscoped.

Results: One hundred seventy-eight individuals of both genders aged 16-80 years who consecutively entered our outpatient clinic were enrolled. One third in each group had never experienced any of the offered medical positionings. Most patients favored the Sims' position if they had the choice. Randomized patients favored the knee-chest position more after experiencing it compared to those without experience (P < 0.03). Patients favored the positions they had recently experienced irrespective of the other positions offered in the questionnaire (P < 0.05). Individual answers to the question 'which position do you find most embarrassing?' did not depend on sex or age at first examination or when their last examination was performed. The majority of patients (55.2%-71.4%) held that no type of proctological positioning was most embarrassing to them.

Conclusions: The medical profession is authorized to use the proctological positioning that allows the most reliable anal diagnoses.

No MeSH data available.


Related in: MedlinePlus