Rectals and Low Back Pain

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Do you do a rectal on your straight-forward Low Back Pain Patients?

  • I am an attending and I do a rectal on nearly all my LBP patients

    Votes: 2 3.3%

  • I am an attending and I rarely do a rectal on my LBP patients

    Votes: 10 16.7%

  • I am a resident/pa and I do a rectal on nearly all my LBP patients

    Votes: 7 11.7%

  • I am a resident/pa and I rarely do a rectal on my LBP patients

    Votes: 26 43.3%

  • I am a med student and I do rectals because I'm told to

    Votes: 8 13.3%

  • I am a med student and I tell the patient to tell the resident I did a rectal

    Votes: 7 11.7%
  • Total voters
    60
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docB said:
Honestly I don't unless there's something else to suggest acute cord compression like incontinance or saddle paresthesia.
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ditto.

Had a lady the other day who said that she'd had LBP and been dribbling urine since she'd fallen. She got a rectal and a cath for post void residual.

In reality, she appeared to be drug seeking, had no focal defecits, & denied saddle anesthesia but I wasn't going to just run with the drug seeking assumption & miss a cauda equina syndrome.
 
docB said:
Honestly I don't unless there's something else to suggest acute cord compression like incontinance or saddle paresthesia.
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Actually I do it looking for prostatitis.
 
BKN said:
Actually I do it looking for prostatitis.
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I am always confused by this. I looked at Rosen's and it says not to do repeated rectal exams in bacterial prostatitis because of the risk of precipitating bacteremia and sepsis. The other problem is that Rosen's says that in chronic prostatitis the examination of the prostate is usually normal. If I suspected prostatitis I would think getting a UA would be of the highest yield.

As far as LBP and DRE I do them whenever there are more concerning aspects of the health history. If the person has EVER shot drugs I 100% of the time do a rectal, even if the back pain is minor. I have talked to the more experienced ED docs here in Detroit and on 2 of the patients we picked up with spinal epidual abscesses they both had a diminished rectal tone.

I do it on everyone who has positive straight leg raises too. And anyone who I think is drug seeking. :) The thing is that the drug seekers know it is coming and they usually don't mind because they know it will bring them closer to the meds they want. An experienced drug seeker probably knows the exam for back pain better than you do.
 
Yep, lets start doing head CTs on any complaint of Headache. I actually knew a resident who would do a full pelvic exam on any female who mentioned any resemblance of "abdominal discomfort". Many thought he was just being very anal and complete. I know for a fact he is a perv and really enjoys doing pelvics.
 
FISKUS said:
Yep, lets start doing head CTs on any complaint of Headache. I actually knew a resident who would do a full pelvic exam on any female who mentioned any resemblance of "abdominal discomfort". Many thought he was just being very anal and complete. I know for a fact he is a perv and really enjoys doing pelvics.
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How can anyone enjoy a pelvic? It isn't like these are healthy coochies you're examining. Even if they were, who has time to do anything but grab the cultures, make sure there aren't any 10 cm adnexal masses, and jiggle the chandelier on the way out?
 
Yep, lets start doing head CTs on any complaint of Headache.
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Don't forget the LP! (Any of you who are subscribers to the EMED-L feel free to groan now)
 
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LBP is one of the most common complaints in the US. Little would be gained with the DRE.
 
Desperado said:
Saddle paresthesia by history or exam? Because if by exam...you might as well do the rectal if you've got to talk them into you touching their perineum.
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History. If they're complaining of a lot of weird crap like weakness, loss of sensation etc. then I violate them. Otherwise not.

I see so much back pain I'd develop some sort of complex if I rectalized all of them. There are two things I can say definitively about all types of chronic pain. It's chronic and it's painful.
 
docB said:
I see so much back pain I'd develop some sort of complex if I rectalized all of them.
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If you were in primary care, I'll bet that a lot fewer of your patients would complain about back pain. ;)

Maybe I should try that... :laugh:
 
I probably do it on slightly more than half but that wasn't a choice
 
Desperado said:
jiggle the chandelier on the way out?
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Hear me now.

I pledge to use this awesome and truly inspiring phrase three times next shift. Just for you.

I love it.

Take care,
Jeff
 
BTW, I do a rectal on every single patient, especially those without red flags. I try to do it while I'm ordering their lumbar films.

Take care,
Jeff
 
Dr.Evil1 said:
As far as LBP and DRE I do them whenever there are more concerning aspects of the health history. If the person has EVER shot drugs I 100% of the time do a rectal, even if the back pain is minor. I have talked to the more experienced ED docs here in Detroit and on 2 of the patients we picked up with spinal epidual abscesses they both had a diminished rectal tone.
Click to expand...


Listen here - As a med student I will do any rectal exam or pelvic exam I can get my finger into. The reason being is that without doing multiple exams, I won't be able to recognize "decreased rectal tone" or pelvic masses as readily. For some reason, people are often taken aback by my willingness to do rectals and pelvics.

What's the big deal? It's pretty cheap (free if you leave out the guiaic) and reasonably quick. Nearly instant data! :D
 
Hard24Get said:
Listen here - As a med student I will do any rectal exam or pelvic exam I can get my finger into. The reason being is that without doing multiple exams, I won't be able to recognize "decreased rectal tone" or pelvic masses as readily. For some reason, people are often taken aback by my willingness to do rectals and pelvics.

What's the big deal? It's pretty cheap (free if you leave out the guiaic) and reasonably quick. Nearly instant data! :D
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Uhhh....I'm not sure what to say about this other than...it will eventually get old. Trust me, I know what decreased rectal tone feels like. It takes about 1 cord injury to learn to recognize it. It is very different.

The big deal is that you have to stick your finger in their ass. As if that doesn't suck enough, you have to talk them into letting you do it. I have gotten pretty good at getting patients to decline a rectal, however.
 
Hard24Get said:
It's pretty cheap (free if you leave out the guiaic) and reasonably quick. Nearly instant data! :D
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It might cost a little more money if you'd use gloves!

Take care,
Jeff
 
socuteMD said:
Oh Jeff, how we've missed you!!!
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Glad to be back. :)

I'm reminded of a conversation one of my classmates had while we were rotating through the prison hospital. In describing a rectal he'd just done, he said he put his hands on the patients shoulders while doing the exam and just didn't understand why the patient was so anxious.

Take care,
Jeff
 
Both hands, on both shoulders?

Oh, my...
 
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