Patients’ views of medical positioning for proctologic examination

Ole Gebbensleben¹, York Hilger², Henning Rohde³

¹Park-Klinik Berlin-Weissensee, Innere Abteilung, Berlin, Germany; ²Institut für Biostatistik, Freiburg, Germany; ³Praxis für Endoskopie und Proktologie, Berlin, Germany

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.

Keywords: anal bleeding, anal itch, anal pain, proctological positioning, pruritus ani, hemorrhoids, benign anal diseases