Almost everyone is embarrassed about seeing the doctor about an anal problem, such as anal pain, wind, or anal itching. It is important that you get over this worry, so that you get treatment for the problem. Value your own health and think of your doctor simply as someone who is helping to maintain your health. Bowel or anal symptoms, such as constipation or bleeding, can sometimes be serious. People are literally dying of embarrassment because they do not see their doctor when bowel symptoms start, often because of a fear of examination of their back passage (rectal examination). Therefore they may reach their doctor only when bowel cancer is quite advanced. Although bowel cancer is much less common than piles, it is always a possibility and can be treated very successfully at an early stage.

Take control
Remind yourself that you are in charge of the consultation with your doctor. He or she cannot examine you without your permission. Therefore it is perfectly OK for you to visit your doctor and say ‘I have such-and-such a problem. At the moment I just want to discuss it. I don’t want to be examined’. When you have got over the hurdle of talking about the problem you may later feel quite alright about being examined, but it is your decision.

Think the problem through
What do you think will be going on in your doctor’s mind while you are being examined? Are you imagining your doctor will be mentally rating and criticizing your appearance? In fact, in this situation your doctor is interested in your insides, not your outsides. By the time he or she becomes a GP, your doctor will have seen literally thousands of backsides and is not interested in their appearance. In fact, he or she will be thinking about the symptoms you have described, and whether they match up with the findings on examination.

Take a friend?
Would it help to have a friend with you? You might feel this would make it worse, but the right person can be reassuring, perhaps someone who has had a lot of medical treatment themselves and so is matter-of-fact about being examined.

What is involved in the examination
If you are a female and the doctor is male, he will ask a female nurse to be present during the examination. Like any other part of the examination, examination of the back passage is methodical, and all doctors are taught the following procedure.

The patient is asked to lie on the left side with the knees drawn up to the chest; this position helps to relax the muscles around the back passage. If you are feeling tense, breathe slowly and deeply with your mouth open. The doctor puts on a pair of gloves and separates the buttocks slightly to look for abnormalities such as piles, cracks in the wall of the anus (anal fissure), skin tags or warts. The doctor then puts some lubricant on the gloved finger, and places the fingertip on the anus, pressing slightly. When the anal muscle relaxes, the finger is inserted slowly and the tip is rotated gently to feel for lumps and bumps and specific structures (such as the prostate in men).The finger is withdrawn slowly and then the doctor inspects the glove for blood or pus. It is not painful,so if you experience any pain, tell your doctor. You may just experience a feeling of rectal fullness during the examination, as if you wish to have your bowels open.

Your GP might suggest inserting a short hollow instrument (proctoscope) to separate the walls of the bowel so that they can be seen clearly as the instrument is withdrawn. Again, this is not painful and your GP will not do this without your permission and explaining it to you.