Patients with anorectal complaints frequently seek medical attention. The range of diseases and associated levels of discomfort vary widely. There are few other disease states that produce as much anxiety and apprehension as those of the anus and rectum. Certainly, most patients have never been subjected to an examination of this area except for the occasional routine rectal exam. The evaluation of such problems can be quite challenging to the patient and to the practitioner. Therefore, a thorough and systematic approach to the patient with problems involving the colon, rectum or anus is essential. During the entire process, the patient must be made as comfortable as possible. If methodical techniques of history taking, examination, and conveyance of information are performed in a nonthreatening environment, both the patient and the physician will feel better at the end of the encounter, and the patient's problem will have been diagnosed and treated in a relatively short period of time.

This article provides guidelines for setting up a comfortable environment, taking an adequate history, performing an examination, and conveying information to the patient. These routines should be mastered by any practitioner and will become easier with repetition. Also, if definitive treatment can not be given in the office or clinic of the primary care physician, a referral can be made more easily if sufficient data already have been gathered. An understanding of available studies for further evaluation tends to enhance the work-up of anorectal problems and will provide insight into which patients might be appropriate for referral to a specialist. After reading this article, the primary care physician should have a better idea of how to approach patients with common anorectal diseases.