Introduction
Introduce yourself
Wash hands
Check patient details
Explain the examination
“I need to perform a rectal examination, which will involve me inserting a finger into the back passage. It will be a little uncomfortable, but shouldn’t be painful and will only last a very short time”
Gain Consent
Request a chaperone
Gain adequate exposure:
- Ask patient to remove trousers / underwear & to cover themselves with the blanket provided
- Leave the room & allow them time to do this
- Maintaining patient dignity is of the highest priority
Position the patient in the left lateral position with their knees to their chest
Put on gloves
Inspection
Separate the buttocks & inspect for:
- Skin excoriation / skin tags
- Rashes
- Haemorrhoids
- Anal fissures
- External bleeding
- Fistulae
Palpation
Lubricate the examining finger
Warn the patient you are about to insert the finger
Insert finger gently into the anal canal
Rotate the finger 360 degrees to assess the entirety of the internal rectum:
- Note location & texture of any masses / irregularities – e.g. 2cm irregular mass at 11oclock
- Is there stool in the rectum? – soft vs impacted
In males the prostate can be located anteriorly:
- Comment on the size / symmetry & texture of the prostate
- It should be smooth, symmetrical & approximately the size of a walnut
Assess anal tone by asking the patient to squeeze your finger
Withdraw finger
- Inspect for blood – fresh red vs malaena
- Inspect for stool / mucous
Clean patient using paper towels
Cover patient with the sheet provided & explain the examination is over
Allow them privacy to get dressed
Wash hands
To complete the examination
Once dressed, thank patient & explain your findings
Further tests such as:
Bloods – FBC & Haematinics (?anaemia)
Tumour markers - e.g. CEA is raised in colorectal cancer
Faecal occult blood
Flexible sigmoidoscopy / colonoscopy - direct visualisation of lesions +/- biopsy
CT Abdo / Pelvis - to identify potential malignant masses / lymphadenopathy / collections