Introduction 1- Introduce yourself 2- Wash hands 3- Check patient details 4- 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” 5- Gain Consent Request a chaperone 6- 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 7- Position the patient in the left lateral position with their knees to their chest Put on gloves Inspection 1- Separate the buttocks & inspect for: Skin excoriation / skin tags Rashes Haemorrhoids Anal fissures External bleeding Fistulae Palpation 1- Lubricate the examining finger 2- Warn the patient you are about to insert the finger 3- Insert finger gently into the anal canal 4- 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 5- 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 6- Assess anal tone by asking the patient to squeeze your finger 7- Withdraw finger Inspect for blood – fresh red vs malaena Inspect for stool / mucous 8- Clean patient using paper towels 9- Cover patient with the sheet provided & explain the examination is over 10- Allow them privacy to get dressed 11- Wash hands Source
