The Rectal Exam

Question 1

What do you do in the introduction?

Answer 1

WIPE

Wash Hands
Introduce myself
Patient ID and DoB
Explain and consent

Undressed completely from their waist down and covered

Patient lay on left hand side with knees drawn up to chest

Question 2

What do you for at the end of the bed?

Answer 2

Surrounding area - drips, O2, catheters, drains, vomit bowels

Patient - Body habitus, well/unwell, pain, fever

Question 3

How do you inspect the peri-anal area?

Answer 3

Put on gloves & apron
uncover patient

Look for any fistulas, haemorrhoids, skin tags, fissures, blood, excoriation

Ask patient to bear down - look for rectal prolapse and normal descent of the perineum

Question 4

How do you palpate?

Answer 4

Lubricate index finger

Run finger along natal cleft to anus

Warn patient - ‘take a deep breath in’ - then put finger in

Ask patient to squeeze your finger

Palpate rectum (360 deg) - note tenderness or masses. Then, insert finger all the way.

Question 5

How do you examine the prostate?

Answer 5

Anterior wall

Identify - sulcus, lobes. Should feel rubbery and non-tender.

Note - any tenderness, enlargement of one or both lobes, obliteration of the sulcus, solid masses

Question 6

What else would you like to do to complete the examination?

Answer 6

Take a full history, examine the abdomen, lymph nodes and external genitalia

Question 7

What investigations would you carry out?

Answer 7

USS
Biopsy
Blood - cancer markers