Digital Rectal Examination of the Prostate

Question 1

What are the steps?

Answer 1

Introduction

Explanation

Position the patient correctly

Ensure adequate lighting and equipment in easy reach

Inspection

Palpation

Doff PPE in correct sequence and dispose of safely in clinical waste, clean your hands and allow the patient to dress in privacy

Question 2

Introduction

Answer 2

Give your name and status

Ask the patient for their name and DOB

Question 3

Explanation

Answer 3

Explain to the patient that you would like to do a rectal examination to examine their prostate gland

Check the patient gives verbal consent

Inform the patient that a chaperone will be present during the examination and check that this is alright with the patient

Question 4

Position the patient correctly

Answer 4

Ask the patient to remove their trousers and undergarments (before they lie down) and maintain their dignity by placing a towel over areas which are not being examined

Ideally the patient should lie on their left side with hips and knees flexed

Ensure the buttocks are positioned at the edge of the bed

Ensure adequate lighting and equipment in easy reach

Question 5

Inspection

Answer 5

Gently separate the buttocks to inspect the perianal area

Look for any blood, rashes, fistulae, fissures, warts

Ask the patient to bear down to look for rectal prolapse

Question 6

Palpation

Answer 6

Apply water-based gel to the examining finger

Inform the patient when you are about to start the rectal examination and kneel down beside the patient

Gently separate the right buttock with your left hand to expose the anus and place the pulp of the index finger on the anal margin

Wait until the anal sphincter relaxes, curve your index finger such that it follows the sacral curve, and then insert the tip of your right index finger into the anal canal

Follow the sacral curve posteriorly and then rotate the wrist counter-clockwise so that the anterior part of your index finger faces anteriorly (i.e. the patients front)

Palpate the anterior rectal wall, and feel the prostate gland anteriorly through the rectal wall and assess its size (normally 2-3cm diameter for an unenlarged prostate i.e. the size of a walnut, approx 20cc)

Palpate the two lateral lobes and the median sulcus

Note the surface texture (i.e. smooth or rough) and consistency (i.e. soft or firm) of the prostate gland

Note any prostate tenderness

Feel for any nodules or firm swellings

Withdraw your finger and inform the patient that you have completed the examination

Question 7

Complete the exam

Answer 7

Offer the patient tissues to clean himself up

Don’t forget to thank the patient!

Doff PPE in correct sequence and dispose of safely in clinical waste, clean your hands and allow the patient to dress in privacy

Question 8

What is the normal size of a prostate?

Answer 8

2-3cm diameter for an unenlarged prostate i.e. the size of a walnut

Which is approximately 20cc

Question 9

When inspecting the perianal area what are you looking for?

Answer 9

• Blood
• Rashes
• Fistulae
• Fissures
• Excoriations and Warts

Also ask patient to bear down to check for any rectal prolapse!

Question 10

What are you palpating the prostate for?

Answer 10

Palpate the two lateral lobes and median sulcus

Note surface texture (smooth or rough) and consistency (soft or firm) of prostate gland

Note any prostate tenderness

Feel for any nodules or firm swellings