Rectal Examination

Question 1

What is involved in the introduction of this particular examination?

Answer 1

Washing hands
My ID
Patients ID - Always address them formally 
Explanation 
Chaperone explanation
Consent

Question 2

What should be explained in the explanation.

Answer 2

1. The reasons for the examination
2. Explain the actual examination
3. “It may be uncomfortable, but shouldn’t be painful, if it is, tell me at any point and I will stop”
4. The exam may make you feel like you are going to open your bowels and pass stool, but it is unlikely to happen

Explain the chaperone and gain consent

Question 3

What position must the patient be in?

Answer 3

Lie on left side with hips and knees flexed and heels out the way
Buttocks at edge of bed

Question 4

What do you do in preparation for the procedure?

Answer 4

Place disposable towels under patient
Put on gloves
Squeeze lube onto an adjacent tissue - do not apply to glove yet
Ask if patient is in any pain

Question 5

What is done after preparation?

Answer 5

Gently separate cheeks and INSPECT the perianal area
Looking for
- Shape
- Tone (is anus closed)
- Ask patient to strain down to revel and prolapses/ hemorrhoids
- Look for warts, ulcers etc

Question 6

What is done after inspection?

Answer 6

Apply lube and let patient know you are about to place finger into the anal canal, place left hand on their side to help relax them
Push finger into the anal canal with the pulp of your index finger touching the posterior margins

Question 7

What is done once the finger is in the anal canal?

Answer 7

Assess for tone by asking patient to squeeze with their anal muscles

Question 8

What should be done once anal tone is assessed?

Answer 8

Push finger further up into the rectum
Palpate the posterior and posterolateral walls in an 180 degree fashion
Once done - rotate wrist doing the same to the anterior and anterolateral walls

Question 9

What is on the anterior wall in men and in women?

Answer 9

Prostate in men

Cervix and/or vaginal tampon in women

Question 10

Once the walls are palpated, what are you feeling for?

Answer 10

• Feel and note the presence or absence of stool in rectum and note consistency
• Carefully assess if there was any palpable abnormalities on the walls
• With the finger inserted maximally, ask patient to bear down: done to see if a higher up lesion is brought down onto finger

Question 11

What is done after asking the patient to bear down?

Answer 11

Remove finger, slowly checking again for any abnormalities in the anal canal

Check finger for feaces, blood and mucus

Question 12

What do you do to close the examination?

Answer 12

Inform patient you have finished
Inform patient you are going to wipe gel away from their anus
Clean and dispose of gloves and let patient get dressed in privacy
WASH HANDS