Rectal examination

Do not do if fissures (splits in skin) around anus, or other painful conditions
Do not perform on a child unless specifically requested and skilled
Very important to explain procedure to person and obtain consent

Can be associated with extreme embarrassment, fear of pain or diagnosis of cancer
May be more at ease if accompanied by friend, relative, chaperone

Note: Tampons in female patients can feel like a tumour, so check first

Ask person to empty bladder
Put clean paper sheet or bluey on bed
Have person lie on left side with knees drawn up, back to examiner
Put on gloves, separate buttocks, inspect anus and surrounding area. Note any abnormality
Ask the person to 'bear down' and note if prolapse etc
Put lubricant on tip of finger and place over anus. Ask person to breathe in and out through open mouth, slowly and deeply
Gently introduce the finger into anal canal, then rectum. Finger will reach 7–8cm with gentle pressure on the perineum
Sweep finger to front of person (anteriorly) to feel for prostate in males Figure 9.26, cervix in females
Feel all the way around rectum, then back the other way until you have been around full circle — Figure 9.27

Figure 9.26

Figure 9.27

Haemorrhoids, fissures (splits), abrasions or fistulas (openings) around anus, in anal canal
Painful or non-painful lumps seen on the outside or felt internally
When bearing down — rectal or haemorrhoid prolapse, anal muscle tone (strength)
For impacted faeces
Check and describe condition of rectal wall

Check prostate

About 3cm long, 2 lobes with central dip/sulcus (groove) — should feel firm, smooth and rubbery
Will feel larger if man has full bladder
Rough or craggy hard mass may mean malignant tumour (cancer)
Enlarged smooth mass may mean benign hypertrophy (enlargement)
Tender, lumpy, boggy mass may mean inflammation/prostatitis (infection)

Before finishing

Slowly withdraw finger — check tip of glove for blood, mucus, pus, colour of faeces
Wipe area with tissues