Rectal examination

Attention

  • 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

What you need

  • Paper sheets or blueys
  • Well-fitting gloves
  • Lubricant
  • Tissues

What you do

  • 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  

Check

  • 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
    • Hard, raised, ulcerated areas
    • Soft, spongy, velvety areas 

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