Table of Contents
Introduction
- Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain examination and obtain consent
- Get a chaperone
- Explain that procedure is intimate and why it is necessary
- Explain what you want the patient to do: ‘Undress from the waist down, then lie on your left side, bringing your knees up to your chest.’
- Allow the patient to undress in privacy and give them a sheet to cover up with
- Use the patient’s name and take care to explain carefully what you are doing. Check they are OK throughout.
Equipment
- Lubricant
- Gauze
- Paper towels
- Put on gloves and apron
Inspection
- Part the buttocks and look for: any blood, rashes, fistulae, fissures, excoriations, warts, haemorrhoids, skin tags
- Ask the patient to bear down and look for rectal prolapse
Examination
- Lubricate gloved index finger and approach anus from posteriorly. Pause when the finger is over the anus and wait until the sphincter relaxes.
- Warn patient then advance finger into anus
- Comment on consistency of any faeces
- Ask the patient to bear down (brings high rectal lesions lower)
- Ask the patient to squeeze your finger (tests anal tone)
- Do a 360Ëš sweep feeling for any masses or wall thickenings
- In men, feel the two lobes of the anterior surface of the prostate and comment on any masses, symmetry, consistency and size
- Remove finger and wipe on gauze – inspect for mucus, blood and melaena
- Clean the anus
To complete
- Thank patient and allow patient to get dressed in privacy
- Dispose of waste
- Wash hands
- Document findings and note presence and identity of chaperone
- Summarise and suggest further investigations you would do after a full history, for example:
- Prostate surface antigen
- Rectal ultrasound
- FBC (anaemia)
- Sigmoidoscopy
- Colonoscopy
