Table of Contents IntroductionEquipmentInspection Examination To complete Try some questionsPractice now with a mock OSCE station 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 Digital rectal exam 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 Try some questions Please list some red flags for anal cancer? Oops! This section is restricted to members. Can you list some differentials of fresh red PR bleeding? Oops! This section is restricted to members. How would you expect a cancer of the prostate to feel on digital rectal examination? Oops! This section is restricted to members. What symptoms may a patient with prostate cancer present with? Oops! This section is restricted to members. Which scoring system may be used to grade prostate cancer and what does this take into account? Oops! This section is restricted to members. Discuss the management options for prostate cancer Oops! This section is restricted to members. Practice now with a mock OSCE station Digital rectal exam You’ll find hundreds more stations here