Digital Rectal Examination Flashcards
How do you introduce yourself and gain consent in a digital rectal examination
- Wash hands while you’re talking to the patient
- Introduce yourself
- Confirm the patient’s identity
- Explain examination
o “Because of the symptoms you’ve been experiencing, I need to examine your back passage, which will involve me inserting a gloved lubricated finger into the back passage. It will be a little uncomfortable, but shouldn’t be painful and will only last a short amount of time.” - Explain the need for a chaperone
o “The examiner will be present throughout the examination to act as a chaperone, is this okay
with you?” - Check understanding
o “Does everything I’ve said make sense?”
o “Do you have any questions?” - Gain consent
o “Are you okay for me to proceed with the examination?” - Position the patient appropriately
o “Can I ask you to pull down your trousers and underwear, and then lie down on the bed on your left side with your knees tucked up all the way to your chest, and a sheet covering yo
What do you say on inspection
- “I’m just going to separate the buttocks so I can have a look alright?”
What are you looking for on inspection
o Skin tags o Rashes o Haemorrhoids o Anal fissures o External bleeding o Fistulae o Abscesses
Ask the patient to strain or bear down as if they are passing stools in order o inspect for rectal prolapse
What do you say before you insert the finger
- “I’m now going to be inserting my finger with some lubricating jelly alright?”
How should you put the finger in
- Begin by placing the pulp of your index finger against the anus in the midline and press in firmly but slowly – most anal sphincters will reflexly tighten when touched but will relax with continued
pressure - When the sphincter relaxes, gently advance the finger into the anal canal
- Rotate the finger backwards and forwards covering the full 360°, note:
o The presence of thickening or irregularities of the rectal wall
o The presence of palpable faeces and its consistency
o Any points of tenderness - In the male, identify the prostate gland in the anterior rectal wall
- Assess anal sphincter tone by asking the patient to clench your finger
- Gently withdraw your finger and inspect the glove for faeces, blood or mucus and note the colour
of the stool if present
What should you do when you finish the examination
- Inform the patient the examination is over and offer them paper tissue to wipe away any jelly, or ask if they’d prefer you to do so
- Leave the room and allow them time to get dressed
- Dispose of clinical waste and wash hands
What subsequent examination findings would you add on
Summarise your findings and offer a list of investigations you would subsequently perform, e.g.
abdominal examination, FBC, faecal occult blood, AXR, flexible sigmoidoscopy/colonoscopy, CT abdo/pelvis
to the right of the male rectum what are the anatomical relationships
- Caecum
- Appendix
in females
- right tube
- right ovary
To the left of the male rectum what are the anatomical relationships
- Sigmoid colon
In females
- Left tube
- Left ovary
To the anterior of the rectum what are the anatomical relationships
In males
- Prostate
- seminal vesicles
- ductus deferentes
In females
- posterior fornix of vagina
- cervix
- pouch of Douglass
to the posterior of the rectum what are the anatomical relationships
- Sacrum
- Coccyx
- Pelvic muscles
Why do you ask the patient to strain the anus
- Look for rectal prolapse
- incontinence
- internal haemorrhoids
- mucus leakage
What can you feel on palpitation
- Polyp
- wart
- ulcer (e.g. malignancy)
- anal sphincter tone (damaged by trauma or neurological deficit)
What might you feel in the rectal mucosa
- polyp
- ulcer (e.g. malignancy)
- you may also feel impacted stool (constipation)
What would tenderness on the right of the rectum suggest
- appendicitis or an appendices abscess
