Digital Rectal Examination

Question 1

Pre examination questions and checks

Answer 1

Introduce yourself
Patient ID
Explain procedure, gain consent
HAVE CHAPERONE PRESENT

Equipment

• lubrication gel, gloves, paper towels
• put on gloves

Patient
-left lateral position with knees tucked up to chest

Question 2

Inspection

-explain what you are doing at all times

Answer 2

I am going to lower the sheet and look at the skin around the bottom
I will need to separate your buttocks
-prolapse
-ext haemorrhoid, masses
-fissure, fistulas
-abscesses
-anal warts, skin tags, rashs

Please can you bear down

• incontinence
• prolapse of int haemorrhoids
• mucus leakage

Question 3

Insertion

• what are you feeling for
• what will you ask the patient to do

Answer 3

Cover finger in gel
I am going to start the internal examination

Feel post aspect of anus
-this is my finger
-I am now going to gently insert it into your bottom
-note any tenderness - anal fissure => STOP EXAM
Feel for masses, swelling
Assess anal tone - ask patient to squeeze finger

Question 4

What you should say when explaining procedure

Answer 4

I would like to perform an internal examination of your back passage

This will require you to remove your trousers and underwear. I will need you to lie on the couch facing away from me on your side
I will ask you to keep your knees together and keep them close to your chest

I will start by looking at the area around you bottom and with 1 gloved finger, I will perform an internal examination of the back passage

This may be slightly uncomfortable but if you would like me to stop at any point, please let me know

As this is an intimate examination and I am a student, it is important that my supervisor is also present. They will also act as a chaperone

Do you have any questions? Do I have your consent to perform this examination?

Question 5

Internal palpation and finger movement within anus

Answer 5

Tell the patient that you will insert your finger deeper

6 oclock - insert full finger => palpate posterior wall
9 oclock - right wall
3 oclock - left wall
12 oclock - anterior wall

Question 6

Prostate examination

Answer 6

12 oclock
Size 
-normally 2-3cm
Tenderness
Consistency 
-tender, boggy => prostatitis
Presence of medial sulcus and symmetry either side
Surface - smooth/irregular
Nodules or masses?
-hard irregular asymmetrical without palpable sulcus => prostate cancer?

Question 7

Removal of finger

Completing the examination

Answer 7

Inspect finger for blood, mucus, discharge

Wipe area
Dispose of dirty tissues

Give patient privacy to get changed

Document in notes

• consent
• name, role of supervisor and other chaperones
• exam findings