GI - Digital Rectal Exam

Question 1

Whats special about the rectal exam explanation?

Answer 1

• Formal (Mr x not Davy)
• Explicitly say it will be uncomfortable and may be painful, if its severe you will stop
• Rectal exam may promote a feeling of rectal fullness causing them to feel like opening their bowel, Very rare
• Introduce chaperone (& Consent for chaperone)

Question 2

How do you position for a rectal exam?

Answer 2

Patient lying on left side with hips/knees both flexed and heels out the way
Buttocks should be at the edge of the bed

Cover the patient with a towel so only the area examined is visible
Put disposable towels under patietn

Question 3

How do you prepare for the exam?

Answer 3

Squeeze some lube onto a paper towel

Then put on gloves

Question 4

Steps of a rectal exam?

Answer 4

• Prepare
• Perinal insepction
• Finger insertion
• Anal Tone
• 4 walls
• Rectal contents
• Withdrawel

Question 5

How do you inspect the perianal area?

Answer 5

Gently seperate the buttocks

• Look for closed anus (normal tone)
• Ask patient to bear down to reveal abnormal descent or prolapse
• Look for any tears, haemorrhoids, abscesses etc.

Question 6

How do you insert you finger?

Answer 6

Apply gel
Place left hand on hip and tell them your about to begin
Place pulp of index on the posterior anal margin, apply gentle pressure and wait for the sphincter to relax then slide on in.

Move your finger further in following the sacral curve posteriorly

Question 7

How do you feel the walls of the rectum,?

Answer 7

Gently sweep the finger 90* left and right to feel the posterior & postero-lateral walls

Rotate the wrist (in crouching position) to feel anterior and antero-lateral walls

Question 8

What might you feel through the rectal walls?

Answer 8

Anterior - Prostate gland with central sulcus in men or cervix/tampon in women

Question 9

How do you check for rectal contents?

Answer 9

Note presence/absence of faeces and its consistency

Finger inserted maximally ask them to bear down to feel higher lesions

Question 10

How do you finish up after removal?

Answer 10

Check gloved finger for stool colour or blood/mucous/pus

Give the patient tissues and allow them to dress in private

Refrain from answering questions while they’re undressed

Document lesions using:

• Rectal quadrants
• Anal clockface (12 oclock in midline anteriorly) for perianal regions