Rectal

Question 1

What indications for carrying out a rectal exam are there?

Answer 1

Acute abdomen
GU problems
Change in bowel habit
Blood / mucus in stool
Anal / rectal irritation or pain
Assess sphincter control

Question 2

What equipment do you need?

Answer 2

Lubricant
Non-sterile gloves
Apron
Gauze
Disposable incontinence pad

Question 3

What do you assess for on closer inspection of the perianal area?

Answer 3

Warts
Worms
Carcinoma of the anus
Anal fissures
Excoriation (abrasion)
Haemorrhoids
Fistulae
Pressure sores
Prolapse

Question 4

What are the steps of examination?

Answer 4

1. Lubricate finger
2. Place first joint of finger into rectum and test sphincter tone
3. Ask patient to relax and advance finger further
4. Perform 180 posterior and anterior sweep
5. Assess pliability, location, size, tenderness, shape of prostate
6. Slowly withdraw finger and examine for blood / mucus / pus

Question 5

What special considerations may patients have that must be taken into account before carrying out exam?

Answer 5

Rectal surgery / trauma
Obvious bleeding
Recent pelvic radiotherapy
Spinal injuries (sympathetic activation -> arrhythmias)
Bowel inflammation
Hx of sexual abuse

Question 6

How should a normal rectum feel?

Answer 6

Smooth, pliable

Should not be painful

Question 7

How should a normal prostate gland feel?

Answer 7

3.5cm side to side
Smooth and rubbery
Non-tender
Should feel 2 lobes and median sulcus

Question 8

What does benign prostatic hypertrophy feel like?

Answer 8

Smooth, symmetrical enlargement
Prostate protrudes more than 1cm into rectum
Median sulcus may be indistinct

Question 9

What does cancer of the prostate feel like?

Answer 9

Asymmetrical
Stony, hard consistency
Discrete nodules may be palpable
Median sulcus obliterated