Rectal examination

Question 1

What are the indications for performing a rectal examination?

Answer 1

Acute abdomen

Assessment of the prostate (particularly when there has been outflow problems)

Change in bowel habit

Blood or mucus in stool

Anal/rectal irritation or pain

Constipation

Problems with urinary or faecal continence

Assess sphincter control

Question 2

What is Tenesmus?

Answer 2

Persistent ineffectual spasm of rectum accompanied by desire to empty the bowel.

Common complaint in IBS and IBD.

Question 3

Why might you not perform a rectal exam even though it would help diagnosis? (6 points)

Answer 3

Rectal surgery or trauma

Obvious bleeding e.g. haemmorhoids or fissures

Recent pelvic radiotherapy

Bowel inflammation

History of sexual abuse

Spinal  injury (above T6)-> autonomic dysreflexia
Impaired autonomic nervous system due to uncontrolled sympathetic nervous system discharge

Question 4

What are being felt for during the examination?

Answer 4

Feel for lymph nodes, abscesses, polyps or faeces and note whether patient experiences any pain

Question 5

What does a normal rectum feel like?

Answer 5

uniformly smooth and pliable

Question 6

In men, what anatomy is found?

Answer 6

anterior to the lower 1/3 of the rectum lie the prostate, bladder base and seminal vesicles

Question 7

in women what anatomy is found?

Answer 7

vagina

Question 8

What are we assessing the prostate for?

Answer 8

size, consistency, nodularity and tenderness

Question 9

What should you tell the patient before you start?

Answer 9

“you might feel like you need to wee, it shouldn’t feel painful but a little bit uncomfortable”

Question 10

what size is the normal prostate?

Answer 10

3.5cm from side to side

Question 11

What are the 7 steps to take before you start the examination?

Answer 11

Introduce yourself

Identify patient

Explain procedure and obtain consent

Chaperone

Wash hands and gather equipment

Patient needs to be lying down in the left lateral position with the knees flexed and as comfortable as possible maintaining dignity at all times

Equipment- gloves, apron, lubricant, gauze/tissue

Question 12

What are we inspecting the perineum for before insertion? (14)

Answer 12

Hygiene / Skin rashes

Pressure sores

External haemorrhoids

External thrombosed piles

Anal fistula/fissures

Pilonidal sinus

Discharge

Polyps/skin tags

Carcinoma

Anal/genital Warts

Worms

Foreign bodies

Rectal Prolapse

Skin discolouration

Question 13

What are the steps of the procedure?

Answer 13

1. Ask the patient to take deep breaths as this helps the patient to relax
2. Apply lubricant to index finger
3. Part the buttocks and inspect the peri-anal area
4. Slide a gloved and lubricated finger along the natal cleft
5. Insert the finger and test sphincter control by asking patient to grip your finger (the one in their bottom)
6. Perform 180° sweep posteriorly to examine rectum
7. Turn arm and sweep 180° of anterior rectum, palpate posterior prostate surface
8. Slowly withdraw finger and examine for blood, mucus pus and faeces
9. Dispose of equipment and wash hands
10. Thank the patient and leave the patient in privacy to get dressed
11. Document findings