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11/13/24, 7\:09 PM Guide | Rectal (PR) examination

Rectal (PR) examination

Table of contents
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Gather equipment

Gather the appropriate equipment\:
Non-sterile gloves
Apron
Lubricant
Paper towels
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Gather equipment

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain what the examination will involve using patient-friendly language\: " T o d a y I n e e d t o p e r f o r m a r e c t a l e x a m i n a t i o n . T h i s
w i l l i n v o l v e m e i n s e r t i n g a
u n c o m f o r t a b l e . Y o u c a n a s k m e t o s t o p a t a n y p o i n t .
"
Explain the need for a chaperone\:
c h a p e r o n e , w o u l d t h a t b e o k ?”
“ O n e o f t h e o t h e r s t a
Gain consent to proceed with the examination\:
h a p p y f o r m e t o c a r r y o u t t h e e x a m i n a t i o n ?"
" D o y o u u n d e r s t a n d e v e r y t h i n g I' v e s a i d ? D o y o u h a v e a n y q u e s t i o n s ? A r e y o u
Ask the patient if they have any pain before proceeding with the clinical examination.
Explain to the patient that they'll need to remove their underwear and lie on the clinical examination couch, covering
themselves with the sheet provided. Provide the patient with privacy to undress and check it is ok to re-enter the room
before doing so.

Preparation

1. Don an apron and a pair of non-sterile gloves.
2. With the clinical examination couch
towards their chest.
3. Then ask the patient if it is ok to remove the sheet to begin the examination.
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Position the patient

Inspection

Separate the buttocks and inspect the perianal region for relevant clinical signs\:
Skin excoriation\: secondary to anal pruritis which can be caused by haemorrhoids, faecal incontinence or constipation.
Skin tags\: minor projections of skin at the anal verge that are usually benign. Perianal skin tags can, in some cases, be
associated with Crohn's disease.
External haemorrhoids\: located below the dentate line and innervated by somatic nerves. On examination, they typically
appear as a lump located just inside or outside the anal verge.
Anal
develop secondary to constipation and are very painful (often making rectal examination impossible).
External bleeding\: may be caused by external haemorrhoids, anal cancer or brisk gastrointestinal bleeding.
Anal
discharge pus and have surrounding in
abscess and diverticulitis.
Irregular growths\: may be due to anal warts or anal cancer.
Ask the patient to cough and inspect for\:
Rectal prolapse\: on inspection, a mass with concentric rings of mucosa will be visible protruding through the anus.
Internal haemorrhoids\: located above the dentate line and innervated by visceral nerves. On examination, bluish, bulging
vessels covered by mucosa may become visible when the patient coughs. Internal haemorrhoids are typically asymptomatic
due to their visceral innervation.
In
In
of the gastrointestinal tract. Ulcerative colitis and Crohn's disease are subtypes of IBD and di
presentation.
Ulcerative colitis is the most common form of IBD and a
examination include loose bloody stool and excess mucous.
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Crohn's disease is another subtype of IBD which can a
anus. Typical
tags.
Inspect the perianal region

Palpation

First steps

1. Lubricate the examining
2. Warn the patient you are about to insert your
3. Insert your
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Lubricate the examining

Prostate examination

4. In males, palpate the prostate gland anteriorly and assess the size, symmetry and texture of the gland\:
A normal prostate is approximately walnut-sized with a palpable midline sulcus.
It should be symmetrical and its consistency should be similar to that of the tip of the nose.
Palpate the prostate anteriorly

Rectal examination

5. Rotate your
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Note the size, location (e.g. 9 o'clock) and texture (e.g. smooth, irregular) of any rectal lumps (e.g. tumour, polyp, internal
haemorrhoid).
Feel for any hard stool present in the rectum, which may indicate constipation.
Note the location of any tenderness, which may indicate an anal
Rotate the

Anal tone assessment

6. Assess anal tone by asking the patient to bear down on your
pathology (e.g. cauda equina syndrome), in
Assess anal tone

Final steps

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7. Withdraw your
Dark sticky blood is known as melaena and is associated with upper gastrointestinal bleeding (e.g. peptic ulcer, gastric
cancer).
Fresh red blood is associated with lower gastrointestinal bleeding (e.g. haemorrhoids, anal
Excess mucous can be associated with in
8. Clean the patient using paper towels.
9. Cover the patient with the sheet, explain that the examination is now complete and provide the patient with privacy so
they can get dressed.
10. Dispose of the used equipment into a clinical waste bin.
Withdraw and inspect

To complete the examination...

Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Document the procedure in the medical notes including the details of the chaperone.
Summarise your
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