Medically Fit For Exams
Medically Fit For Exams

Digital rectal (PR) examination

  • Wash hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination and gain consent
  • Ask for a chaperone/comment on the availability of the examiner as a chaperone
  • Ask the patient to undress from the waist down, ideally behind a screen
  • Give the patient a piece of couch roll to cover themselves with, and ask them to lie on their side facing away from you, with their knees tucked up to their chest
  • Put gloves on
  • Place an inco-sheet under the patient
  • Squeeze a walnut sized piece of lubricant onto a paper towel

 

Common causes of anal bleeding

Haemorrhoids

Anal fissure

Colon polyps

Colorectal cancer

Inflammatory bowel disease

Intestinal infection

Diverticular disease

 

 

 

 

 

 

 

 

 

 

 

Inspection

  • Explain what you are going to do
  • With the left hand, separate the buttocks
  • Observe the anus and perianal area for:
    • Fissures
    • Skin tags
    • Haemorrhoids
    • Erythema
    • Fistulae
    • Ulceration

 

Examination

  • Lubricate your right index finger
  • Separate the buttocks with the left hand
  • Place the pad of your right index finger over the anus and apply pressure to overcome sphincter tone
  • Insert finger into the anus aiming upwards towards the umbilicus
  • Palpate the anterior, right lateral, posterior and left lateral walls in a circular motion
  • In males, palpate the prostate gland
    • Note the size, surface consistency and any lumps
  • Pay attention to pain and lumps/irregularities in the rectum
  • Comment on stool in the rectum
  • Ask the patient to squeeze your finger, to test anal tone
  • Withdraw finger, inspecting for blood, faeces, mucus or melaena
  • Offer the patient a paper towel to wipe themselves with, or help the patient wipe the lubricant
  • Remove gloves and place directly into clinical waste bin
  • Inform the patient that the exam is over, and thank them for their compliance

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