An example of a perfect rectal examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering an examination, as well as important safeguarding and legal aspects.
Rectal Examination
1. Explain what the procedure will involve and gain consent
2. Ask the patient if they would like a chaperone to make them a bit more comfortable
3. Ask the patient to undress from the waist down, and lie at the edge of the bed on their left side with their
knees up – there’s a blanket to keep you bit warmer and covered up
4. Wash hands
5. Apply gloves and apron
6. Remove gown/blanket to expose peri-anal area
7. Inspect for: (you will have to separate the cheeks – ask the patient if they can feel this both sides (cauda equina))
- Haemorrhoids
- Abscesses
- Bleeding
- Fissures
- Fistulae
- Prolapsed rectal mucosae
8. Lubricate your finger with lots of jelly (let the patient know you’re doing this)
9. “I’m going to insert my finger now, it might be a bit cold from the jelly” let me know if you’re in any pain
10. Place finger on sphincter first to relax, then insert gently
11. Rotate finger 360degrees – rectal wall should feel smooth and pliable
- Prostate will be anterior – expect smooth, cleft-y mass (not craggy or uneven cleft-y lumps)
12. Check anal tone by asking the patient to squeeze your finger
13. Remove finger gently
14. Inspect glove and wipe glove on gauze – inspect this obviously
- Blood
- Mucus
- Stool
15. Clean patient with gauze or tissue and put gown/blanket back over
16. Remove gloves, wash hands
17. Inform patient the examination is complete, “I’ll let you get dressed”
To complete the procedure:
- I would like to take a full medical history
- I would like to perform a full abdominal examination
Clinical findings:
- 12 ‘o’ clock = forwards
- 6 ‘o’ clock = behind
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