GI surgery -PRE

1. Rectal (PR) Examination
Rectal (PR) examinations are performed for a number of clinical reasons e.g. altered bowel habit,
rectal bleeding, urinary symptoms and is a skill surgeons perform on all patients. It is commonly
examined as it is an important skill to know. For the purpose of examinations you will be
provided with a mannequin, however you should pretend it is a real patient and talk to it as such,
which will also form part of the marking scheme.
Subject steps
1. Wash your hands, introduce yourself to the patient and clarify their identity. Explain
what you would like to do and obtain consent. This is a slightly uncomfortable procedure
so you should warn the patient of this. A chaperone is required for this procedure.
Ensure you have all of the necessary equipment for the station. This is:
o gloves
o lubricant
o tissues
o Rectal Kit
2. Positioning of the patient in this procedure is very important. Ask them to lie on their left
hand side with their knees drawn up towards their chest, their feet pushed forwards and
their anus exposed.
3. Having washed your hands and put on your gloves, separate the buttocks and inspect the
area around the anus. Look for any abnormalities including skin tags, haemorrhoids and
fissures.
4. External inspection.
5. After inspecting, lubricate your right index finger.
o Lubricate your right index finger
6. Tell the patient you are about to start the procedure. Place your finger on the anus so that
it points anteriorly and apply pressure to the midline of the anus.

2. o Apply pressure
7. Maintain the pressure so that your finger enters the rectum. Initially you need to assess
anal tone by asking the patient to squeeze your finger.
o Maintain the pressure to insert
8. Next you need to systematically examine each part of the rectum. This is done by
sweeping the finger both clockwise and anti-clockwise around the entire circumference.
You should be feeling for any abnormalities such as impacted faeces, masses or ulcers.
o Sweep clockwise
o Sweep anti-clockwise
9. One of the main reasons for performing a rectal examination in males is to assess the
prostate gland This lies anteriorly and should always be felt. You should check the size,
consistency and presence of the midline groove.
10. Remove your finger and examine the glove for the colour of any faeces as well as the
presence of any mucus or blood.

3. o Examine the glove
11. Clean off any lubricant left around the anus and remove and dispose of your gloves in the
clinical waste bin.
o Clean off any lubricant
12. Allow the patient to dress and thank them. Wash your hands and report your findings to
the examiner.