1. 9/20/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 1
Rectal examination
 Rectal examination may be required for many reasons some
of which are:
 Rectal bleeding
 Rectal itching
 Rectal Pain
 Abdominal Pain / Pelvic pain (as part of an abdominal examination)
 Passing blood
 Passing mucus
 Presence of lumps or other palpable abnormalities
 Neurological symptoms

2. Preparing the patient 1
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 Introduce yourself fully including your role within the patients
care
 The reason and nature of the technique of rectal
examination should be explained to the patient, informed
consent can then be gained.
 Reassure the patient the that examination may be
uncomfortable, but it should not be painful
 The clinical room must be appropriate for an intimate
examination and a chaperone present for the duration
 A private area for the patient to undress from the waist down
should be available and a cover for the patient provided

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Preparation of patient 2
 Patient should be asked to lie in the
lateral position, close to the edge of the
bed with the hips and knees flexed.
Expose only as much as necessary.
 A blanket should be draped across the
patient to minimize exposure and reduce
level of patients vulnerability
 Assistance by yourself or the chaperone
should be offered to help the patient get
into position
 Have a clean tray containing water
soluble gel and tissues

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Inspection of the anus
 Wash hands and don a pair of
disposable gloves
 Gently separate the buttocks
and inspect the natal cleft and
anal verge
 Look for fissures, rashes,
haemorrhoids, warts etc
 The position of an anal lesion
is described in relation to the
face of a clock
 The anterior aspect of the
anus is assigned to 12 o’clock

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Rectal examination technique 1
 Lubricate (gloved) index finger
 Place pulp of index finger on
posterior anal verge so a small angle
exists between the palmar surface of
the finger and the natal cleft
 Press gently on the anus and slip the
tip of the index finger into the anal
canal by increasing the angle of the
finger
 Avoid using force, wait for the
sphincter to relax, if still difficult do
not continue with the examination

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Rectal examination technique 2
 Insert the index finger into the rectum as
far as it will go, following the sacral curve
 If there is believed to be a problem with
the anal sphincter, ask the patient to
squeeze the examining finger to assess
anal tone
 Examine the posterior and lateral walls of
the rectum for palpable lumps or tears
(rectal walls should be smooth)
 Assess the presence or absence of
faeces: palpable as a mobile putty-like
substance (in constipation may be hard),
which you can indent with your fingertip.

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Rectal examination technique 3
 Rotate wrist so that finger pulp
faces anteriorly and examine the
anterior rectal wall.
 In the male examine the prostate
gland (see slide 10) may be
palpated. In the female the cervix
may be palpable.

8. Rectal examination technique 4
 Rotate wrist, so that your examining
finger is facing posteriorly again
and then withdraw finger.
 On withdrawal check gloved finger
for stool (normal colour, pale stool,
malaena etc) and any blood or
mucus
 Clean patient, dispose of gloves
and wash hands
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Prostate Examination
 The prostate gland is examined during a male
rectal examination.
 A normal prostate measures approximately 3.5cm
from side to side and protrudes 1cm into the
rectum. It can be felt through the anterior rectal wall
and has a median sulcus separating the two lobes.
 The prostate should not be tender to palpation but
the patient may experience discomfort or an urge to
urinate.

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Palpation of the Prostate Gland
Palpation of the prostate gland aims to assess:
 Size
 Presence of two equally sized lobes with a
median sulcus
 Consistency (firm)
 Surface (smooth or nodular)
 Tenderness
 However assessment of prostatic size is
learnt through experience!

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Abnormalities of the Prostate
 Benign Hypertrophy of the prostate is common in men over
the age of 60years.
 The enlargement is smooth and maybe unilateral or bilateral
the gland feels rubbery or slightly boggy.
 A cancerous prostate may feel asymmetric, with a stony
hard consistency maybe with the presence of palpable
nodules
 Tenderness of the prostate may be due to prostatic
inflammation or infection.
 All findings must be documented and further
investigations/treatment/management must be considered.

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Recording your findings
 Don’t forget when recording your findings to include the
patient identifiers, date (and time), your signature and
printed name at end
 When documenting or describing your findings remember
to comment on the anus (inspection), anal tone (if
performed), rectal walls, contents of rectum (stool etc),
the prostate (see slide 11) and any abnormal masses
palpated.
 Remember to describe your findings as fully as possible:
eg size, position (relative to face of clock), shape of a
swelling etc
 A diagram may often be useful in written notes