The Digital Rectal Examination

Original Author: Ollie Jones
Last Updated: February 17, 2017
Revisions: 9

Introduction

  • Introduce yourself to the patient
  • Wash your hands thoroughly
  • Explain to the patient what the examination involves
    • Reassure them that you will stop immediately if it becomes too painful at any point
  • Ensure verbal consent is adequately obtained
  • Request a chaperone

Preparation

  • Put on apron and gloves
  • Ask the patient to remove trousers and underwear
    • Cover the patient with a blanket when appropriate to maintain dignity
  • Position patient on their left side and bring their knees to their chest, positioning the buttocks at the edge of the couch
    • Ensure there is adequate lighting available for good visibility during the examination

Inspection

  • Gently part the buttocks and expose the natal cleft.
  • Inspect the perianal area for:
    • Skin disease (e.g. dermatitis) or skin tags
    • Pilonidal sinus, anal fissures, or anal fistula
    • External haemorrhoids
    • Rectal prolapse

Palpation

  • Lubricate your examination finger
  • Press your finger by the posterior anal edge
    • Note any anal fissures that can be felt here
  • Gently insert your finger into the anal canal, following the natural curve of the sacrum
  • Assess anal tone by asking the patient to squeeze your finger
  • Carefully rotate your finger to feel all walls of the rectum
    • This is best done by pronating at the wrist
  • In males, palpate the prostate on the anterior wall
  • Withdraw the finger and inspect contents for stool, blood, or mucus
  • Clean the patient with paper towel

Completing the Examination

  • Ask the patient to re-dress
  • Wash your hands
  • Perform a gastrointestinal examination if indicated

Findings are usually described by convention of a clockface, with anterior as 12 o’clock and posterior as 6 o’clock

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