Introduce yourself to the patient Wash your hands thoroughly Explain to the patient what the examination involves Make sure you reassure the patient you can stop 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 Ask your chaperone to be on the other side of the coach, supporting the patient as they face away from you 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 By TeachMeSeries Ltd (2025) Figure 1Findings as seen on DRE (A) Skin Tags (B) Anal Fissure 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, also confirm 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 Completing the Examination Clean the patient with paper towel 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 Rate This Article