Digital Rectal Examination

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Before you start

Ensure patient needs a DRE

Check patient's allergy status (e.g. latex)

Be able to tell patient what you intend to do & why

Be able to discuss the risks and benefits of the intended procedure

Understand how to gain informed consent

Introduction

1. Wash hands

2. Introduce yourself

"Hi, my name is Aleda and I'm a 3rd year medical student"

3. Confirm patient details

Name, DOB, NHS no.

4. Ask about allergies

"Do you have any allergies?"

5. Explain the procedure

"I'll be doing a rectal examination on you. This involved me inserting a single finger into your back passage. It will be a little uncomfortable but shouldn't be painful and will only last a short while. This is being because...."

6. Assess understanding

"Do you understand everything I've said to you?"

7. Gain consent

"Are you happy to go ahead with the procedure?"

8. Request a chaperon

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Equipment

PPE (Gloves & Apron)

Lubricant

Paper towels

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Prep

1. Wash hands

2. Don gloves & apron

3. Adequately expose & position patient while maintaining dignity

Ask patient to remove underwear & cover themselves with the blanket while laying in the left lateral position with knees to their chest

In privacy

Inspection

1. Separate buttocks and inspect externally for:

Skin tags

Rashes

Haemorrhoids

Anal fissures

Usually located posteriorly in midline

External bleeding

Fistulae/abscesses

Anal excoriation (e.g. incontinence, sphincter dysfunction)

Palpation

1. Lubricate examining finger

2. Warn patient you're about to insert finger

Encourage them to relax

3. Insert finger gently into anal canal & allow time for sphincter to relax

4. Palpate prostate anteriorly

Comment on size, symmetry & texture of prostate

Normal = Walnut sized, symmetrical with central sulcus with "tip of the nose" texture

"Boggy texture" = Prostatitis

Loss of sulcus = BPH (smooth) or malignancy (irregular)

5. Rotate finger 360 degrees (Anterior 180 sweep & Posterior 180 sweep) to assess entire rectum

Note location of masses/abnormalities

Is there stool in the rectum?

6. Assess anal tone by asking patient to squeeze finger

7. Withdraw finger

Inspect for blood (fresh vs. malaena)

Inspect for stool/mucus

8. Clean patient with paper towels

9. Cover patient with sheet provided and let them know the exam is over

10. Give patient privacy to clean themselves further and get dressed

11. Dispose of gloves and waste appropriately .

12. Wash hands

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Completing the exam

Thank the patient

Summarise findings

External perianal appearance?

Anal tone?

Rectal contents?

Mucosal surface?

Prostate?

Suggest further investigations

Full abdo exam

Bloods (e.g. FBC, PSA)

Faecal occult blood

Abdo XR

Flexible sigmoidoscopy/Colonoscopy

CT abdo/pelvis