Digital rectal examination

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Info bulb.pngThe surgeon's maxim: "If you don't put your finger in it, you'll put your foot in it."

Vital part of the physical examination, particularly associated with the detection of abnormal masses in the rectum, including Haemorrhoids, prostatomegaly and rectal carcinoma. Often referred to as a "PR" (short for "examination per rectum).

Procedure

  • Lubricant jelly
  • Should always precede endoscopy, particularly to exclude low rectal tumours that can be missed on endoscopy.
  • If combined with endoscopy, wear two gloves on right hand and discard outer glove once PR examination finished (leaves operating wearing one pair of unsoiled gloves).

External inspection

Internally

Need to know anatomical relations.

  • Laterally, ischiorectal fossa.
  • Posteriorly, rectal wall and sacrum.
  • Anteriorly,
  • Presence of stool (?hard ?impacted ?soft ?bloody)
  • Pelvic tenderness (if ?appendicitis)
  • Anal tone (esp. as part of trauma log-roll or if concerned about neurological deficit).

Don't forget to wipe excess lubricant jelly off at the end, or at the very least, give the patient some tissue so they can do it themselves.

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