Alimentary | Rectal Examination
Alimentary: Rectal Exam
  1. Setting up
  2. External inspection
  3. External inspection: straining
  4. Internal palpation
  5. Stool examination
Setting up
  • Describe procedure to pt.
  • Pt. in Sim position: on table, lying on L side, knees up towards chest, facing away from Dr.
  • Gloves on.
External inspection
  • Piles.
  • Skin tags (normal, Crohn's, hemorhoids).
  • Rectal prolapse.
  • Anal fissure.
  • Fistula.
  • Anal warts.
  • Carcinoma.
  • Signs of incontinence, diarrhea.
External inspection: straining
  • Ask pt. to strain.
  • Rectal prolapse upon straining.
  • Hemorrhoid prolapse.
  • Incontinence.
  • Ask if straining is painful.
Internal palpation
  • Lubricate index finger.
  • Insert finger slowly, assessing external sphincter tone as enter.
  • Male: palpate prostate [anterior of rectum]:
    Hard nodule (prostate cancer).
    Tender (prostatitis).
  • Female: palpate cervix [anterior of rectum]:
    Mass in pouch of Douglas.
  • Rotate finger, palpating along left, posterior, right walls.
  • Withdraw finger.
  • Wipe lubricant off pt.
  • Ask if was significant pain during examination. 
Stool examination
  • Inspect withdrawn fingertip for:
    Blood, melena.
    Stool color.
  • If indicated, do a fecal occult blood test: blue result means blood.