Introduction
- Wash hands (and don PPE if needed)
- Introduce yourself (name and role)
- Confirm patient’s name and DOB
- Explain what the examination involves
- Explain the need for a chaperone
- Gain consent to continue
- Ask if patient in any pain before continuing
- Ask the patient to expose themselves in privacy and check when to re-enter
Gather equipment
- Non-sterile gloves
- Apron
- Lubricant
- Paper towels
Preparation
- Don an apron and pair of gloves
- With the couch flat, ask the patient to lie down on their left with their knees bent up towards their chest
Inspection
Clinical Signs
- Skin excoriation - caused be haemorrhoids , faecal incontinence or constipation
- Skin tags - can be associated with Crohn’s
- External haemorrhoids
- Anal fissure
- External bleeding - external haemorrhoids, anal cancer or brisk GI bleeding
- Anal fistula - may discharge pus with surrounding inflammation. Crohn’s disease, chronic anal abscess and diverticulitis
- Irregular growths - anal warts or anal cancer
Ask patient to cough & inspect
- Rectal prolapse
- Internal haemorrhoids - above the dentate line
Palpation
- Lubricate the digit
- Warn the patient
- Insert the digit
- In males palpate the prostate gland anteriorly - size symmetry and texture
- Rotate finger 360° and feel for abnormalities and location of any tenderness
- Withdraw the finger and examine for blood mucus or pus
- Clean the patient using paper towels
- Cover the patient and say that the exam is complete
- Dispose of used equipment
To Complete the Exam
- Explain to the patient that the examination is now finished.
- Thank the patient for their time.
- Dispose of PPE appropriately and wash your hands.
- Summarise your findings.
Further Assessments and Investigations
- Abdominal Exam
- Blood tests - FBC, U&Es, haematinics
- FIT testing - gastrointestinal malignancy
- Colon/sigmoidoscopy
- CT abdo/pelvis