Rectal Exam (PR)

Last updated 20.09.12



Assessment by manual digital exam on anus & rectum


-  Assessment of perianal, anal & rectal areas


-  Assessment of prostate

-  Assessment for cord pathology, prostate haematoma or bleeding in Trauma setting (Pelvic Trauma)

-  Evaluation post perineal repair



-  Gloves

-  Lubricant gel (KY Jelly)

-  +/- FOBT Kit



-  Explain procedure, consent

-  Position

-  Left lateral decubitus w knee flexion

-  Bending forward over table/couch..

-  Inspect perianal skin: fissures, skin tags, haemorrhoids

-  Insert index finger into anus to MCP joint

-  Examine in full circle

-  Lumps, tenderness, texture of walls

-  Prostate Exam

-  Anterior wall of rectum

-  2.5cm length +/-

-  Smooth lateral lobes w midline sulcus

-  Note shape, size, consistency, smoothness

-  Should be smooth, firm, non-tender

-  Consistency

-  Forehead: firm: prostate Ca

-  Nose: normal

-  Chin: boggy: BPH

-  Does not raise PSA significantly in normal prostates

-  Remove finger

-  Look for stool & blood

-  Gross blood: haemorrhoid, Ca, strangulated bowel obstruction




Procudure for TraumaSetting

-  Patient log rolled onto side

-  Tone detected on insertion + patient bears down on finger

-  Poor tone indicates spinal cord pathology

-  Detect bleeding

-  Feel for boggy high riding prostate

-  Indicates prostate haematoma & possible pelvic fracture


Paediatric Setting

-  Try to avoid if at all possible

-  Lose trust & repore with patient