Introduction
Wash hands
Introduce yourself
Confirm patient details – name / DOB
Explain the examination
Gain consent
Explain procedure is intimate but explain why it is necessary
Explain what you want the patient to do “undress from the waist down, then lie on your left side then bring your knees up to your chest”
Give them a sheet to cover up until you are ready
Use the patients name and comfort them, explaining what you are doing and checking they are okay throughout
Chaperone
Ask if the patient currently has any pain
Gather equipment
Gloves
Apron
Lubricant
Gauze
General inspection
Part the buttocks and look for any blood, rashes, fistulae, fissures, excoriations and warts
Examination
Lubricate gloved finger and approach the anus from posterior angle/intergluteal cleft.
Pause when the finger is over the anus and wait until the sphincter relaxes.
Insert finger into anus (warning patient just before you do)
Comment on consistency of any faeces
Ask the patient to squeeze your finger (tests anal tone)
Do a 360˚ sweep feeling for any masses or wall thickenings
PROSTATE: (male only)
o Size (walnut sized is normal) (enlargements may indicated BPH if smooth, or malignancy if irregular)
o Presence of two lobes with central median sulcus
o Consistency (firm is normal) (boggy may indicated prostatitis)
o Surface
o Tenderness
Remove finger and inspect to determine if there are any faeces and any mucus or blood
If there is blood, comment on the colour (is it fresh red blood or dark red melena)
Clean the anus or provide tissues/gauze for the patient to clean themselves
To complete:
Thank the patient and cover them up using a sheet, allow them to re-dress
Document procedure findings and that a chaperone was present and who it was
Wash hands
Dispose of clinical waste appropriately
Summarise and suggest further investigations you would do after a full history including full abdominal exam, FBC, Faecal occult blood test, abdominal XR, flexible colonoscopy and CT abdomen.
Questions:
Give 3 indications for performing a PR examination?
What are the 4 hallmark symptoms/signs suggesting intestinal obstruction?
Give 2 possible origins of bleeding for dark red blood (melaena) on PR exam?
Give 2 possible origins of bleeding for bright red blood on PR exam?
If a patient was diagnosed with BPH, what class of medication would you give to help manage symptoms? Give an example of a drug from this class?
What is the likeliest cause of bright red blood on your gloved finger on inspection?
Comments