The Rectal examination is performed with the index finger (gloved/lubricated).

Positions: Patient standing, bent over forward. Also, Patient in lateral decubitus and knee chest position.

Always tell the Patient what you are going to do.


Inspection:

Normal Shape (anterior-posterior split, converging creases).

Surface (lesions, erythema, fissures, ulcers, hemorrhoids, abscesses, fistula, polyps).

Sphincter:
Internal, External. Tone (hypotonic/hypertonic).

Anal Canal (caliper, stenosis, walls).


Walls (surface, consistency).
Tumors, masses, polyps.


*Best position: patient standing bends over the table.
Contraindicated in acute MI. Suppurative urethritis and severe neutropenia/agranulocytosis.

Estimate:

Site: below the anterior wall of the rectum.

Shape: wallnut with medial groove.

Size: 3cm by 4cm by 2.5cm (20grams) approximately.

Consistency: Rubbery, smooth, non-tender.

Mobility: lateral and anterior-posterior.

masses: Tumors, nodules (hard, irregular, nodular, tenderness, attachment).

Hemoccult test
Should be performed selectively, not routinely.