Yulian Salis P

Definition
Examination in which inserts a lubricated, gloved
finger into the rectum and feels for abnormal areas.
It consist of visual inspection of the perianal skin,
digital palpation of the rectum, and assessment of
neuromuscular function of the perineum.

Walker HK, Hall WD, Hurst JW, editors. Boston: Butterworths; 1990.
 Anatomy
In men, anterior to the
lower 1/3 of the rectum
lie the prostate, bladder
base and seminal
vesicles.

Bates Guide to Physical Exam and History Taking 8th Edition. 2002
 In women, anterior to
the lower 1/3 of the
rectum lies the vagina.
At the tip of the
examining finger it may
be possible to feel cervix
and even a retroverted
Uterus

Bates Guide to Physical Exam and History Taking 8th Edition. 2002
 Indication
Assessment of the prostate (particularly symptoms of
outflow obstruction).
When there has been rectal bleeding (prior to
proctoscopy, sigmoidoscopy and colonoscopy).
Constipation.
Change of bowel habit.
Problems with urinary or faecal continence.
In exceptional circumstances to detect uterus and
cervix (when vaginal examination is not possible).

Anna Shirley. The Digital Rectal Examination. Journal Clinical Examination. 2011.
 Contraindication
Imperforate Anus
Unwilling patient
Absence of anus
Moderate to severe anal pain
Prolapsed thrombosed internal hemorroids

Anna Shirley. The Digital Rectal Examination. Journal Clinical Examination. 2011.
 Preparation
Ensure examination environment is appropriate in
privacy.
Wash hands and introduction to patient.
Check patients identity.
Advice the patient that discomfort.

Anna Shirley. The Digital Rectal Examination. Journal Clinical Examination. 2011.
 Equipment
Lubricaing Jelly

Non-Sterile Glove

Tissue

Anna Shirley. The Digital Rectal Examination. Journal Clinical Examination. 2011.
 I. Standing
II. Dorsal Lithotomy
III. Lithotomy
IV. Lateral Recumbent

Anna Shirley. The Digital Rectal Examination. Journal Clinical Examination. 2011.
 Procedure
Inspection natal cleft, anus and perianal skin.

Anna Shirley. The Digital Rectal Examination. Journal Clinical Examination. 2011.
 Lubricate index finger of your gloved hand.
Assessment anal tone.
Palpation mucosa in 12 clock position
Feel median sulcus (prominent or dissapear)
Right lateral lobe, Left lateral lobe (size, regularity,
consistency, tenderness)
extend finger above the prostate.

Anna Shirley. The Digital Rectal

Examination. Journal Clinical
Examination. 2011.
 Normal prostate :
Smooth, regular surface, firm and symmetrical.
Enlargement prostate :
Smooth, regular surface, firm, symmetrical, median
sulcus dissapear, lateral and superior border
enlargement.
Suspicious Prostate cancer :
Hard, irregular surface, asymmetrical,

Anna Shirley. The Digital Rectal Examination. Journal Clinical Examination. 2011.
 Inspect the gloved finger
Color stool
Presence blood or mucus
Bates Guide to Physical Exam and History Taking 8th Edition. 2002
Anna Shirley. The Digital Rectal
Examination. Journal Clinical
Examination. 2011.