This document provides guidance on performing a digital rectal examination (DRE). It outlines the indications for a DRE, including suspected appendicitis, lower GI bleeding, changes in bowel habits, and genitourinary problems. It describes the steps to take, including obtaining consent, inspecting and palpating the rectal area, and examining the prostate if relevant. Precautions like wearing gloves and lubrication are also covered.

1. MAL.Z
Presents
DIGITAL RECTAL
EXAMINATION.

2. DIGITAL RECTAL EXAMINATION
Aim
. To understand the reason for performing a DRE
. To know the issues around consent and chaperones
. To be knowledgeable in the procedure of DRE
Indications
. Suspected appendicitis
. Lower GI bleeding characterized by bleeding from
below the ligament of Trietz
. Change in bowel habits
. A part of the abdominal examination
. Genitourinary problems
. Pelvic/Spinal trauma

3. • Steps
• Wash hands and introduce yourself to the pt. (Name and Title)
• Confirm the pt. by checking their names and DOB
• Explain the procedure (DRE)
• Explain to the pt. that for intimate procedures, it’s normal to have a second person
present
• Get their verbal consent and ensure the pts. privacy and ask them to undress from
the waist downwards; to lay on the bed and cover themselves up
• If the pt. is under general anaesthesia;
• . Check the name band against the pts. notes
• . Check consent form signed and dated or documentation done in order to perform a
DRE under a GA.

4. • Equipments
• . Non-sterile gloves
• . Lubrication, it could be;
* Water-based gel
* Silicone oil though mostly used on mannequins
• . Gauze/tissue

5. Preparation
• . Wash hands and put on gloves
• Ask pt to lie on their left side on the edge of the bed with their knees brought up to
the chest
Inspection
• Make sure there’s a good light source
• Inspect around the perianal area looking for; (Haemorrhoids, Fistulae, Abscesses,
Lesions or Warts and general cleanness of the area) (Explain to the pt. what you’re
looking for)
• Ask the pt. to strain/bend down in order to look for signs of a prolapse.

6. Palpation
• First, start by lubricating the index finger
• Then place the index finger down the natal cleft on to the anal margin (This area is
the groove btwn the buttocks that extends from just below the sacrum to the
perineum above the anus.
• Ask pt. to relax and take a deep breath
• As the sphincter relaxes, advance the finger into the anal canal
• Then, check the sphincter tone by asking the pt. to squeeze the finger with their anal
muscles
• After, rotate the finger through 360 sweep ( in order to feel for thickening and
masses)
• Warn the pt. and insert the finger deeper into the rectum
• And rotate the finger through 360 sweep again and feel for thickness, masses and
feaces.

7. Prostate Examination
• The prostate is felt through the anterior rectal wall. This is done by identifying 2
lobes either side which should normally be smooth and rubbery and identify the
central sulcus in order to check for masses.
Finally…
• Warn the pt. then gently withdraw the finger
• Then inspect the glove for blood, feaces and mucus
• Then tell the pt. that the examination is over and offer to wipe the natal cleft for
them
• Remove the gloves and wash hands
• Explain to the pt if any further examinations need to be performed.