Rectal examination (OSCE)

Introduction (Use the acronym WIPER to prepare for the examination)

• W - Wash your hands
• I - Introduce yourself and confirm patient details
• P - Permission - gain consent to proceed with the examination, including explaining relevant details
• E - Expose the patient appropriately, gather Equipment
• R - Position the patient lying back at 45 degrees comfortably

• Positions correctly (lying on left side, fetal position with hips and knees flexed)
• Check patient is comfortable and aware of procedure
• Offer a chaperone and ensure total privacy - screen at the door
• Wash hands and don gloves and apply lubricating gel to index finger of gloves
  • Gently parts buttocks and inspects for
    • Skin tags, ulcers, abnormal growth
    • Warts, fissures, fistulas
    • External haemorrhoids and any bleeding
  • Tells patient before inserting finger Inserts one lubricated finger into anus
  • Examines sensation of the perianal skin
  • Ask patient to 'bear down' and squeeze on finger to examine anal tone
  • Explain need to feel
    • Entire wall of rectum by moving finger 180 degrees in either direction:
    • Polyps
    • Lumps
    • Faecal impaction/hard stool
    • Prostate: Comments on:
    • Size
    • Symmetry
    • Midline sulcus
    • Texture
• Tell patient before removing finger
• Inspects glove of finger for melaena, mucus, fresh blood
• Dispose of gloves