Author: A. Chandrasekhar, MD

Consultant: M. Klamut, MD

Have the patient stand and learn forward, resting his hands on the examining table. Place a small amount of lubricant on your gloved index finger.

Place your finger at the anus and wait for reflex sphincter relaxation.
Gently insert your finger and examine as much of the rectal wall as possible.
Sequentially examine the right lateral, posterior and left lateral surfaces feeling for pelvic structures.
Evaluate the prostate gland in men along anterior wall.
- Examine the posterior surface of the prostate.
- Evaluate the lateral lobes and the sulcus.
- Note the size, shape, consistency and tenderness.
Note the rectal contents.
Remove finger and evaluate the faeces on the gloved finger and save it for Guaic testing.

An alternate method: The rectal exam can also be done in the left lateral decubitus.

Normal:

Rectal exam is unpleasant.

The sphincter has sufficient tone to grasp your finger.
Soft stools may be felt.
The walls of the mucosa are smooth.
The prostate gland is about 2.5 cm in length, with a medial sulcus, is firm and non-tender.
Stools can be seen on the gloved finger and retain it for Guaiac testing.