Rectum Examination

Inspect the right external inguinal ring and the femoral canal for hernias and ask the patient to bear down. Bear down? Although it is often impossible to palpate an inguinal hernia in a supine patient, you may try to do so by the usual method. Bear down. Relax. Next, feel for a femoral hernia as you did with the patient standing. Then examine the other side. Relax. To examine the rectum, position the patient on his left side close to the edge of the table. His right leg should be flexed at the hip and knee.

Drape the patient appropriately and adjust the lighting for a good view of the anus and surrounding area. Spread the buttocks apart and inspect the sacrocoxidio and perianal areas for lesions, redness, rashes or excoriation. Palpate any abnormal areas noting any tenderness. Ask the patient to bear down as you inspect the anus for hemorrhoids, fissures or other lesions. None are seen here. Now lubricate your index finger and tell the patient that you're going to put a finger into his rectum. Ask the patient to bear down and place the pad of your index finger over the anus.

As the sphincter relaxes, gently insert your fingertip into the anal canal pointing toward the umbilicus. Ask the patient to relax. Note sphincter tone, tenderness, ingeration, irregularities or nodules. To palpate as much of the rectal wall as possible, insert your finger fully and rotate your hand clockwise as far as possible and counterclockwise. Note any nodules, irregularities or undue tenderness. By asking the patient to bear down, you can sometimes bring a suspected lesion into reach. With your hand still in a full counterclockwise position, slide your finger over the posterior surface of the prostate gland,

noting its size, shape and consistency. Identify the lateral lobes, median sulcus and any hard areas, nodules or tenderness. Return your hand to a neutral position and gently withdraw your finger. Your examination is complete. Wipe the anus to remove any lubricant or give the patient tissues to do so himself. If people matter is present, test it for occult blood. There were no masses on your examination.