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Stanford Medicine 25 An Initiative to Revive the Culture of Bedside Medicine

#21 Rectal Exam

Key Learning Points

  • Learn the important parts the rectal exam

 

Introduction: A rectal exam should be performed on most patients with abdominal pain and any concern for blood loss. Here, we review some important steps of a compete rectal exam.

 

Rectal Exam

 

Positions

 

Sims position

 

Inspection of Anus

 

Palpate Rectum and Prostate

  1. Use a small amount of lubricant on the index finger and ask the patient to take a deep breath and insert the finger facing down (6 o'clock position)
  2. Appreciate the external sphincter tone then ask the patient to bear down and feel for tightening of the sphincter
  3. Palpate the prostate gland. Note the following:
    1. Approximate size of the prostate gland (normally about the size of a walnut, 2-3 cm but wider at the top)
    2. Feel for tenderness (prostatitis)
    3. Feel for nodules or masses
  4. Palpate the rectal wall starting from the 6 o'clock position clockwise to the 12 o'clock position. Then return to the 6 o'clock position and palpate the other half of the rectal wall feeling for masses, nodules and tenderness.

 

Occult Blood Test