Introduction:

1. Wash hands and don appropriate PPE.
2. Introduce yourself: Name, role, and purpose of the examination.
3. Confirm patient details: Ask for the patient’s name, date of birth, and how they like to be addressed.
4. Explain the examination: “I need to perform a rectal examination, which involves inserting a finger into your back passage to check for any abnormalities. It shouldn’t be painful, but it may feel uncomfortable.”
5. Obtain consent: Confirm the patient understands and agrees to the procedure.
6. Chaperone: Explain the presence of a chaperone for comfort and consent.
7. Provide privacy for the patient to undress from the waist down and cover with a sheet.

Equipment Needed:

• Non-sterile gloves
• Apron
• Lubricant
• Paper towels

Positioning:

1. Ask the patient to lie on their left side, knees bent towards their chest.

Inspection:

1. Part the buttocks and visually inspect the perianal region for:
   • Blood, rashes, excoriations, warts, haemorrhoids, skin tags, fissures, fistulae, or masses.
   • Ask the patient to cough to inspect for rectal prolapse or internal hemorrhoids 

Palpation:

1. Lubricate your gloved index finger.
2. Gently insert the finger into the anus, waiting for the sphincter to relax.
3. Assess the consistency of faeces and any tenderness.
4. Ask the patient to bear down to help bring any internal lesions lower.
5. Test anal tone by having the patient squeeze your finger.
6. Complete a 360° sweep of the rectal wall to check for masses, tenderness, or abnormalities.
7. In males, palpate the prostate gland for size, symmetry, consistency, and any abnormalities.

Post-examination:

1. Withdraw the finger and inspect for blood, mucus, or melaena (sticky dark blood indicating upper GI bleeding).
2. Clean the anus and wipe any excess lubricant.
3. Thank the patient and offer privacy for them to get dressed.
4. Dispose of waste appropriately and wash hands.
5. Document findings in the patient’s notes, including the presence of the chaperone and a summary of the exam.

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