Rectal Examination (PR) OSCE Guide

Introduction

• Rectal examination frequently appears in OSCEs and requires identifying relevant signs using clinical examination skills.
• The guide provides a step-by-step approach to performing a rectal examination in an OSCE setting, with video demonstrations and checklists.

Equipment Needed

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

Procedure Overview

1. Introduction

• Wash hands and don PPE.
• Introduce yourself with your name and role.
• Confirm patient's name and date of birth.
• Explain the examination procedure in patient-friendly language.
• Discuss the necessity of a chaperone.
• Gain consent.
• Check for any patient pain before proceeding.

2. Preparation

• Wear an apron and gloves.
• Position patient in the left lateral position with knees bent.
• Ensure patient privacy and readiness.

3. Inspection

• Separate buttocks and inspect the perianal region for:
  • Skin excoriation
  • Skin tags
  • External haemorrhoids
  • Anal fissure
  • External bleeding
  • Anal fistula
  • Irregular growths

4. Palpation

Initial Steps

• Lubricate the examining finger.
• Warn the patient before insertion.
• Insert finger gently into the anal canal.

Prostate Examination (in males)

• Palpate the prostate gland to assess size, symmetry, and texture.

Rectal Examination

• Rotate finger 360 degrees to assess the rectal wall for lumps, hard stool, or tenderness.

Anal Tone Assessment

• Assess anal tone by asking the patient to bear down.

5. Final Steps

• Withdraw finger and inspect for blood or mucous.
• Clean the patient and dispose of used equipment.
• Cover the patient and provide privacy for dressing.
• Dispose of PPE and wash hands.
• Document the procedure and summarize findings.

Completing the Examination

• Thank the patient.
• Document findings and details of the chaperone.

Example Summary

• Describe general patient comfort and any findings.
• Note any abnormalities or normal findings in the rectal examination.

Further Assessments and Investigations

• Abdominal examination
• Blood tests (FBC, haematinics, U&Es)
• Faecal immunochemical test (FIT)
• Flexible sigmoidoscopy/colonoscopy
• CT abdomen and pelvis

Prepared by Dr. Ally Speight, Consultant Gastroenterologist.

References available upon request.