Expansion
Inspect, then palpate the canal, rectum and prostate
Expansion
Preparation: explain, gain consent, offer a chaperone and document their name, left lateral position with knees drawn up, gloves and lubricant, good light.
- Inspect the perianal skin: skin tags, fissure (usually posterior midline, and exquisitely painful), external haemorrhoids, fistula openings, excoriation, warts, prolapse, and a gaping anus
- Insert the lubricated finger, warning the patient, and assess resting tone then squeeze tone
- Sweep the rectum through 360 degrees for masses, tenderness, and the rectovesical or rectouterine pouch
- Prostate in men: two lobes with a median sulcus, size, symmetry, consistency, nodules, tenderness
- Withdraw and inspect the glove for stool colour, blood, melaena and mucus
- Clean the patient and document
Prostate findings
| Finding | Suggests |
|---|---|
| Smooth, symmetrical, enlarged, sulcus preserved | Benign hyperplasia |
| Hard, irregular, nodular, sulcus lost | Carcinoma |
| Exquisitely tender, boggy, hot | Prostatitis, and vigorous massage should be avoided |
Indications include rectal bleeding, altered bowel habit, anaemia, tenesmus, prostatic symptoms, faecal incontinence, constipation and impaction, suspected cauda equina (where tone and perianal sensation are the point), and unexplained pelvic pain.
Perianal sensation and anal tone are the essential elements in suspected cauda equina, and their omission is a recurring source of avoidable harm.