Palpation

Ask the patient to breathe in and out slowly, as an aid to relaxation and a distraction.

Place the pulp of the gloved right index finger on the anal margin. Gently curl the tip into the anus. Slowly advance through the anal sphincter into the anal canal and lower rectum making note of:

• sphincter tone, tenderness, spasm
• any lumps or nodules within the anal canal or rectum

Turn the hand anticlockwise round the left side of the pelvis to examine the anterior wall of the rectum, noting:

• the prostate gland in the male:
  • hard and nodular in prostatic carcinoma
  • boggy and tender in prostatitis
• the cervix in the female

Rotate the finger clockwise to examine in turn the left lateral wall, posterior wall and right lateral wall of the rectum.

Advance the finger as high as possible into the rectum. Note the presence of faeces. Withdraw slowly along the rectal wall. Feel for a polyp or carcinoma.

On removal of the finger, note:

• presence of faecal material, its consistency and colour
• blood, whether fresh or melaena
• mucus

Clean the anus with tissue paper and ask the patient to return to the supine position.