💡 This OSCE is rarely examined on real patients – more likely on a manikin. Still, know the full process, including consent, chaperone, and documentation.

🩺 Rectal Examination: Overall Plan
🧼 Preparation: Wash hands, introduce yourself, confirm identity, offer a chaperone, and obtain consent. 👀 Inspection: Examine perianal area for haemorrhoids, skin tags, fissures, ulcers, fistulas, or bleeding. ✋ Digital Rectal Examination: Assess tone, tenderness, lumps, hard stool, or faecal impaction. ♂️ Prostate Exam (in males): Comment on size, symmetry, sulcus, consistency, and tenderness. 🧤 Glove Check: Inspect for blood, mucus, pus, or melaena. 🙏 Closure: Thank patient, redress, wash hands, and present findings systematically.

🩺 Rectal Examination: Overall Plan

🧼 Preparation: Wash hands, introduce yourself, confirm identity, offer a chaperone, and obtain consent.
👀 Inspection: Examine perianal area for haemorrhoids, skin tags, fissures, ulcers, fistulas, or bleeding.
✋ Digital Rectal Examination: Assess tone, tenderness, lumps, hard stool, or faecal impaction.
♂️ Prostate Exam (in males): Comment on size, symmetry, sulcus, consistency, and tenderness.
🧤 Glove Check: Inspect for blood, mucus, pus, or melaena.
🙏 Closure: Thank patient, redress, wash hands, and present findings systematically.

🔑 Introduction (WIPER)

W – Wash: Hand hygiene 🧼
I – Introduce: Yourself, confirm details 🙂
P – Permission: Explain gently and gain consent ✅
E – Expose & Equipment: Gloves, lubricant 🧴, tissues, apron
R – Reposition: Left lateral (hips/knees flexed), sheet for dignity

📊 Common Rectal Findings

Finding	Description	Interpretation
✅ Normal	Smooth wall, normal tone, no masses	Normal
🍇 External Haemorrhoids	Tender bluish lumps at margin	Haemorrhoidal disease
⚡ Anal Fissure	Linear tear, painful	Chronic fissure; cause of PR bleeding
🎱 Rectal Mass	Irregular, hard, nodular	Suspicious of cancer → colonoscopy
🩸 Blood on Glove	Fresh red blood, mucus, melaena	Haemorrhoids, fissure, malignancy
⬇️ Decreased Tone	Weak squeeze	Neuro deficit, obstetric injury
⬆️ Increased Tone	Spastic contraction	Anal spasm, fissure pain
♂️ Enlarged Prostate	Rubbery, smooth, enlarged; central sulcus still palpable	Benign prostatic hyperplasia (BPH)
⚠️ Hard, Irregular Prostate	Nodular, obliterated sulcus, asymmetry	Suspicious for prostate cancer
🔥 Tender, Boggy Prostate	Soft, warm, very tender	Acute prostatitis

🧭 Examination Steps

Positioning: Offer a chaperone 👥, ensure privacy. Left lateral is most common.
Preparation: Gloves 🧤, lubricant 🧴. Warn before each step.
Inspection: Part buttocks, inspect for haemorrhoids, fissures, fistulae, warts, bleeding.
Digital Exam:
- Lubricated index finger → apply gentle pressure at anal verge.
- Advance slowly on inspiration → reassure throughout.
- Assess anal tone (squeeze + rest).
- Sweep circumferentially for masses, tenderness, impacted stool.
- Males → palpate prostate: size, symmetry, midline sulcus, tenderness, nodularity.
- Females → comment on cervix/uterus if palpable through anterior wall.
Glove Check: Blood, pus, mucus, melaena.
Closure: Remove glove safely, clean patient, thank them, wash hands.

🌟 OSCE Pearls

Always offer a chaperone and document this ✅
Never forget the glove check – examiners love this step 🧤
Describe prostate properly: “enlarged, smooth, rubbery, with a preserved sulcus” vs “hard, irregular, obliterated sulcus”
Say you would complete exam: abdominal exam, external genitalia, urinalysis, stool occult blood, colonoscopy if indicated.

📚 References

Talley & O’Connor – Clinical Examination
Geeky Medics: Rectal OSCE
OSCEstop – GI Examination

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Rectal examination (OSCE)

🔑 Introduction (WIPER)

📊 Common Rectal Findings

🧭 Examination Steps

🌟 OSCE Pearls

📚 References

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