Having a nurse in the room for the procedure is recommended, they may act both as a chaperone as well as assistant.

• Don your gloves, placing 2 gloves on your dominant hand and one on your non-dominant hand. Utilize universal precautions as appropriate during exams.

Inspection:

• Inspect the buttocks
• Use both hands to gently spread the buttocks apart to inspect the perianal and sacrococcygeal regions
• Note any lesions, lumps, ulcers, inflammation, rashes, or excoriations
• Ask the patient to bear down and observe for any hemorrhoid or mucosal prolapse

Palpation:

• Apply lubricant to the index finger of your DOUBLE GLOVED hand and to the patient's anus
• Instruct the patient to relax their anal sphincter
• Once the anal sphincter is relaxed, insert your finger pointed towards the umbilicus with your palm facing towards the patient's head. Insert your finger slowly and in a step-wise fashion, feeling the anal canal initially and then advancing as far as possible
• Slowly rotate your hand clockwise to palpate the right side of the patient's rectum, then counterclockwise to palpate the left side of the patient's rectum
• Have the patient squeeze their anus and then bear down. Note sphincter tone, any tenderness, induration, irregularities, or nodules

Palpation of the Prostate in Male Patients: Reassure the patient that when palpating the prostate they may feel the urge to urinate but that they will not do so. Then, turn your body so that you can further rotate your finger counterclockwise to palpate the posterior surface of the prostate gland.

• Identify the lateral lobes and medial sulcus
• Note the size, shape, and consistency
• Identify any nodules or tenderness

Palpation of the Cervix in Female Patients: Inform the patient that you will be feeling for the cervix of the uterus.  Note tenderness, irregularities, and mass effect.

Removal of the Finger:

• Ask the patient to strain, once the patient relaxes their sphincter, withdraw your finger from the anus and note the presence of fecal matter (its colour and consistency) and the presence of blood
• Remove and discard the now dirty glove from your dominant hand (taking care not to contaminate the clean one underneath)