II. Indications
- Colon Cancer Screening (low efficacy)
- Prostate Cancer Screening (low efficacy)
- Benign Prostatic Hyperplasia (assess size of Prostate)
- Cauda Equina Syndrome (low efficacy)
- Gastrointestinal Bleeding (or occult acute blood loss)
III. Technique: Finger Insertion
- Lubricate gloved index finger
- Patient bears down as if straining at stool
- Gently insert finger after sphincter relaxes
IV. Technique: Evaluation
- Assessment of 360 degree sweep of Rectum
- Anal sphincter tone
- Tenderness
- Nodularity or masses
- Assessment of anterior Prostate surface (males)
- Evaluate lateral lobes of Prostate
- Normal Prostate is Rubbery, non-tender
- Assess for nodularity (Prostate Cancer)
- Evaluate median sulcus
- Absent sulcus suggests Benign Prostatic Hypertrophy
- Evaluate lateral lobes of Prostate
- Assessment of Rectal Tone (evaluation of S2-S4 function, e.g. cauda equina evaluation)
- Resting tone applies pressure to inserted finger without patient bearing down
- Patient tries to resist Defecation
- Puborectalis Muscle contracts and applies pressure to the anterior inserted finger
- External anal sphincter contracts and applies pressure circumferentially around the inserted finger
- Patient bears down
- Pressure on inserted finger increases
- Overall poor efficacy of Rectal Tone to diagnose S2-S4 neurologic deficit
V. Technique: Completing Examination
- Observe for grossly bloody stool
- Consider test for Stool Occult Blood