Physical assessment - Anus, rectum, and prostate: Nursing

Assessment of the anus and rectum should be completed as part of a comprehensive assessment like during a routine physical exam, or as part of a focused exam if a client is experiencing issues like rectal pain or changes to bowel patterns. For clients with a prostate, a prostate assessment provides the nurse with information about sexual health and genitourinary function. Let’s review the process of completing an assessment of the anus, rectum and prostate.

Okay, the supplies needed for this examination include a penlight, water soluble lubricant, drapes, gloves, a good source of light, and fecal occult blood testing material, as needed.

Now, this exam can be uncomfortable, both physically and emotionally, or even embarrassing for some clients;

which is why it’s important to explain every step in order to promote trust and relaxation.

You should also let your client know that at any time the exam can be stopped or paused if they request.

For clients with a known history of sexual abuse or trauma, remember not rush your examination, and use a gentle touch.

You can assist your client into one of three positions for this examination: lying on their back with their knees to their chest, also known as lithotomy, lying on the left side with their hips and knees flexed, or standing and leaning over the examination table.

In clients assigned male at birth, the last two positions work best for the anus, rectum, and prostate assessment, whereas with those assigned female at birth, anal and rectal examination is usually performed during a female reproductive exam while they’re already in the lithotomy position. It’s important to note that transgender clients should be examined in the position best suited for their preferance and identified gender.

Prepare for the exam by ensuring your client is in a comfortable position. For all clients, it’s recommended to let them know you’re starting the examination by touching them in a neutral location, such as the leg or foot.

Keep in mind that cold temperatures can cause rigidity of the rectal and pelvic muscles, making it more difficult for the healthcare provider to perform some assessment techniques; so ensure your hands are warm, and that the temperature in the room is comfortable. Provide privacy by closing the door and curtains, properly draping your client, and only exposing areas of their body as needed to perform your examination.