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The patient is told that a rectal examination will now be performed. The examiner should tell the patient that a lubricant that will feel cool will be used, and this will be followed by the sensation of having to move the bowels; the patient should be assured that he will not do so.

The examiner lubricates the right gloved index finger and places the left hand on the patient's buttocks. As the left hand spreads the patient's buttocks, the examiner's right index finger is gently placed on the anal verge. The sphincter should be relaxed by gentle pressure

with the palmar surface of the finger, as shown in Figure 17-34. Figure 17-35A illustrates the procedure.

The patient is instructed to take a deep breath, at which time the examiner's right index finger is inserted into the anal canal as the anal sphincter relaxes. The sphincter should close completely around the examining digit. The sphincter tone should be assessed. The finger should be inserted as far as possible into the rectum, although 4 inches (10 cm) is the probable limit of digital exploration. The examiner's left hand can now be moved to the patient's left buttock, while the right index finger examines the rectum. This examination is illustrated in Figure 17-35B.

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