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Authors: Kellee Slater
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on the role of ensuring that no student left medical school without having learned how to do a proper rectal examination. He regularly lined up a succession of wonderfully gracious volunteers who gave permission for their bottoms to be gingerly probed by the index fingers of medical students. Our teacher was always sure to let the patient know that they were contributing greatly to the advancement of medicine and he explained it to them so well that, strangely, the patients who consented to this significant invasion of their privacy didnât seem to mind that much.
The night before I was to christen my finger in this way, I was pretty nervous and didnât sleep well at all. How do you prepare for such a thing? I thought that trimming my fingernails definitely couldnât hurt. Should I wash my hands before, after, or both? What would it feel like? One glove or two? What if the glove broke? These sessions were done in groups of six, and my five colleagues and I all turned up at the prescribed time and place, giggling and nudging each other like silly schoolgirls. We were brought into the room where the patient was lying under a sheet, naked from the waist down. After some preliminary introductions, our instructor asked the patient to turn on his side and pull his knees up to his chest.
âIt is important to explain to the patient that when a finger is put in their bottom they will have a desire to move their bowels. You must reassure them that this is unlikely to happen,â he told us.
âMy goodness, is that a possibility?â I thought, not having contemplated that messy outcome. One by one we stepped up, gloves on. The surgeon stood by with a tube of lubricating jelly ready to squeeze onto our outstretched fingers. When it was my turn, I took a deep breath, inserted a very shaky finger and probed. Once in position, I was supposed to run my finger over the back wall of the rectum and then rotate my body through 180 degrees so my finger would turn to feel the prostate gland in the front. What an unusual sensation. It was soft and warm and I was repulsedas I felt a large chunk of faeces bumping around on my finger. All the while we were being observed to make sure our technique was correct.
âThe normal prostate should be about the size of the pad of the finger. Feel the walls of the rectum, they should be smooth,â the surgeon explained. This was followed by the old chestnut, âIf you donât put your finger in it, youâll put your foot in it,â meaning that if you avoid doing a rectal examination you will miss something vitally important, like a hidden cancer. It was a little unclear how long I was supposed to stay up there but when I thought I had got everything out of the experience that I could, I withdrew my finger. Then, the last part of the job was revealed to us. I was to carefully raise my soiled finger to eye level and closely inspect the poo that was now smeared on my glove for any sign of blood or pus. Was he kidding me?
Once the secrets of examining the anus and rectum were divulged to me, I felt that one of the great mysteries of medicine had been unlocked and I was no longer afraid. Nothing will ever change the fact that it is a truly unpleasant task for everyone involved, but it is a very important part of the examination of the human body and there are a lot of fascinating things to be discovered up there. Even after all these years, it is still exciting to see what you can discover just with an enquiring finger; this simple thing can often tell you much more than any scan.
When I was no longer a digital rectal examination novice, I was ready to progress to the more advanced techniques of examining the rectum. As a surgical registrar, it was time for things to get visual. Rigid sigmoidoscopy involves looking up someoneâs bottom with a 20-centimetre long tube that is lit up along its length. This tube allows you to find things in the rectum further afield
The night before I was to christen my finger in this way, I was pretty nervous and didnât sleep well at all. How do you prepare for such a thing? I thought that trimming my fingernails definitely couldnât hurt. Should I wash my hands before, after, or both? What would it feel like? One glove or two? What if the glove broke? These sessions were done in groups of six, and my five colleagues and I all turned up at the prescribed time and place, giggling and nudging each other like silly schoolgirls. We were brought into the room where the patient was lying under a sheet, naked from the waist down. After some preliminary introductions, our instructor asked the patient to turn on his side and pull his knees up to his chest.
âIt is important to explain to the patient that when a finger is put in their bottom they will have a desire to move their bowels. You must reassure them that this is unlikely to happen,â he told us.
âMy goodness, is that a possibility?â I thought, not having contemplated that messy outcome. One by one we stepped up, gloves on. The surgeon stood by with a tube of lubricating jelly ready to squeeze onto our outstretched fingers. When it was my turn, I took a deep breath, inserted a very shaky finger and probed. Once in position, I was supposed to run my finger over the back wall of the rectum and then rotate my body through 180 degrees so my finger would turn to feel the prostate gland in the front. What an unusual sensation. It was soft and warm and I was repulsedas I felt a large chunk of faeces bumping around on my finger. All the while we were being observed to make sure our technique was correct.
âThe normal prostate should be about the size of the pad of the finger. Feel the walls of the rectum, they should be smooth,â the surgeon explained. This was followed by the old chestnut, âIf you donât put your finger in it, youâll put your foot in it,â meaning that if you avoid doing a rectal examination you will miss something vitally important, like a hidden cancer. It was a little unclear how long I was supposed to stay up there but when I thought I had got everything out of the experience that I could, I withdrew my finger. Then, the last part of the job was revealed to us. I was to carefully raise my soiled finger to eye level and closely inspect the poo that was now smeared on my glove for any sign of blood or pus. Was he kidding me?
Once the secrets of examining the anus and rectum were divulged to me, I felt that one of the great mysteries of medicine had been unlocked and I was no longer afraid. Nothing will ever change the fact that it is a truly unpleasant task for everyone involved, but it is a very important part of the examination of the human body and there are a lot of fascinating things to be discovered up there. Even after all these years, it is still exciting to see what you can discover just with an enquiring finger; this simple thing can often tell you much more than any scan.
When I was no longer a digital rectal examination novice, I was ready to progress to the more advanced techniques of examining the rectum. As a surgical registrar, it was time for things to get visual. Rigid sigmoidoscopy involves looking up someoneâs bottom with a 20-centimetre long tube that is lit up along its length. This tube allows you to find things in the rectum further afield
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