Examination Explain to the patient that you will be starting the procedure. If the patient suffers local discomfort (or symptoms of autonomic dysreflexia) during this procedure local anaesthetic gel maybe instilled into the rectum prior to the procedure. It should also be considered if this is undertaken as an acute intervention. This requires five to ten minutes to take effect and lasts up to 90 minutes. Note that long term use should be avoided due to systemic effects. Lubricate one gloved finger with plain lubricating gel. Insert the lubricated gloved finger slowly into the patient’s rectum If stool is a solid mass, push finger into centre, split it and remove small sections until none remain. If stool is in small separate hard lumps remove a lump at a time. Great care should betaken to remove stool in such away as to avoid damage to the rectal mucosa and anal sphincters. Using a hooked finger can lead to scratching or scoring of the mucosa and should be avoided. Where stool is hard, impacted and difficult to remove other approaches should be employed in combination with digital removal of faeces. If the rectum is full of soft stool continuous gentle circling of the finger maybe used to remove stool. This is still digital removal of faeces. During the procedure the person delivering care may carryout abdominal massage. Once the rectum is empty on examination, conduct a final digital check of the rectum after five minutes to ensure that evacuation is complete. Place faecal matter in an appropriate receptacle as it is removed. Dispose as per National Infection Prevention and Control Manual. When the procedure is completed, wash and dry the patient’s buttocks and anal area and position comfortably before leaving. Remove the gloves and apron disposing of them as per National Infection Prevention and Control Manual. Wash your hands (refer to hand hygiene. Allow the patient to dress in private, unless they require assistance. Explain your findings and discuss and agree plan. Document in nursing notes all observations, findings and action. Consider onward referral to another healthcare professional if appropriate.