Policy for the digital rectal examination and manual removal of faeces in adults

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1 Explain and discuss the procedure with the Patient, To obtain patient consent and cooperation Ensure privacy and dignity Reduce patient’s embarrassment and maintain dignity
3 Attempt rectal sweep (to assess if rectal stimulation will promote natural bowel movement. If possible allow the patient to sit on a commode, so that rectal stimulation can be performed, if the patient is bedbound or manual removal of faeces is required, assist the patient to lie in the left lateral position with knees flexed, the upper knee higher than the lower knee, with the buttocks towards the edge of the bed This allows ease of examination into the rectum by following the natural anatomy of the colon.
4 Place a disposable incontinence pad beneath patients hips and buttocks. To prevent contamination and to reduce embarrassment to patient
5 Wash hands with bactericidal soap and water or bactericidal alcohol hand-rub and put on apron and gloves (double glove) To minimise cross infection and protect hands
6 Place some lubricating gel on a swab and gloved finger. Inform patient you are about to proceed To minimise discomfort. Assists with patient cooperation
7 Observe anal area prior to the insertion of the finger into the anus for evidence of skin soreness, excoriation, haemorrhoids, rectal prolapse or infestation Abnormalities should be reported to medical staff before any examination is undertaken (RCN 2008)
8 On insertion of gloved finger assess anal sphincter control. Resistance should be felt Digital insertion with resistance indicates good sphincter control, poor resistance may indicate the opposite
9 On examination note faecal matter within Rectum, note consistency. Remove a lump at a time until rectum empty To minimise discomfort and facilitate easier removal of the stool

Manual removal of faeces by nursing staff for adult patients who have an established bowel management plan
Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust Page 10 of 10

Exclusions: staff caring for children purpose:
Indications for manual evacuation of faeces
Exclusions / contraindications
Circumstances when extra care is required
Appendix ab btraining and competence assessment

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