Rectal Exam Reasons and Digital Rectal Examination Procedure

What is a digital rectal examination?

A rectal exam, or more accurately digital rectal examination (DRE), is an investigative procedure where a medical professional uses a gloved finger to reach the rectum via the anus and examine for abnormalities in the pelvis and lower abdomen. It is done in both men and women although in women it may involve a rectovaginal examination.

Often dreaded by patients, the procedure is not intended to cause pain and in patients with no abnormalities of the anorectal area or in the pelvis, it is usually not painful. However there may be some degree of discomfort even in patients with no medical disorders. The gloved finger is lubricated and inserted gently without harsh forceful movements.

Procedure in Men and Women

The procedure can be done while lying on the side, usually left side, but is generally performed while standing or lying on the back. Although the doctor usually examines the anus for signs of hemorrhoids, anal fissures, warts or rashes, patients with hemorrhoids should inform the doctor before the procedure.

For men the procedure is usually done while standing up. The patient is asked to lean against the examination table and squat slightly. For women the procedure is usually down when lying on the back with the legs in stirrups. Patients may be asked to squeeze against the inserted finger as means of testing the anal and rectal muscle strength. The doctor may apply pressure on the lower abdomen and pelvis with the other hand to help detect any abnormalities.

The entire procedure takes about one minute but can be extended longer to up to three to four minutes but almost never past five minutes. It is important for patients to report even minor pain during the examination as this could be an indication of underlying pathology. Some minor rectal bleeding, particularly after a bowel movement, may be noticed after the procedure but this is more likely to occur in patients with hemorrhoids.

Reasons for a Rectal Examination

A rectal examination may be done as a routine screening procedure for men with a history of benign prostatic hyperplasia (enlarged prostate) or at risk of prostate cancer. It may also be done in men and women at risk of  colorectal cancer, however, modern diagnostic techniques often means that procedures such as a colonoscopy would be preferable. Less frequently a rectal exam is done in women where a vaginal examination is inappropriate.

Other than in these instances, a rectal examination may be done based on a history or other clinical features that may indicative of disorders in these systems.

Digestive System / Gastrointestinal Tract

  • Abdominopelvic inflammation/infection – appendicitis, peritonitis, pelvic abscess, lower abdominal pain with tenderness and fever.
  • Abnormal bowel habits, especially a change in bowel habit, including diarrhea, constipation, straining to pass stool, constant urging despite a bowel movement, anorectal pain, and painful bowel movements.
  • Rectal bleeding and excessive mucus
  • Iron deficiency anemia with no indication of bleeding from other sites
  • Abdominal mass
  • Unexplained weight loss

Genitourinary System

  • Prostate disorders – prostate involvement in urinary obstruction (prostatism) or suspected prostatic cancer.
  • Urinary symptoms including dysuria (pain when urinating), frequent urination and hematuria (blood in the urine).
  • Epididymo-orchitis – inflammation of the epididymis and testes
  • Gynecological symptoms/disorders where a vaginal examination is not possible.

Back

  • Backache – particularly low back pain, coccyx pain
  • Lumbosacral nerve root pain
  • Injury to the spine

Other Indications

  • Fever of unknown origin
  • Unexplained bone pain
  • Unexplained lower abdominal pain, pelvic pain
  • Trauma to the abdomen and/or pelvis

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