Male Rectal Exam, Other Tests and Alternatives

BernieK Asked :

I am a 52 year old male and have been have had 3 urinary tract infections in the last 8 months. The first two times I was just given antibiotics by my doctor. No tests apart from an examination. I developed severe diarrhea that lasted for like 2 months. When I got my third infection I insisted that tests be done because I was tired of this repeated antibiotic prescription. The doctor took blood and urine for testing and now wants to send me to a specialist for a further check up. I know this is necessary especially as I am getting older.

My doctor says that the specialist will have do a rectal exam and other tests to strike off certain possibilities. He did not specify anything and I am now a bit worried. I was wondering if there are tests and so on that my doctor could do ahead of time so that we don’t waste the specialist’s time. I want to get all this over and done with instead of going back and forth between doctors. What are the alternatives and what should my doctor be looking for? Like most men, I am really not looking forward to my first and hopefully last rectal exam.

This question was posted under the What is a UTI? Causes of Urinary Tract Infections article.

Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.

Dr. Chris Answered :

Horror stories about digital rectal examinations (DRE’s) has a lot to do with media portrayals of this simple and quick procedure. There is no reason to be apprehensive about it. A DRE may seem like an archaic procedure but the findings provide a wealth of information to your doctor before expensive tests and investigations are conducted.

In terms of a rectal exam, the signs of the following may be evident :

  • Prostate enlargement (BPH, prostatitis, tumor)
  • Abscess
  • Mucus, blood in the stool
  • Crohn’s disease
  • Rectal tumors, polyps, prolapse

By taking the findings of the rectal exam into consideration, coupled with previous test results, the specialist (urologist, proctologist – you did not specify) can decide upon further examinations to consider, like a protoscopic investigation, colonoscopy, CT scan, other blood, urine and stool tests and so on. It may be unnecessary to conduct these investigations ahead of time so it is best to allow the specialist to complete the physical examination before taking the evaluation further.

Your doctor has decided upon a referral to a specialist for a number of reasons which he may not have divulged to you as yet. If you do ask him, he will explain his decision. Based on his differential diagnoses or other concerns as a result of your past medical history, family history, current health status and results of the tests, he has made this decision in your best interests. Therefore we cannot advise you on what your doctor is or should be “looking for” unless you have more details at hand.

The most common concerns for a man who has experienced recurrent UTI’s include :

  • Benign prostatic hyperplasia
  • Prostatitis (infectious or non-infectious causes)
  • Cancer of the prostate, urethra, bladder
  • Interstitial cystitis
  • Urinary stones
  • Sexually transmitted diseases (STD’s)

This accounts for the symptoms you experienced related to your UTI but your doctor may have other concerns possibly relating to your persistent diarrhea or based on other findings upon conducting those tests. This opens up a host of other possibilities as well.

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