Rectal examination

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Rectal examination
Intervention
Digital rectal exam nci-vol-7136-300.jpg
Digital rectal exam: side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder.
ICD-9-CM 89.34
MeSH D051517
MedlinePlus 007069

A rectal examination, commonly called prostate exam, is an internal examination of the rectum such as by a physician or other healthcare professional.

Procedure[edit]

The digital rectal examination (DRE; Latin: palpatio per anum, PPA) is a relatively simple procedure. The patient undresses, then is placed in a position where the anus is accessible (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups). During this procedure area which can be palpated are: Bulb of penis,urogenital diaphragm, anorectal ring etc. but it can't palpate structure like ureter and urethra.

If the patient is lying on their side, the physician will usually have them bring one or both legs up to their chest. If the patient bends over the examination table, the physician will have them place their elbows on the table and squat down slightly. If the patient uses the supine position, the physician will ask the patient to slide down to the end of the examination table until their buttocks are positioned just beyond the end. The patient then places their feet in the stirrups.

The physician spreads the buttocks apart and will usually examine the external area (anus and perinium) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient relaxes, the physician slips a gloved and lubricated finger into the rectum through the anus and palpates the insides for approximately sixty seconds.

Usage[edit]

This examination may be used:

The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.

The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; sigmoidoscopy is preferred. However, it is an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum.

Sometimes proctoscopy may also be part of a rectal examination.

Veterinary medicine[edit]

In veterinary medicine rectal examination is useful in dogs for analysis of the prostate (as in men), pelvic urethra, sublumbar lymph nodes, and anal glands. In horses it is a vital component of the clinical examination for colic, to determine the presence or absence of bowel torsion, impaction, or displacement. When horses undergo a rectal examination there is a small risk of a rectal tear occurring, which can be a life-threatening event, rapidly leading to peritonitis and septic shock. It is also a common procedure in cattle, and is one method of diagnosing pregnancy in both the horse and the cow.

The procedure in dogs and cats is similar to humans. For the horse, the patient stands in a stock and may be sedated. The examiner puts on a long glove that extends to the shoulder. The examiner inserts the hand and arm into the rectum as far as necessary.

Popular culture[edit]

Due to the taboos surrounding the anus, and the potential for discomfort and embarrassment, the rectal exam is a common comedic device, including in episodes of Saturday Night Live,[4] Futurama, The Family Guy and South Park.

A popular variation is the use or overuse of rectal examinations by inquisitive extraterrestrials. One early reference occurs in Communion: A True Story (1987) by Whitley Strieber: "There were clothes strewn apart, and two of the stocky ones drew my legs apart. The next thing I knew I was being shown an enormous and extremely ugly object, grey and scaly, with a sort of network of wires on the end. It was at least a foot long, narrow, and triangular in structure. They inserted the thing into my rectum. It seemed to swarm into me as if it had a life of its own. Apparently, its purpose was to take samples, possibly of fecal matter, but at the same time I had the impression I was being raped and for the first time I felt anger.[5]

Similar activities are attributed to extraterrestrials in video games such as Saints Row IV, Gaia Online and Destroy All Humans!.[6]

See also[edit]

References[edit]

  1. ^ Chodak, GW.; Keller, P.; Schoenberg, HW. (May 1989). "Assessment of screening for prostate cancer using the digital rectal examination.". J Urol 141 (5): 1136–8. PMID 2709500. 
  2. ^ Schroder, F. H.; Kruger, A. B.; Rietbergen, J.; Kranse, R.; Maas, P. v. d.; Beemsterboer, P.; Hoedemaeker, R. (1998). "Evaluation of the Digital Rectal Examination as a Screening Test for Prostate Cancer". JNCI Journal of the National Cancer Institute 90 (23): 1817–1823. doi:10.1093/jnci/90.23.1817. ISSN 0027-8874. 
  3. ^ "Effects of False-Positive Prostate Cancer Screening Results on Subsequent Prostate Cancer Screening Behavior". Retrieved August 11, 2013. 
  4. ^ New York Magazine - Vol. 28, No. 11. "Saturday Night Live at twenty"
  5. ^ Strieber, Whitley (1987). Communion: A True Story. Beech Tree Books. pp. 21–22. ISBN 9780688070861. 
  6. ^ "Alien anal probe saw Saints Row IV refused classification in Australia". IGN Entertainment Inc. June 25, 2013. Retrieved July 19, 2014.