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Digital rectal exam: side view of the male reproductive and urinary anatomy, including the prostate, rectum and bladder
The digital rectal examination (DRE; Latin: palpatio per anum, PPA) is a relatively simple medical procedure. The patient undresses and is then placed in a position where the anus is accessible (lying on the side, squatting on the examination table, bent over it, or lying down with feet in stirrups). 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 or the back of a chair, the physician will have him place his elbows on the table and squat down slightly; generally a man having his prostate examined can expect it to be examined in the bending position, as it is easier to conduct the examination with a man standing. 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 perineum) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient relaxes, the physician slips a lubricated finger into the rectum through the anus and palpates the insides for a short time (from about 5 to 60 seconds).
This examination may be used:
- for the diagnosis of rectal tumors and other forms of cancer;
- for the diagnosis of prostatic disorders, notably tumors and benign prostatic hyperplasia, but the DRE frequently misses more early-stage tumors than prostate-specific antigen (PSA) among African-American and Caucasian men. If PSA is positive (frequently false positive), then DRE can be done to reduce the false positive.[medical citation needed]
- for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease);
- for the estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries;
- in females, for gynecological palpations of internal organs;
- for examination of the hardness and color of the feces (i.e. in cases of constipation, and fecal impaction);
- prior to a colonoscopy or proctoscopy;
- to evaluate hemorrhoids;
- in newborns to exclude imperforate anus.
- through the insertion of medical devices including thermometers or specialized balloons; to identify digestion problems, parasites, organ damage, anal bruising, and foreign objects in the rectal cavity.
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.
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.
Controversies and popular culture
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, Impractical Jokers, Futurama, Family Guy, South Park and the movie Fletch, with M. Emmet Walsh as the general practitioner and Chevy Chase as the patient being examined. Similar activities to the rectal exam are attributed to extraterrestrials in video games such as Saints Row IV, Gaia Online and Destroy All Humans!. The practice of rectal exams without prior consent has been reported by many patients in various countries. According to a media report, a number of student physicians in Australia and the United Kingdom had not been taught to obtain prior consent from patients prior to examining their rectum.
- "Digital Rectal Examination". Healthline. 26 June 2017. Retrieved 31 March 2018.
- New York Magazine - Vol. 28, No. 11. "Saturday Night Live at twenty"
- "Alien anal probe saw Saints Row IV refused classification in Australia". IGN Entertainment Inc. June 25, 2013. Retrieved July 19, 2014.
- Melnick, Meredith. "Report: Medical Students Perform Intrusive Exams on Unconscious Patients" – via healthland.time.com.