Digital Rectal Exam: Indications and Procedure

A digital rectal examination (DRE) is a component of the physical exam where the physician inserts a gloved lubricated finger into the anal opening to feel for any local abnormalities. This is commonly done as part of the examination of the prostate gland in men while screening for cancer. It is also a routine component of the abdominal exam.

Indications for a DRE

1. Screening for prostate disease: enlargement of the prostate can be felt in Benign Prostatic Hypertrophy and also in Cancer. In addition, the presence of irregular nodules is suggestive of cancer.
2. Symptom of bleeding from the rectum, with blood in the stools or tissue paper: hemorrhoids, anal fissures and fistulae are causes for bleeding which can be identified by DRE. Cancers of the anal canal and lower end of rectum can also be felt on DRE as a mass.
3. Pelvic Examination: A DRE is done alongside a vaginal exam to assist in examining the uterus and ovaries for tumors.

Preparing for a DRE

There is no special preparation needed for a DRE. Carry out routine daily activities including passing stool as usual prior to meeting the doctor. Inform your physician if you are experiencing pain or bleeding while passing stool so that they can take appropriate precautions while examining to avoid triggering excess pain or bleeding.

A gown will be provided for the examination. The DRE will only take a few minutes and is performed by a qualified doctor.

The DRE procedure

• The individual is made to lie down in their gown, either on their side or on their backs (for women undergoing a pelvic examination). It can be done while standing and bending forward as well.
• The doctor inserts a gloved lubricated finger gently through the anal cavity while urging you to take deep breaths and relax the anal sphincter. This allows easy passage of the physician’s finger into the canal without the need to apply excessive force.
• The doctor uses their finger to feel for any nodules or lumps on the prostate and the walls of the gut by sweeping the finger around the canal.
• Upon removing their finger, the physician examines for the presence of blood before cleaning the area.

Following the DRE

After completing the DRE, your physician is likely to discuss the findings from the examination. An additional bedside test called proctoscopy may be done to visually inspect the anal canal to look for tumors or hemorrhoids.

There are no precautions to be taken after the DRE and normal activities can be performed. If there is any bleeding noted after the DRE, report this immediately to your health care provider.

References

1. Digital Rectal Exam (DRE). American Society of Clinical Oncology. Accessed April 14, 2019