What is a digital rectal exam (DRE)?
The digital rectal exam (DRE) is a common procedure used by doctors to examine the lower rectum and other internal organs. DRE occurs for several reasons. This is a quick and easy way to monitor the health of a man’s prostate test. It can detect conditions such as an enlarged prostate (benign prostatic hyperplasia) and prostate cancer.
The prostate is an organ the size of a walnut that supplies part of the semen released during male ejaculation. This fluid nourishes and protects the sperm released during intercourse. Combined with a prostate-specific antigen (PSA) blood test, the DRE can monitor changes in the health of the prostate.
Why the digital rectal exam (DRE)?
Digital rectal exam (DRE) can be used to:
- Confirm rectal tumors
- Assess the size of the prostate and look for tumors or infection of the prostate.
- Obtain faecal matter for stool occult blood test (used to detect gastrointestinal bleeding or colon cancer)
- Assess the function of the anal sphincter in cases of constipation
- Assess the extent of haemorrhoids (swollen veins in the anus)
- Check the causes of rectal bleeding
- Check the space between the vagina and rectum in women.
What is used for?
Doctors use a digital rectal exam to evaluate certain symptoms in both women and men. These are usually symptoms that affect the digestive system, genitals, and urinary tract. For example, a doctor may perform a prostate test on a person who complains of frequent urination or as part of the evaluation of a woman with abdominal pain. Although the test can detect some gynaecological abnormalities in women, a vaginal (pelvic) exam is usually required.
During a stool test, your doctor may also collect a small sample of stool to check for bleeding from the stomach or intestines. However, the faecal occult blood test as part of a digital stool test is not as reliable as the test of stool samples obtained during bowel movements at home.
In men who choose to screen for prostate cancer, a stool test may be done along with a blood test to detect prostate-specific antigen (PSA test).
Who should have a digital rectal exam?
Not all medical institutions agree on when men should begin screening (routine testing) for prostate cancer or if it is part of a DRE screening.
To help detect prostate cancer early, the American Cancer Society recommends that men discuss the benefits, risks, and limitations of prostate cancer screening with their doctors before deciding whether to test. try or not.
For most average-risk men, discussions about screening begin in their 50s. However, some doctors recommend that men at risk for prostate cancer (African American men or men with a family history of prostate cancer) begin screening early.
Indications for a rectal examination
This is an intimate and sometimes uncomfortable examination which is most often done when disease (usually gastrointestinal or genitourinary disease) is suspected or already identified. It may also be done as part of a screening examination when there is no suspicion or expectation of disease but the examination is performed as part of a thorough screening process. It is important in all cases to explain the reasons for the examination (see ‘Preparing for the examination’, below) and to obtain verbal consent. Examples of indications for examination include:
- Assessment of the prostate (particularly symptoms of outflow obstruction).
- When there has been rectal bleeding (prior to proctoscopy, sigmoidoscopy and colonoscopy).
- Change of bowel habit.
- Problems with urinary or faecal continence.
- In exceptional circumstances, to detect uterus and cervix (when the vaginal examination is not possible).
How often should the digital rectal exam be done?
The frequency of this digital rectal exam is usually determined by your doctor. Because there is insufficient evidence to show that DRE reduces prostate cancer mortality, the American Cancer Society and Canadian guidelines recommend that men considering prostate screening discuss the risks and benefits with their doctors. to use the DRE for detection.
If you are a man age 50 or older, it is a good idea to discuss this with your doctor. You can have a DRE even if you are under the age of 50 (for example, if you have a family history of prostate cancer or are of African descent) if your risk of prostate cancer is high.
Your doctor may recommend DRE as part of a physical exam to check for problems other than prostate cancer.
Are there accidents and precautions?
You may feel a bit uncomfortable during the test. You may also experience a small amount of bleeding from your rectum, especially if you have haemorrhoids or anal fissures.
In rare cases, some people may feel dizzy or pass out during the test, especially if they are standing up.
There are no special preparations for a digital rectal test.
How is the digital rectal exam done?
You should remove the clothing from the waist or pull it down and then pull the knee towards the chest. The test can also be performed while the men are bent over the testing table. Women with a pelvic exam can be tested while on strips.
Your doctor inserted a lubricated, gloved finger into your rectum. It is often helpful to feel pressure when you have a bowel movement. Your doctor will feel the wall of your rectum, looking for abnormal lumps, swelling, or tenderness. In men, the doctor will feel the prostate gland through the rectal wall and look for suspicious nodules, as well as abnormalities in the size or shape of the gland. In women, the doctor may examine the rectum and vagina at the same time or separately.
What happens in a digital rectal exam?
Your healthcare provider inserts a glove into the rectum so that the prostate can feel rough, lumpy, or abnormal areas. The test only takes a few minutes to complete.
You may feel a slight transient discomfort during the test. This procedure does not cause significant pain or damage to the prostate.
What happens after a digital rectal exam?
You can continue your normal activities. Your doctor will discuss the test results with you. If they detect a suspicious lump or area during the test, the next test will be the next step.
After your GP has completed the rectal examination, they’ll gently remove their finger from your anus. There may be a small amount of bleeding from your rectum, particularly if you have haemorrhoids.
Your GP will clean any gel or blood from your rectum before leaving the room so that you can get dressed in privacy. Once you’re dressed, your GP will return to discuss the results of the rectal examination with you.