Digital Rectal Exam: Uncomfortable But Important

A rectal exam can be unpleasant and uncomfortable, but it can also be an important part of a complete physical exam in certain situations. There are several situations where a doctor may perform a rectal exam, including during a pelvic exam (women), an emergency room visit, or during a regular physical. Periodic rectal exams are recommended for men at higher-than-usual risk for developing prostate cancer.

Key takeaways:
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    A Digital Rectal Exam (DRE) involves a doctor inserting their finger into your anus to examine your sphincter, rectum, and prostate.
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    DRE can be an important part of prostate cancer screening in men, along with the prostate-specific antigen (PSA) test.
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    Men 50 and older should be screened for prostate cancer. Men with the highest risk of prostate cancer should be screened starting at age 40.
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    DRE is invasive and can be painful for some people, so be sure to discuss its risks and benefits if your doctor recommends it.

Digital rectal exam

A digital rectal exam (DRE) is a brief test that involves a doctor inserting a finger into an individual’s rectum to manually examine the anal sphincter tone, check for hemorrhoids, and examine the prostate. The test is typically performed by having a patient stand and bend at the waist or lie on their side with their legs pulled up to their chest. A doctor, nurse, or other healthcare provider wearing gloves inserts a lubricated index finger into the anal sphincter and the rectum. Using that finger, they can feel the walls of the rectum and, in men, the posterior (rearward) portion of the prostate. A rectal exam is also an opportunity for a healthcare provider to obtain a small stool sample for a fecal occult blood test (FOBT), used to detect blood in the stool and screen for colorectal cancer.

A rectal exam may be performed in several settings. In women, this test is usually performed as part of a pelvic exam. In the emergency department, rectal exams may be performed in people presenting with abdominal pain. In men, a rectal exam may be performed as a screening test to check for signs of possible prostate cancer or to assess other prostate problems.

Prostate exam

A DRE allows a doctor to assess the size, shape, and texture of the prostate gland, which surrounds the urethra between the bladder and the penis. Inflammation of the prostate, an enlarged prostate, tenderness, and the presence of lumps or nodules can all be detected during a rectal exam. Additionally, applying pressure on the prostate during an exam can sometimes express fluid from an enlarged prostate, causing discharge from the penis that can be analyzed to help determine the cause of prostate problems. However, prostate cancer is not always detected with a DRE alone, which is why prostate-specific antigen (PSA) testing is an important part of prostate cancer screening.

DRE and prostate cancer

In the US, prostate cancer is the second most common non-skin cancer and the second most common cause of cancer death in men. A prostate-specific antigen (PSA) test is recommended as a non-invasive screening test for prostate cancer, and a rectal exam is recommended for some patients who are at high risk of developing prostate cancer. The American Cancer Society recommends prostate cancer screening using PSA and DRE for men who are:

Age 50 with an average risk of prostate cancer and at least 10-year life expectancy.

Aged 45 who are African American or have a first-degree relative with prostate cancer before age 65.

Aged 40 who have more than one first-degree relative with prostate cancer before age 65.

A prostate exam (DRE) is neither necessary nor recommended for all men. Because of its invasive nature and the risk of pain, it should be performed only when the clinical usefulness outweighs the risk.

Possible complications

If your doctor recommends a DRE, you should discuss any concerns you have about the exam with your doctor. A rectal exam is usually brief and uneventful, but is also often uncomfortable and—for some people—painful. If you have hemorrhoids or anal fissures, a DRE can aggravate those conditions, potentially causing pain and bleeding. Make sure that you tell your doctor if you are having any symptoms of pain or bleeding in or around your anus before a rectal exam. Some people may not want to undergo the exam due to past experiences with pain, trauma, or abuse. Be sure to tell your doctor if you do not want to undergo the exam. Depending on your situation and your cancer risk, if you do not want to undergo a DRE, your doctor may recommend alternative tests, such as magnetic resonance imaging (MRI).

Usefulness for prostate cancer screening

DRE has been used for many years to screen for prostate cancer. However, recent research has called into question whether it does more harm than good in a primary care setting. Some research has concluded that rectal exams should not be part of an annual primary care visit in patients who have no symptoms. In men with symptoms consistent with prostate cancer, DRE may be unnecessary since these patients should be referred to a urologist for evaluation regardless of the exam findings. For men who are at risk of prostate cancer, a PSA test may be more important than a rectal exam. However, a DRE can increase the odds of detecting prostate cancer, though it may be only a slight increase.

Uncomfortable but useful

A digital rectal exam can be an unpleasant experience for some individuals, but it can also be a useful part of prostate cancer screening in some men. DRE is a very brief but invasive exam. For most people, it is a minor inconvenience, but for some, it can be painful. If your doctor recommends a rectal exam for prostate cancer screening, colorectal cancer screening, or other reasons, discuss the risks and benefits with them. Not everyone needs a rectal exam, but it can be a useful tool for detecting prostate cancer in men who are at high risk.

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