What It’s Used For
Doctors use the digital rectal exam to evaluate certain symptoms in both men and women. Usually these are symptoms affecting the digestive system, genitals and urinary tract. For example, a doctor may do the exam to check the prostate in a man who complains of frequent urination or as part of the evaluation in a woman with abdominal pain. Although the exam can detect some gynecological abnormalities in women, a vaginal exam is usually necessary.
During a rectal exam, your doctor also may obtain a small stool sample to test for bleeding from the stomach or bowels. However, testing for hidden blood in the stool as part of a digital rectal exam may not be as reliable as testing stool samples obtained during bowel movements at home.
In men that opt for prostate cancer screening, the rectal exam may be done in combination with a blood test for prostate-specific antigen .
Digital Rectal Examination For Prostate Cancer
A digital rectal examination , performed as part of an annual physical checkup, is one of the most important tests for the early detection of prostate cancer. Because the prostate gland is located just in front of the rectum, it cannot be felt from the outside of the body.
During the DRE, a doctor inserts a lubricated, gloved finger into the patient’s rectum to feel for lumps, enlargements, or areas of hardness that might indicate prostate cancer. The procedure lasts for less than minute and, while uncomfortable, should cause no pain. However, a painful examination could indicate the presence of other, benign conditions, such as prostatitis.
Enhancing Healthcare Team Outcomes
The fecal occult blood test has no role in the evaluation of acute gastrointestinal bleeding. The test has low specificity, and reasons for false-positive include medications, digital manipulation, diet, and more. The FOBT can be used in annual colon cancer screening, as recommended by the interprofessional taskforce. A positive test may also confirm the need for endoscopic evaluation in a patient with chronic anemia. However, patients with unexplained iron deficiency anemia should already be considered for endoscopy regardless of the outcome from FOBT.
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When A Rectal Examination May Be Needed
A rectal examination is sometimes needed to investigate:
- being unable to control when you go to the toilet including bowel incontinence or urinary incontinence
Men sometimes need a rectal examination to check for problems with the prostate.
The prostate is a small gland that only men have. It:
- often gets larger with age
- may cause problems with how easily you pee and how often you need to go
What The Results Mean
A normal finding means your doctor didnt detect any problem during the exam. However, this test does not rule out all problems and additional testing may be required. Abnormal findings may include:
- enlargement of the prostate gland or growths or tumours in the prostate gland
- hemorrhoids, polyps, a small cauliflower-like growth on a mucous membrane, such as the lining of the colon or bladder, fissures or other problems in the rectum
- growths or tumours, such as cancer in the rectum
If you experience anything unusual following your examination, which can include abdominal or rectal pain, or bleeding from the rectum, contact your doctor immediately.
Related: Concerned about possible prostate cancer symptoms or diagnosis? Learn more about treatments and SMART Robotic Prostate Surgery.
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Worried About Having A Dre
Its natural to feel worried or embarrassed about having tests, but some men find the idea of having a DRE upsetting. For example, if youve been sexually abused as a child or an adult, you might feel very upset about having this test. Theres no right or wrong way to feel about this, and it is your choice whether or not you have tests for prostate cancer.
It might be helpful to talk to a counsellor about your experience, thoughts and fears. Or you could contact a charity for people whove been sexually abused, such as the National Association for People Abused in Childhood or SurvivorsUK. If you do decide to have a DRE, explain your situation to your doctor as they can talk through the test with you and help to reassure you.
When I had the DRE I thought, For a few seconds of discomfort, I can live with it. Yeah its uncomfortable, but it could save your life. A personal experience
How Often Do I Need A Dre
As part of the annual checkup, the American Cancer Society recommends digital rectal examinations and PSA testing for:
- Men 50 and older with a life expectancy of at least 10 years.
- Younger men at increased risk for prostate cancer, including:
- Men with a close male relative with prostate cancer.
- African American men.
The Prostate Cancer pages of this website are part of the Comprehensive Prostate Cancer Awareness Program , a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.
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What Happens During A Digital Rectal Exam
Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete.
You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.
Urine As A Source Of Biomarkers
In contrast to PB, for physiological and anatomical reasons, post-DRE urine sample may represent the most minimally invasive and valuable source of PC biomarkers . Because of urine likely to pass through the malignant lesions in the urologic system before discharge, its molecular content often reflects the disease status as presented by tumour tissues. The gentle massage of each side of the prostate gland during DRE stimulates the release and movement of prostatic fluids and detached epithelial cells into the urethra . These fluids can contain both cells and secretions originating in PC .
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What Are The Risks With Digital Rectal Exams
One of the risks associated with digital rectal exams is the discomfort and pain that can result from the test.
There is also a possible risk for infection if local wounds become contaminated during the examination.
There is also the risk of injury to the rectal wall or worsening of rectal defects that already exist.
Just like with most medical tests, there are risks of false-positive results and false-negative results .
It is also possible that the uncomfortable nature of the exam could cause you to have a vasovagal response. This can cause you to feel lightheaded and possibly even faint.
What A Digital Rectal Exam Is For
For men, the primary reason for a digital rectal exam is to palpate the prostate, which sits right in front of the rectum. The most common positions for the digital rectal exam: standing and bent over at the waist or lying on an exam table in the fetal position, knees pulled up. Apprehension about the digital rectal exam is a primary reason many men avoid wellness exams.
OCCULT BLOOD CHECK
At the time of your digital rectal exam, a small bit of stool may be obtained to test for blood, especially if youre having any symptoms, like a change in your bowel habits. This test is called a fecal occult blood testoccult meaning blood that is not visible. A positive result means blood was found in the sample and further testing may be required to find the source of the blood, such as ulcers, polyps, hemorrhoids, or benign or cancerous tumors.
There are two different tests for occult blood: the guaiac test and the immunoassay test. The guaiac test has been around longer. Guaiac is a chemical that changes color when blood is detected. The immunoassay uses a protein that binds to hemoglobin .
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In Prostate Cancer Screening Of Asymptomatic Men Aged 55 To 69
- In men aged 55â69 who have been counseled on the known harms and potential benefits of prostate cancer screening, the U.S. Preventive Service Task Force May 2018 statement states, “The use of digital rectal examination as a screening modality is not recommended because there is a lack of evidence on the benefits.” The American Academy of Family Physicians states, “Digital Rectal Exam does not improve detection of prostate cancer and should not be performed as a part of screening.” The American Urology Association 2013 guideline panel states, “The literature supporting the efficacy of digital rectal exam for screening with the goal of reducing prostate cancer mortality provide limited evidence to draw conclusions.” “The guideline panel could find no evidence to support the continued use of DRE as a first-line method of screening.” Although DRE has long been used to diagnose prostate cancer, no controlled studies have shown a reduction in the morbidity or mortality of prostate cancer when detected by DRE at any age.
- A meta-analysis published in the Annals of Family Medicine concluded: “Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.”
Questions To Ask Your Health Care Team
Before having a DRE, you may want to ask these questions:
Why do you recommend that I have a DRE?
What happens during the DRE?
Who will do the DRE?
How long will the DRE take?
Can a DRE find cancer?
When and how will I get my test results?
Who will explain them to me?
Will I need more tests, such as a colonoscopy or a barium enema, if the DRE suggests cancer?
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How Often Should You Get A Digital Rectal Exam
You should be getting a digital rectal screening exam every five years once you reach the age of 50 .
You should also be getting a regular PSA test to check your PSA levels, as well as a genitourinary and pelvic examination. Dont be afraid to talk to your doctor about the rectal exam risks and benefits and to have an open conversation about it.
What Should I Expect During A Digital Rectal Exam
Your healthcare provider will perform the digital rectal exam in a private exam room at their office. You will need to undress from the waist down, and youll be given a gown or cloth to cover yourself. The procedure only takes a few minutes. Its typically painless, but you may be slightly uncomfortable. Some people may feel a need to pee .
For men and people AMAB
Your healthcare provider will ask you to get in one of two positions for the DRE. They may ask you to stand and lean forward over the exam table or lie on your side on the exam table with your knees pulled up into your chest.
Your healthcare provider will feel for your prostate gland, checking the size and the surface of the gland. If your prostate is enlarged, you may feel some discomfort or mild pain/pressure during the exam. Finally, your provider will examine the wall of your lower colon and rectum, checking for any abnormalities.
For women and people AFAB
Your healthcare provider may perform a digital rectal exam as part of your pelvic exam. Theyll ask you to lie on your back on an exam table with your feet in raised stirrups.
Once youre ready, theyll ask you to relax and take a deep breath. Theyll gently insert a gloved, lubricated index finger into your rectum. During this process, your provider will examine the wall of your lower colon and rectum, checking for any abnormalities.
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Why Do I Need A Digital Rectal Examination
Most early prostate cancers cause no symptoms and are found only through early detection by a digital rectal examination and a prostate-specific antigen test. Recent studies indicate that the combination of DRE and PSA testing is more effective in the early detection of prostate cancer than either procedure is on its own.
Does A Dre Always Detect Prostate Abnormalities
A digital rectal examination allows a doctor to feel only the back wall of the prostate gland, so any abnormalities located in the middle or front part of the gland cannot be felt. For this reason, the DRE is performed in conjunction with PSA testing. Although the PSA test can detect many cancers which doctors cannot feel during a DRE, it has also been shown that DREs detect some cancers which are not associated with an elevated level of PSA in the bloodstream.
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Questions To Ask Your Doctor
Before having a DRE, consider asking your doctor the following questions:
- What will happen during the DRE?
- How long will the procedure take?
- Will it be painful?
- How accurate is a DRE at finding cancer?
- When will I learn the results of the DRE? How will they be communicated to me?
- Who will explain the results to me?
Before Having A Rectal Examination
Your doctor or nurse should explain what’s going to happen and why you need a rectal examination.
They’ll know that some people can feel embarrassed, but it’s a common procedure.
Let the doctor or nurse know if:
- you’d prefer a man or woman to perform the examination
- you’d like someone else in the room it could be a friend, family member or another doctor or nurse
- you have severe pain in your bottom they may be able to use local anaesthetic to numb the area
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What Does A Dre Involve
You might have a DRE at your GP surgery or at the hospital.
The doctor or nurse will ask you to lie on your side on an examination table, with your knees brought up towards your chest. They will slide a finger gently into your back passage. Theyll wear gloves and put some gel on their finger to make it more comfortable.
You may find the DRE slightly uncomfortable or embarrassing, but the test isnt usually painful and it doesnt take long.
How Often Should I Get A Digital Rectal Exam
Once youve discussed the use of DREs with your healthcare provider, they may recommend you get a digital rectal exam as part of your annual physical examination. In addition to a DRE, your provider may also recommend prostate-specific antigen testing. The PSA is a protein in your blood that can also give some information about the health of your prostate.
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How Do I Prepare For A Digital Rectal Exam
There are no special preparations necessary for a digital rectal exam. You can help yourself and ease the exam by trying to stay relaxed. Plan ahead by recalling a pleasant or happy memory or vacation you can think about during the exam. Your doctor will also ask you to take a deep breath during finger insertion.
Why I Stand Behind Digital Rectal Exams For Prostate Cancer Screening
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
“You want to put your finger where? Why? Do you really need to do that? Ive heard many men say this or something similar after I recommend a digital rectal exam, also known as a DRE.
I understand where theyre coming from. The test can be a little uncomfortable. But the value of DREs in detecting prostate cancer and other urological problems far outweighs a little awkwardness. Thats especially important for patients in Washington, D.C., We have the second-highest incidence rate of prostate cancer in the country and the highest number of people who die from the disease.
A DRE actually is the second of two tests I use when screening patients for prostate cancer. The first test is a blood test for prostate-specific antigen, or PSA. Lets go over how the two tests work together and what you can expect from a prostate cancer screening.
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Who Needs A Digital Rectal Exam
For men with an average risk level, they should be getting digital rectal exams at 50 years of age and up.
For men at higher risk, digital rectal exams should begin at age 45. How do you know if youre at higher risk?
The men of African descent, as well as anyone with a family history of prostate cancer, are high-risk for prostate cancer.
What Do The Results Of A Digital Rectal Exam Mean
Normal results of a digital rectal exam mean your healthcare provider didnt find anything abnormal during the exam. However, they may recommend additional tests to confirm the results.
An abnormal digital rectal exam may mean many different things. There may be blood present, palpable nodules, tears in your rectum, hemorrhoids or significant pain with the exam. Your provider will discuss this more with you during your visit as well as any next steps.
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In Colorectal Cancer Screening Of Asymptomatic Adults Aged 50 To 75
- Even though 1 in 4 colorectal cancers is located in the rectum, little evidence supports the effectiveness of using the DRE for rectal cancer detection and it is not recommended in the colorectal cancer screening guidelines. The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa sigmoidoscopy is preferred.
- Although the DRE is commonly used as a way to obtain a stool sample for a FOBT in an office based setting, this is an insufficient way of screening for colorectal cancer and is not recommended. A single office-based FOBT performed following a digital rectal examination is not an adequate screen due to low sensitivity for advanced tumor and colorectal cancer. Screening for colon cancer this way does not meet HEDIS, Medicare or American Cancer Society standards. The FOBT has never been validated for any purpose other than as a take home colon cancer screening test. A paper published in the Journal of General Internal Medicine states, “While FOBT done appropriately is an important screening option, in-office FOBT may be worse than no screening at all because it misses 95% of cases of advanced tumor, giving many patients a false sense of reassurance.”