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This article was co-written by Gary Hoffman, MD. Gary Hoffman is a colorectal surgeon and chief clinician in the department of colorectal surgery at Cedars Sinai Medical Center. With over 35 years of experience, Dr. Hoffman has helped improve laparoscopic and automated surgery for colorectal cancer. Dr. Hoffman holds a bachelor of science degree from the University of California, Irvine, and a doctorate in medicine from Vanderbilt University. He completed a surgical internship at USC Medical Center – Los Angeles County and a resident surgeon program at the Louisiana State University Charity Hospital of New Orleans Medical Center. Hoffman is a physician in the Department of General Surgery and Colorectal Surgery at Cedars Sinai Medical Center. He is also an associate professor of clinical surgery at the David Geffen School of Medicine, University of California, Los Angeles. Hoffman is a member of the American Society of Colorectal Surgeons, the Southern California Association of Colorectal Surgeons, the American Society of Surgeons, and the American Medical Association.
This article has been viewed 2,878 times.
A rectal exam is a screening test for both men and women to detect abnormalities in the rectum, anus, and prostate (for men), such as cancer, infections, and other lesions. . [1] X Research Sources This test should be performed periodically (annually) during a physical exam. Only medical professionals should examine the rectum as an untrained person can injure the delicate tissues of the rectum/anus during the examination.
Steps
Rectal examination
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Explain this procedure to the patient and confirm their consent. If you are a healthcare professional who needs to examine a patient’s rectum, the first step is to explain the test to them. Then ask them to sign the statement if they agree to do so.
- You might explain something like, “For this test, I will put on gloves and insert my finger into the rectum to check for abnormalities. You may be sore and/or uncomfortable, but the test should only last a minute or two.” [2] X Research Source
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Sanitize hands and wear gloves. Before performing any procedure on a patient/other person, you must wash and disinfect your hands to avoid spreading bacteria, viruses or parasites to them. [3] X Source of Study Using warm water with soap is sufficient to disinfect hands, but an alcohol-based antiseptic gel is recommended. Dry hands thoroughly and put on a new pair of medical gloves that do not contain nitrile or latex.
- In the medical field, a digital rectal exam (DRE) is usually performed by a family doctor, gynecologist, proctologist, or nurse practitioner.
- Rectology is a branch of medicine that deals with problems in the anus, rectum, and colon.
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Reassure the patient and ask them to lie on their side. For both the doctor and the patient, a rectal exam is a rather embarrassing or embarrassing process, so it’s important to act professionally and reassure them. [4] X Trusted Source National Health Service (UK) Go to Source After a general explanation of the procedure, ask them to take off their clothing, lie on their side (usually left side), head bent Kneel up and place your hands near your chest – this is fetal position. Cover them with a cloak or blanket to keep warm and ensure privacy. Place a protective mattress underneath their butt.
- DRE can be performed in a standing position. Women may have a rectal exam during a pelvic floor exam, so they will lie on their backs with their legs raised. Men are usually examined standing up, and unless they are concerned, lying down may be more comfortable. Lying on your side is usually more relaxing, and your doctor can also have easier access to the anal canal.
- To avoid embarrassment, the DRE procedure should be performed by a physician of the same sex as the patient. Men see men, women see women, or ask for a nurse to be present during the examination.
- To reduce anxiety and embarrassment, you can ask a friend or loved one to be present during the examination.
- Adjust the patient’s position and cover them with blankets for warmth and privacy.
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Apply warm lubricant to your index finger. As a courtesy and to help prevent shock or discomfort from the patient, it is important to warm up the lubricant slightly before applying it to your index finger. Even gel at room temperature cools the patient and constricts the anal canal, making it more difficult to examine with a finger. Your goal is to ensure that the anal tissue is as relaxed as possible, so as not to cause discomfort or pain when your finger is inserted.
- Sometimes a rectal exam is done with an anesthetic to numb the anal area and reduce discomfort. This is even more important if the examiner has large fingers and the patient has tight anal sphincters. [5] X Trusted Source National Health Service (UK) Go to Source
- Gel warmers are inexpensive and available at medical supply stores. Alternatively, you can warm the gel and lubricant in the microwave for 20-30 seconds.
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Gently insert your finger into the anal canal. After applying lubricant to your fingers and anus, separate the patient’s buttocks and slowly insert your index finger. It is best to ask the patient to take a deep breath while inserting the finger to help them relax and prevent the anal sphincter from contracting. [6] X Research Source To make it easier to insert your fingers into your anus, rotate your hand slowly in a back and forth motion.
- Just before inserting your finger, do a quick assessment for any abnormalities in the anus, such as hemorrhoids (swollen blood vessels), warts, erythema, or fissures. [7] X Research Sources[8] X Trusted Source National Health Service (UK) Go to Source
- After inserting your finger into the rectum, assess the firmness of the anus by asking the patient to push to squeeze your finger.
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Look for unusual places. Once you have inserted your finger into the rectum, feel for abnormalities such as lumps, hard spots, soft spots, or cracks. [9] X Source of Study Rotate finger clockwise and counterclockwise to feel the entire rectal circumference. You can also tap the prostate gland through the rectal wall. Feel the front of the body to find the prostate gland, which has two lobes and a slit in the center.
- A healthy prostate gland should feel flat and painless to the touch. [10] X Trusted Source National Health Service (UK) Go to Source
- If you feel pain when you press on your prostate, it could be a sign of a benign tumor, infection, or cancer.
- When you press your hand or examine the prostate from the anal canal, you often feel like you are urinating.
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Remove your finger and clean the area after examination. After the examination is complete, slowly remove your finger and examine the glove for blood and/or mucus. [11] X Research Source Clean perianal lubricant, remove and discard gloves, then wash hands. Let the patient clean in private with a soft tissue on their own and let them know they can get dressed again.
- To remove a dirty glove, place the index finger of your other hand (which is clean) under the cuff of the glove, then pull the glove toward the tip of your hand and remove it.
- The exam itself won’t bleed, so if you see blood on your glove it could be a sign of hemorrhoids or other problems.
- After the procedure is over, ask how the patient is feeling, especially if he or she has expressed concern before. It should be remembered that the transition from lying to standing can make some people feel dizzy, so you should remind the patient to get up slowly and observe them for a few minutes.
Understanding rectal examination
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Do an anorectal exam if you have blood in your stool. If you see blood in the toilet when you have a bowel movement or when you wipe your anus, see your doctor. If your doctor suspects that you have bleeding from somewhere in your digestive tract (namely the large intestine or colon), they will order a colonoscopy. [12] X Research Sources Some common reasons for blood to appear in the stool are: hemorrhoids, small fissures in the anus, and broken blood vessels from straining or wiping too hard.
- More seriously, other possible causes of bleeding include: anorectal cancer or some form of irritable bowel syndrome, such as ulcerative colitis or Crohn’s disease.
- If your doctor doesn’t find anything obvious, your condition is normal, but an anorectal exam doesn’t rule out all causes. You may have other tests, like a colonoscopy or x-rays.
- DRE is usually done without any medication because it rarely causes pain. [13] X Source of Study This visit only lasted a few minutes.
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See your doctor if you are a man and have trouble urinating. Another common reason for an anorectal exam is to examine the prostate gland for an abnormal lump or tenderness to the touch. [14] X Research Source The prostate gland is about the size of a walnut, and secretes fluid when you ejaculate to protect and nourish sperm cells. The prostate is located near the bladder and in front of the rectum, so it can be checked easily with the DRE test. A swollen or inflamed prostate can cause pelvic pain and some problems with urination, such as dribbling and difficulty urinating at first.
- In men, a DRE is done to check the size of the prostate gland, and look for an abnormal lump or tenderness to palpation. Benign prostate tumors are very common (but not serious) in American men over the age of 50. However, melanoma is serious, and additional testing for early detection increases the likelihood of successful treatment. You should get tested every year or more often if you suspect you have a problem.
- If your doctor thinks your prostate is abnormal, he or she will likely order a blood test to look for prostate-specific antigen (PSA). High PSA levels are sometimes a sign of prostate cancer.
- Another test used to diagnose prostate problems is an ultrasound (transrectal ultrasound) and is often done along with a prostate biopsy (tissue sampling).
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Ask for an anorectal exam during your routine physical exam. You should have an anorectal examination periodically instead of waiting for symptoms to appear in the gastrointestinal tract. Most doctors recommend adding a DRE test to your annual physical, regardless of whether you’re a woman or a man. [15] X Research Source Men should consider having a DRE during annual prostate screening, especially if they are over 40 years of age. A finger exam and a stool blood test (fecal sample) are recommended if you are over 40 years old. Women should have these tests along with their annual gynecological exam.
- For men, the DRE is performed in a standing position bent at the waist because this position allows easier access to the prostate.
- For women, ovarian and uterine cancers can be detected when a doctor performs a DRE along with a vaginal exam. [16] X Research Source
- In addition to rectal bleeding and urinary tract problems, other reasons for a DRE are: change in bowel habits, pelvic and/or abdominal pain, discharge or bleeding from the urethra.
Advice
- There is no preparation required prior to the anorectal exam and you can resume your normal activities after the examination is complete. Having a bowel movement earlier can make the examination more comfortable.
- A DRE can be performed to collect a stool sample to screen for anorectal cancer.
- Probing the anal canal with your fingers can stimulate the sensation of having a bowel movement, so you should have a bowel movement before a DRE is performed.
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This article was co-written by Gary Hoffman, MD. Gary Hoffman is a colorectal surgeon and chief clinician in the department of colorectal surgery at Cedars Sinai Medical Center. With over 35 years of experience, Dr. Hoffman has helped improve laparoscopic and automated surgery for colorectal cancer. Dr. Hoffman holds a bachelor of science degree from the University of California, Irvine, and a doctorate in medicine from Vanderbilt University. He completed a surgical internship at USC Medical Center – Los Angeles County and a resident surgeon program at the Louisiana State University Charity Hospital of New Orleans Medical Center. Hoffman is a physician in the Department of General Surgery and Colorectal Surgery at Cedars Sinai Medical Center. He is also an associate professor of clinical surgery at the David Geffen School of Medicine, University of California, Los Angeles. Hoffman is a member of the American Society of Colorectal Surgeons, the Southern California Association of Colorectal Surgeons, the American Society of Surgeons, and the American Medical Association.
This article has been viewed 2,878 times.
A rectal exam is a screening test for both men and women to detect abnormalities in the rectum, anus, and prostate (for men), such as cancer, infections, and other lesions. . [1] X Research Sources This test should be performed periodically (annually) during a physical exam. Only medical professionals should examine the rectum as an untrained person can injure the delicate tissues of the rectum/anus during the examination.
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