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Digital rectal exam

Definition

A digital rectal exam is an examination of the lower rectum. The doctor uses a gloved, lubricated finger to check for abnormalities.

Alternative Names

DRE

How the test is performed

The doctor will first examine the outside of the anus for hemorrhoids or fissures. Then the doctor will put on a latex glove and insert a lubricated finger into the rectum. In female patients, this exam may be done together with a pelvic exam.

How to prepare for the test

The doctor will ask you to try to relax before the test and to take a deep breath during the actual insertion of the finger into the rectum.

How the test will feel

You may feel mild discomfort during this test.

Why the test is performed

This test is performed for various reasons, but is most often done as part of a routine yearly physical examination in both men and women.

In men, the test is used to examine the prostate, looking for abnormal enlargement or other signs of prostate cancer.

In women, a digital rectal exam may be performed during a routine gynecologic examination.

A digital rectal exam is also done to collect stool for testing for fecal occult (hidden) blood as part of screening for colorectal cancer.

This procedure is also done before other tests, such as a colonoscopy, to make sure nothing is blocking the rectum before inserting an instrument.

Normal Values

The digital rectal exam is usually treated as an initial screening examination. It is usually done together with other tests to rule out abnormalities.

A "normal" finding is when the doctor does not feel any abnormalities -- but this test does NOT completely rule out potential problems.

What abnormal results mean

Any bleeding in the gastrointestinal tract calls for emergency care. Patients should be evaluated in the emergency department for gastrointestinal bleeding (hemorrhage).

If tests reveal occult (hidden) blood, but there is no obvious hemorrhaging (bleeding), the patient will undergo blood tests for anemia, followed by colonoscopy.

A male patient with an enlarged or nodular prostate will undergo a blood test of prostate specific antigen (PSA test), and then possibly a prostate ultrasound and biopsy after referral to a urologist.

What the risks are

The exam itself generally carries no risk, but it is possible to have a normal exam and still have an occult (unidentified/hidden) source of bleeding.

Special considerations

References

Seidel HM, Ball JW, Dains JE, Benedict GW. Mosby's Guide to Physical Examination. 6th ed. Philadelphia, Pa: C.V. Mosby; 2006.
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    Review Date: 11/5/2009

    Review By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital.

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