Rectal examination

A rectal examination or rectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.

Digital rectal exam: side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder.

The digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple procedure. The patient undresses, then is placed in a position where the anus is accessible (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups).

If the patient is lying on their side, the physician will usually have them bring one or both legs up to their chest. If patient bends over the examination table, the physician will have them place their elbows on the table and squat down slightly. If the patient uses the supine position, the physician will ask the patient to slide down to the end of the examination table until their buttocks are positioned just beyond the end. The patient then places their feet in the stirrups.

The physician spreads the buttocks apart and will usually examine the external area (anus and perinium) for any abnormalities such as hemrroids, lumps, or rashes. Then, as the patient strains down, the physician slips a gloved and lubricated finger into the rectum through the anus and palpates the insides for approximately 60 seconds.

The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; colonoscopy is preferred. However, it's an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum.

This examination may be used:

• for the diagnosis of rectal tumors and other forms of cancer;
• in males, for the diagnosis of prostatic disorders, notably tumors and benign prostatic hyperplasia;
• for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease);
• for the estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries;
• in females, for gynecological palpations of internal organs
• for examination of the hardness and color of the feces (ie. in cases of constipation, and fecal impaction);
• prior to a colonoscopy or proctoscopy.
• to evaluate haemorrhoids

The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.

Sometimes proctoscopy may also be part of a rectal examination.

Veterinary medicine

In veterinary medicine rectal examination is useful in dogs for analysis of the prostate (as in man), pelvic urethra, sublumbar lymph nodes, and anal glands. In horses it is a vital component of the clinical examination for colic, to determine the presence or absence of bowel torsion, impaction, or displacement. Horses undergoing a rectal exam are at relatively high risk of a rectal tear, which can be a life-threatening event, rapidly leading to peritonitis and septic shock.

The procedure in dogs and cats is similar to humans. For the horse, the patient stands in a stock and may be sedated. The examiner puts on a long glove that extends to the shoulder. The examiner inserts the hand and arm into the rectum as far as necessary.

Popular culture

Due to the taboos surrounding the anus, and the potential for discomfort and embarrassment, the rectal exam is a common comedic device. Generally, it's not shown directly, but implied as the examiner dons and lubricates a glove while behind the patient. The body cavity search is frequently used the same way.

See also

• Anal probing
• Colonoscopy

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