Rectum: Anatomy
To gain a better understanding of a digital rectal exam (DRE), it is helpful to have a basic understanding of the anatomy of the anorectal area.
The rectum is a component of the digestive system of the human body. The digestive system breaks down the food that the body does not use. The colon is the largest section of the large intestine and empties into the rectum, wherein waste gathers as bowel movements. Then the rectum empties into the anus, where bowel movements exit the body.
An Overview of Digital Rectal Exam
A digital rectal examination, also known as a DRE test, is a medical procedure in which a healthcare provider inserts a lubricated finger into the rectum to assess the rectal area and nearby structures for any abnormalities.
For men, a digital rectal examination may be included as a component of a complete physical examination to assess the condition of the prostate gland. Similarly, for women, a digital rectal examination may be performed as part of a gynaecological examination to evaluate the health of the uterus and ovaries. In certain cases, a digital rectal examination can also allow for the assessment of other organs, such as the bladder, by palpation.
Despite its invasive nature, DRE remains an essential diagnostic tool, providing valuable information for detecting diseases and guiding further investigations. This write-up will explore the purpose, procedure, how to prepare for the DRE test, what to expect during and after the procedure, potential findings, and significance of the digital rectal examination.
Why is the DRE Test Performed?
The DRE test may be performed for a number of reasons. It may be performed:
- As part of an annual physical examination for both women and men.
- When the doctor suspects bleeding inside the digestive tract
- When men experience symptoms that may indicate their prostate is enlarged or they may be suffering from a prostate infection
- To check the space between the vagina and the rectum in women
- To evaluate the anal sphincter functioning in instances of faecal incontinence
- To detect cancers such as prostate cancer, ovarian cancer, or uterine cancer, along with a vaginal exam
In males, the test can be done to determine prostate size as well as to search for abnormal bumps or other abnormalities in the prostate gland.
Additionally, the digital rectal exam may be utilised to collect stool samples for the purpose of screening for hidden blood as part of the preventive measures against rectal or colon cancer.
Who Performs a Digital Rectal Exam (DRE)?
A DRE may be performed by several healthcare experts to aid in the diagnosis of the issue. Among these service providers are:
- Primary care physicians
- Gastroenterologists (doctors who specialise in digestive tract disorders)
- Surgeons
- Gynaecologists and obstetricians
- Oncologists (cancer specialists)
How is a Digital Rectal Exam Performed?
To conduct a digital rectal exam (DRE), the doctor will insert a lubricated, gloved finger into the patient’s anus to examine for any irregularities or changes.
For men, this includes the examination of the prostate gland for signs of enlargement, which can be identified by a bulge located behind the wall of the rectum. In the case of prostate cancer, the doctor will feel for abnormalities such as irregularities or bumps on the prostate gland on its typically smooth surface. During the exam, some men may experience mild discomfort or a sensation of needing to urinate due to the applied pressure on the prostate.
A DRE test is commonly performed as part of routine physical examinations for both men and women. In gynaecological exams, a DRE may be conducted to evaluate the area between the rectum and vagina for potential abnormalities. Generally, the procedure causes minimal discomfort. However, individuals with anal fissures or haemorrhoids may experience minor bleeding.
It is important to note that a DRE is not the primary method for detecting colon cancer, as it only provides limited access to the lower part of the colon. Nevertheless, the exam can be utilised to collect a stool sample, and the presence of blood in the stool may indicate colon cancer or other underlying conditions.
To confirm the presence of blood in the stool, which may not be visibly apparent, a doctor may perform a faecal occult blood test.
How to Prepare for a Digital Rectal Exam?
To prepare for a digital rectal exam (DRE), no special preparations need to be made.
Individuals should inform the healthcare provider if they have specific concerns or medical conditions, such as haemorrhoids or anal fissures before undergoing a digital rectal exam (DRE). This is because the exam may worsen these conditions.
What to Expect During a Digital Rectal Exam?
- The digital rectal examination is typically conducted in a private exam room at the doctor’s office for the patient’s comfort and relaxation, as this exam can be perceived as a little awkward or uncomfortable sometimes.
- Individuals are typically requested to undress and wear a hospital gown.
- During the examination, the doctor will determine the most comfortable position, which may involve:
- Squatting on the exam table
- Lying on the side
- Lying on the table with feet placed in stirrups
- Bending over the table
- The patient will be requested to relax while the healthcare provider gently inserts a lubricated and gloved finger into the anus.
- The doctor may probe the lower rectum for a brief period, ranging from a few seconds to a few minutes. Additionally, the healthcare provider may apply pressure to the lower abdomen throughout the exam.
What to Expect After the Digital Rectal Exam?
A digital rectal exam (DRE) is a straightforward and safe examination that requires minimal equipment, such as gloves and lubricant. One can resume regular activities immediately following a digital rectal exam. Mild bleeding from the rectum is not common, but it can happen. Bleeding is more common if one has anal fissures or haemorrhoids. If the rectal bleeding is profuse following the DRE, notify the health care practitioner.
During the exam, the doctor can promptly identify any abnormal findings and often provide an initial assessment of the issue. They will be attentive to signs of bumps or tenderness in the prostate, enlarged prostate, haemorrhoids, visible blood, rectal tumours, and anal fissures. In cases where a definitive diagnosis cannot be made during the exam, further testing such as a proctoscopy, biopsy, colonoscopy, or sigmoidoscopy may be necessary. If the doctor is conducting the exam to check for occult blood, a specimen/sample will be forwarded to the laboratory, and the results are typically available in 1 to 2 days.( 3,4)
When to Expect the Results of a DRE Test?
The doctor should be able to give the findings of the digital rectal exam right away following the exam.
What do the Findings of a Digital Rectal Exam Imply?
Normal digital rectal exam results indicate that the doctor found nothing untoward during the test. They may, however, suggest further testing to confirm the findings.
An abnormal digital rectal exam might imply a variety of reasons. The inspection may reveal blood, rips in the rectum, palpable nodules, haemorrhoids, or considerable discomfort.
During the appointment, the doctor will go through this in further detail with the patient, as well as any future actions.
Are Digital Rectal Exams Commonly Included as a Part of Colonoscopies?
A digital rectal exam (DRE) may be conducted as an initial step during a colonoscopy procedure. However, it is important to note that the DRE performed in this context typically focuses on evaluating and lubricating the anal canal in preparation for the colonoscopy rather than specifically examining the prostate.
If you are interested in having your prostate checked during the DRE performed for a colonoscopy, it is recommended that you discuss this with your healthcare provider. Combining these examinations can potentially screen for two common causes of cancer simultaneously.
Is Rectal Examination Performed in Children?
The rectal examination can be a distressing experience for children and should be minimised whenever possible. There are only a few situations where it is absolutely necessary. If it is deemed essential, it might be appropriate to consider using the fifth finger instead of the index finger.
Takeaway
Understandably, a digital rectal examination (DRE) may not be the most pleasant experience, and feelings of discomfort and embarrassment are valid. However, it is crucial to recognise its significance for your overall health and well-being, just like having your temperature or blood pressure measured. Remarkably, the DRE takes no longer to perform than these routine tests, and considering the wealth of valuable information it can provide, it is worth taking a deep breath and perhaps envisioning yourself in a serene setting to help you through it. It is important to remember that for your healthcare provider, the DRE is a routine procedure, and they will be equipped to assist you in managing any discomfort you may encounter.
