Digital Rectal Examination

This piece was published in the Gale Group's Encyclopedia of Cancer, 2000.

I Digital rectal examination

Definition

The digital rectal examination (DRE) is a routine part of the physical examination and includes manual exami­nation of the rectum, anus and, in men, the prostate.

Purpose

The purpose of the digital rectal examination is to identify lesions within the rectum and the prostate. It is the most widely used and oldest technique for the detec­tion of prostate cancer and is used in screening for colon cancer and for the detection of rectal polyps.

Description

Usually the patient is positioned on the left side with the knees close to the chest. Sometimes the patient is asked to stand up and lean over the examination table. For women, sometimes this examination is part of the routine gynecological exam, and it may be done in a dif­ferent manner than described here. During the examination, the health care practitioner examines the anus and the surrounding skin for hemor­rhoids, tags, fissures and abscesses. After lubricating the gloved finger and anus, the examiner gently slides the finger into the anus and follows the contours of the rec­tum. The examiner notes the tone of the anus and feels the walls and the edges for texture, tenderness and mass­es as far as the examining finger can reach. The examiner evaluates the prostate for nodules and tenderness. Stool on the finger should be examined for blood, color, tex­ture and tested for fecal occult blood. *The examination takes less than two minutes and can be uncomfortable when the patient is not relaxed or anxious. Occasionally, when the DRE is performed ob a man the penis may become erect. A gentle reminder and reassurance helps to relieve the embarrassment associated with the unexpected erection.

Preparation

The patient must be carefully positioned and the doctor should take care to explain the examination to the patient and to explain to the patient what to exgject. The digital rectal examination may be uncomfortable and embarrassing. Much of the discomfort can be reduced by an understanding, unhurried and gentle examiner.

Precautions

When there are infections of the anus and of the rec­tum, the digital rectal examination should not be per­formed. Manipulation of the anal and rectad tissues increases the risk of infection and of bleeding.

Results

In the normal anus and rectum, there are no hemor­rhoids or bleeding about the anus. The anal tone is not loose. The rectum is smooth and non-tender. No masses should be palpated, or felt.
The digital rectal examination is helpful in identifying areas of peritonitis or tender areas that can be felt through a the wall of the rectum It is used to identify perineal *disease or deformity, abnormal location of the anus, rectal prolapse and atrophy of the gluteal muscle. Digital exami-ion can detect a stenosis (or narrowing) of the anal canal, assess the tone and strength of the anal muscles or ect the presence of a rectal mass or fecal impaction. Any masses, including hard stool, blood or tenderness considered abnormal. Cancer masses may be flattened, isular, cauliflower-like or ring-shaped. Polyps can be but must be visualized using anoscopy or flexible sig-idoscopy to be distinguished from other lesions, such nternal hemorrhoids or malignant growths. Hard masses of feces may be felt and may be removed.

Aftercare

Aftercare of the digital rectal examination is minimal. It requires removal of the lubricating jelly residue from around the anus. The lubricating jelly dissolves easily in water and may be washed off in bathing after the imination. It can be removed with toilet paper imme-tely after the examination.

See Also Rectal cancer

sources
OKS
Dowin. R. and D. D. Brown. DeGowin's Diagnostic Exami­nation Seventh Edition. New York. New York: McGraw-Hill, 2000.

nada, Tadatake. ed. Textbook of Gastwenterology Volumes One and Two. 3rd Edition. Philadelphia: Lippincott. Williams & Wilkins. 1999.

Cheryl L. Branche. M. D.