Rectal examination

This examination may be used

• for the diagnosis of prostatic disorders, benign prostatic hyperplasia and the four types of prostatitis. Chronic prostatitis/chronic pelvic pain syndrome, chronic bacterial prostatitis, acute (sudden) bacterial prostatitis, and asymptomatic inflammatory prostatitis. The DRE has a 50% specificity for benign prostatic hyperplasia.[1] Vigorous examination of the prostate in suspected acute prostatitis can lead to seeding of septic emboli and should never be done. Its utility as a screening method for prostate cancer however is not supported by the evidence;[2]
• for the evaluation of certain clinical symptoms: a male with change in urinary ability, impotence, or dysuria (blood in the urine), pain with bowel movements;[3]
• a DRE with a FOBT might have value for the anemic patient in the emergency room who has no other identifiable cause for anemia, is not actively bleeding, and you are concerned that Gastrointestinal malignancy may be the cause for their anemia;[4][5][6][7]
• a true active gastrointestinal bleed: vomiting blood, vomiting coffee-grind like material, defecating blood or black tarry stools that can not be easily attributed to facial trauma or oral surgery, eating beets or anything with red food dye or overuse of NSAIDS/over the counter pain medication. Doing a rectal exam to examine stool color may provide a clue as to the location of the bleed but is not a reliable indicator;[8][9][4][5][6]
• for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease). Although a Journal of Emergency Medicine paper concludes: "We found the DRE to have a limited role in the diagnosis of acute, undifferentiated abdominal pain and acute appendicitis.";[10][4]
• for the estimation of the muscle tone of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries;
• traditionally, the digital rectal examination (DRE) was considered an essential part of the physical examination for all trauma patients. However, the sensitivity of the DRE for injuries of the spinal cord, pelvis, and bowel is poor, and false positive and negative results are common. Thus, routine performance is unnecessary and generally unhelpful. The examination is warranted in cases where urethral injury or penetrating rectal injury is suspected;[11][12]
• in females, for the limited gynecological palpations of internal organs when you are unable to access the vaginal vault or it is too painful (vaginal atrophy);
• for examination of the hardness and color of the feces (i.e. in cases of constipation, and fecal impaction);
• prior to a colonoscopy or proctoscopy;
• to evaluate hemorrhoids although internal hemorrhoids are often too soft to be felt, a visual inspection may be more useful;[13]
• in newborns to exclude imperforate anus;
• through the insertion of medical devices including thermometers or specialized balloons; to identify digestion problems, parasites, organ damage, anal bruising, and foreign objects in the rectal cavity;

The digital rectal examination is a relatively simple medical procedure. The patient undresses and is then placed in a position where the anus is accessible (lying on the side, squatting on the examination table, bent over it, or lying down with feet in stirrups). If the patient is lying on his/her side, the physician will usually have her/him bring one or both legs up to his/her chest. If the patient bends over the examination table or the back of a chair, the physician will have her/him place his/her 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 his/her buttocks are positioned just beyond the end and then place her/his feet in the stirrups. The physician spreads the buttocks apart and will usually examine the external area (anus and perineum) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient relaxes and bears down (as if having a bowel movement), the physician slips a lubricated finger into the rectum through the anus and palpates the insides for a short time.[28]

Due to the taboos surrounding the anus and the potential for discomfort and embarrassment, the rectal exam is a common comedic device, including in episodes of Saturday Night Live,[29] Impractical Jokers, Futurama, Family Guy, South Park and the movie Fletch, with M. Emmet Walsh as the general practitioner and Chevy Chase as the patient being examined. Similar activities to the rectal exam are attributed to extraterrestrials in video games such as Saints Row IV, Gaia Online and Destroy All Humans!.[30] The practice of rectal exams without prior consent by medical students has been an area of concern.[31]

In veterinary medicine rectal examination is useful in dogs for analysis of the prostate (as in men), 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. When horses undergo a rectal examination there is a small risk of a rectal tear occurring, which can be a life-threatening event, rapidly leading to peritonitis and septic shock. It is also a common procedure in cattle, and is one method of diagnosing pregnancy in both the horse and the cow.

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.

• Body cavity search
• Colonoscopy
• GCC homosexuality test

• Rectal Examination