rectal examination

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Rectal Examination

 

Definition

Rectal examination or digital rectal examination (DRE) is performed by means of inserting a gloved, lubricated finger into the rectum and palpating (feeling) for lumps.

Purpose

DRE is used as a screening tool to locate rectal cancer and prostate cancer. It is also used as a diagnostic test to find non-cancerous abnormalities within the rectum like hemorrhoids, anal fissures, or congenital deformities that can cause chronic constipation.

Precautions

There are no precautions when performing DRE, aside from routine sanitary procedures.

Description

DRE is performed in most instances as an annual routine procedure in colorectal cancer screening. Digital palpitation of the rectum can often find abnormal growths which may require further testing or commonplace hemorrhoids. It is a critical initial clinical test and is important in the assessment of the size and location of tumors.
This procedure is often not performed routinely on patients over 70, even though this population is at high risk for colorectal cancer. It also is not done as often in elderly women as in elderly men.
DRE has also been used as a screening tool for prostate cancer. It seems to be very effective for larger masses found in the prostate and correlated well with higher prostate-specific antigens.
Of less predictive value was DRE in routine rectovaginal examinations of women under the age of 50. These instances of DRE did not locate colorectal cancer or any other abnormality.
More gastroenterologists are recommending that pediatricians and family physicians perform DRE on pediatric patients exhibiting chronic constipation before those patients are referred to intestinal specialists. The pediatrician or family physician could identify fecal compaction and treat it themselves, and then only refer patients who have a specific abnormality to gastroenterologists.

Preparation

The physician must conduct DRE using a gloved hand. Some sort of lubricant should be used so that penetration of the rectum is easier and does not create the damage that the procedure is seeking.

Aftercare

There is no aftercare after a DRE is performed.

Risks

There are no risks to DRE and it is virtually painless.

Normal results

The physician finds a normal rectal canal with no abnormalities.

Abnormal results

Growths, tears, anal fissures, or congenital structural defects can be found inside the rectum with DRE.

Resources

Periodicals

Kirchner, Jeffrey T. "Digital Rectal Examination in Children with Constipation." American Family Physician 60, no. 5 (October 1, 1999): 1530.
Schroder, Fritz H. "Evaluation of the Digital Rectal Examination as a Screening Test for Prostate Cancer." JAMA, The Journal of the American Medical Association 281, no. 7 (February 7, 1999) 594.

Other

Practice Parameters for the Treatment of Rectal Carcinoma American Society of Colon and Rectal Surgeons May 7, 2001. 〈http://www.asco.org/prof/me/html/abstracts/gasc/m_969.htm〉.

Key terms

DRE — Digital rectal examination.
Gastroenterologist — A physician who specializes in diseases of the digestive system.
Rectum — The last eight to ten inches of the colon, of which the anus is a part and the opening through which wastes are removed from the body.

rectal examination

An important method of examination performed with a gloved, lubricated finger. Rectal examination can reveal thrombosed internal piles, ano-rectal abscesses, benign or cancerous enlargement of the PROSTATE GLAND, rectal polyps, RECTAL CANCER, abnormalities of the CERVIX of the womb, enlargement of the ovaries or inflammation in the APPENDIX.

rectal

pertaining to the rectum.

rectal examination
digital (in small animals) or manual examination of the visceral contents of the posterior abdomen for the purposes of diagnosis, in cattle and horses especially of pregnancy. See also rectum, proctoscopy.
rectal fistula
see rectovaginal fistula.
rectal impaction
see fecal impaction.
rectal inflammation
rectal massage
massage of the accessory sex glands, a method of semen collection in dogs.
rectal paralysis
occurs especially in cows and mares in late pregnancy. No feces are passed and the rectum is distended with feces, and there is no peristalsis during their manual removal. Dogs may show posterior paresis.
rectal polyp
see colorectal polyp.
rectal probe
used in pregnancy diagnosis in ewes and in electroejaculation.
rectal rupture
the wall is perforated into the peritoneal cavity. Death occurs quickly as a result of endotoxic shock because of the absorption of enteric toxins through the peritoneum.
rectal stricture
stenosis of the rectum occurs in dogs, presumably resulting from trauma and anorectal disease, and in pigs following local ulceration caused by infection with Salmonella spp. Abnormal abdominal distention, small diameter feces and straining result.
rectal tear
most common in mares in association with manual rectal examinations. The mucosa is damaged but the wall is not ruptured. Leads to perirectal abscessation and subsequent peritonitis.
rectal temperature
see rectal temperature.
References in periodicals archive ?
The current standard of care forProstate Cancer (PCa)screening practiced in the Midwest is the digital rectal exam (DRE - the finger in the rectum test) and PSA test Prostate-Specific Antigen.
He also listed the risks and causes of this cancer and the different ways of detection used based on two key elements: the digital rectal exam and the PSA blood test (prostate specific antigen) which is the most common test used to detect the cancer.
They were undergoing an initial biopsy because of elevated prostate-specific antigen levels and/or abnormal findings on digital rectal exam.
Services include regular blood pressure monitoring; counseling on breastfeeding, smoking cessation and lifestyle modification; screening services to detect breast and cervical cancers; and digital rectal exam.
Men can easily be tested for palpable prostate abnormalities with a digital rectal exam (DRE), a simple test that provides a lot of information.
Other causes include the insertion of a foreign object, anal intercourse, a digital rectal exam and chronic constipation or diarrhea.
However, several key areas for improvement (male genitourinary exam, digital rectal exam and sexual history) were identified among undergraduates.
While no change of digital rectal exam was found in the treated group, in the control group, more abnormalities such as nodules and further prostate 1 enlargement were seen after the study, suggesting progression of the BPH in those patients
At Arkansas Urology, we recommend a combination of two tests - the digital rectal exam and a blood test to detect PSA, the prostate-specific antigen.
Those indicators could be an elevated baseline PSA or a positive digital rectal exam (DRE)," said Andrew Vickers, Associate Attending Research Methodologist in the Department of Epidemiology and Biostatistics and lead author.
These include a recent study published in The Journal of Urology, which confirmed that the phi score is a better predictor of prostate cancer risk than PSA or percent free PSA alone in men 50 years of age and older with a PSA range of 2-10 ng/mL who had a digital rectal exam with no suspicious findings.
Crawford and colleagues tested Progensa in about 1,900 men who had high PSA readings, an abnormal digital rectal exam or both and who were scheduled to have biopsies.

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