Rectal Examination (redirected from Digital rectal exam)

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.

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rectal

pertaining to the rectum.

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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

see proctitis, rectitis.

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.