The digital rectal exam (DRE) is a straightforward diagnostic procedure that assesses the lower rectum, anus, and other internal organs.
This diagnostic procedure can help detect abnormalities such as tumours, polyps, and signs of conditions like prostate enlargement or rectal cancer. A lubricated, gloved finger is inserted into the rectum during a DRE to feel for irregularities. This procedure is typically quick, lasting only a few minutes, and is often part of a routine physical examination for men over 50.
A digital rectal exam (DRE) is indicated in several clinical scenarios, primarily to evaluate symptoms or conditions affecting the rectum, anus, prostate, or pelvic area. Key indications include:
DRE is routinely used to assess prostate size, texture, and the presence of any nodules or irregularities, particularly in men over the age of 50.
It aids in detecting masses or abnormalities that might suggest rectal cancer.
Recommended for patients presenting symptoms such as rectal bleeding, irregular bowel habits, or unexplained pain in the anal or rectal areas.
Useful in diagnosing causes of pelvic pain which could be linked to conditions affecting internal pelvic organs.
It is also performed regularly to monitor known issues such as chronic inflammatory diseases of the rectum like Crohn’s disease or ulcerative colitis.
Here are the key steps involved before undergoing a Digital Rectal Exam:
The digital rectal exam (DRE) is a straightforward procedure, typically performed in a doctor’s office or clinic. Here’s what happens during the exam:
The patient is positioned to ensure both comfort and accessibility to the rectal area. Common positions include lying on the side with knees pulled toward the chest (left lateral position) or bending forward at the waist while standing.
A sterile, lubricated glove is used to ease the insertion of a finger into the rectum and to ensure the procedure is hygienic.
The lubricated, gloved finger is gently inserted into the rectum through the anus. Once inserted, the finger is used to palpate the lower rectum, surrounding tissues, and, in males, the prostate gland.
During the procedure, communication with the patient informs them what to expect as the exam progresses and checks for discomfort. The entire process usually takes only a few minutes.
The results provide insights into a patient’s rectal and prostate health. Results are typically interpreted as follows:
A normal DRE result would find no abnormalities in the texture, size, and shape of the prostate in men and no lumps, bumps, or irregularities in the rectum and anus. This indicates the absence of notable pathologies like tumours or significant inflammation.
Any irregularities felt—such as lumps, hardness, or nodules—may suggest conditions such as prostate cancer, rectal tumours, or other abnormalities. Increased firmness or asymmetry in the prostate can also indicate potential issues.
If abnormalities are detected during a DRE, diagnostic tests are often recommended. These might include prostate-specific antigen (PSA) tests, ultrasounds, or biopsies to investigate the nature of the abnormality.
Depending on the results and additional tests, follow-up appointments may be scheduled to monitor any suspect areas or to discuss treatment options if a disease is diagnosed.
The digital rectal exam (DRE) is a valuable diagnostic tool, but it has certain limitations and considerations to be aware of:
Dr Png is a United States fellowship-trained urologist who received his urology specialist board certification from Singapore. He is the first and only urologist in Singapore to be inducted into the Fellow, American College of Surgeons (FACS) after completing a minimally invasive surgery fellowship in the USA at the Indiana University School of Medicine, where he sub-specialised in robotic and laparoscopic surgery for urological cancers.
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The DRE is generally not painful, though it may be uncomfortable for some people. The level of discomfort can vary based on personal sensitivity.
The frequency of DREs depends on age, family history, and personal health conditions. Typically, it is recommended annually for men over 50 or younger if there are risk factors for prostate issues.
Yes, a DRE can be performed on women to check for abnormalities in the pelvic area, including the health of internal organs like the uterus and ovaries, especially when other pelvic exams are inconclusive.
