The digital rectal exam (DRE) is a routine physical assessment performed by a healthcare professional. It is a quick, in-office method used to check the health of the prostate gland in men and to examine the lower gastrointestinal tract in both men and women. The examination is frequently incorporated into annual checkups or used to investigate symptoms related to the urinary or bowel systems. The DRE provides immediate, valuable information about internal structures that cannot be assessed externally.
Defining the Digital Rectal Exam
The DRE is a physical examination technique where a clinician manually assesses the lower rectum and nearby pelvic organs. The procedure involves inserting a single, gloved, and lubricated finger into the rectum through the anus. This allows the professional to palpate structures that border the rectal wall. The primary structure targeted in men is the prostate gland, which sits just in front of the rectum.
The assessment is important because the posterior surface of the prostate is directly accessible through the rectal wall. For all patients, the DRE allows for the detection of abnormalities within the lower rectal wall, such as masses or internal hemorrhoids. The examination also provides a tactile sense of the anal sphincter muscle tone, which is relevant in cases of bowel function changes.
The Steps of the Procedure
The examination begins with the patient assuming a specific position that allows comfortable access to the rectum. For men, this often involves standing and bending forward over the table or lying on the side with knees drawn toward the chest. Women may be positioned similarly or on their back with feet in stirrups, especially if the DRE is part of a pelvic examination. The provider first visually inspects the external area for any signs of skin lesions or fissures.
The clinician then applies lubricant to a gloved index finger before gently inserting it into the anal opening. Patients should anticipate a sensation of pressure during insertion, which is normal. The procedure is brief, lasting only a few seconds while the clinician performs the necessary palpation. Communicating any discomfort or pain to the provider is important so they can adjust the examination immediately.
What the Examination Reveals
During the DRE, the clinician assesses several characteristics of the organs being felt. For the prostate, the provider evaluates its size, shape, symmetry, and surface texture. A healthy prostate is typically smooth, firm (similar to the tip of a nose), and symmetrical. An enlarged prostate, often a sign of benign prostatic hyperplasia (BPH), will feel larger than expected.
The detection of firm areas, hardness, or distinct nodules on the prostate surface is a finding of concern that suggests potential malignancy. Since the DRE only allows palpation of the posterior wall, it targets the area where most prostate cancers originate, though it cannot assess the entire gland. For the rectal wall, the clinician feels for polyps, growths, or masses that could indicate colorectal concerns. Internal hemorrhoids or an anal fissure can also be identified through this tactile assessment.
Clinical Guidelines for DRE Screening
The DRE is utilized as a component of a larger screening strategy for prostate cancer. Current medical guidelines recommend that men at average risk begin discussing screening with their doctor around age 50. Men at higher risk, such as African American men or those with a close family history of prostate cancer, may begin this conversation as early as age 40 or 45. The DRE is rarely used alone for screening purposes due to its qualitative nature and limited reach.
The DRE is typically performed in conjunction with a Prostate-Specific Antigen (PSA) blood test. The PSA test measures a protein level that can be elevated by prostate cancer or other conditions. Using the DRE and PSA test together offers a more comprehensive assessment for early detection than either test can provide individually. Major health organizations recommend shared decision-making between the patient and physician after reviewing the potential benefits and risks of screening.