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Digital Rectal Exam

A digital rectal exam (DRE) is a type of physical test your doctor performs to identify any possible health issues in the pelvic and lower belly region. Note that the word "digital" in DRE refers to the finger as a digit, rather than some a computerized mechanism.

During a DRE, a doctor will lubricate one or two fingers on his gloved hand and then slowly insert them into the patient's rectum. Once the finger(s) has been inserted, the doctor will lightly press on the patient's belly with his free hand as he uses the inserted finger to detect any abnormalities.

What DREs Detect

Digital rectal exams are an important diagnostic tool that doctors use on both men and women alike. While men receive DREs during their general wellness checkups, women often get DREs during their regular gynecology exams. Here are some of the health problems DREs can help detect:

Coloncancer: A digital rectal exam can help doctors identify abnormal growths in the rectum that may indicate tumors in the colon. If a doctor detects growths that he suspects are tumors, further testing will be needed to make a proper diagnosis of colon cancer.
Hemorrhoids: Like malignant lumps, hemorrhoids generally make themselves known during a DRE in the form of abnormal growths. Hemorrhoids are breaks or sores in the skin surrounding the anus. However, while a digital rectal exam can help doctors identify external hemorrhoids, the soft nature of internal hemorrhoids makes them harder to feel. As a result, more rigorous testing is needed to diagnose internal hemorrhoids.
Prostate problems: During a digital rectal exam, doctors can feel a man's prostate gland, checking it for enlargement and hardness. Hard lumps typically indicate the presence of tumors.
Uterine and ovarian problems: DREs can help doctors identify any potential or existing problems in a woman's uterus and ovaries. Any abnormalities that doctors detect during routine DREs generally call for further testing to diagnose or rule out health problems, such as ovarian cancer and uterine cancer.

Doctors may also use the digital rectal exam to check the cause of any problem related to excretion, such as bloody bowel movements.

Preparing for a Digital Rectal Exam

Before your doctor performs a DRE, he will ask you to change into a medical, open-backed gown. At this time, be sure to tell your doctor if you suffer from hemorrhoids so that he takes care to not disturb them during his examination.

Because a DRE examines different parts of a man's and woman's body, each gender must assume a different position when receiving this diagnostic test:

For men: Men will be asked to stand and bend forward from their waists. Occasionally, doctors will ask men to lie on their sides, holding their knees as close as possible to their chests. Either one of these positions opens the rectum, allowing the doctor to thoroughly examine it.

During a digital rectal exam, men should expect to feel slight pain, discomfort and the need to urinate. More intense pain can indicate the presence of prostate problems.
For women: Because DREs are typically performed during a woman's routine Pap test, she usually just stays with her feet in the stirrups as the gynecologist performs this test. This position allows for optimum examination of the uterine region.

Unlike men, women typically don't feel pain during a DRE. Instead, they generally experience discomfort and slightly increased pressure in the abdominal region.

If, however, patients suffer from undiagnosed hemorrhoids, a digital rectal exam is likely to be significantly painful. Tell your doctor if you experience sharp, persisting pain during a DRE so that he can perform more extensive testing to see whether or not you suffer from hemorrhoids.

DRE Risks and Side Effects

Because the digital rectal exam is only a slightly invasive procedure, associated risks are usually minimal, subsiding in a day or two, if no other serious health problems are present. The most common side effect of this diagnostic test is anal bleeding, especially if a patient suffers from hemorrhoids. Bleeding generally clears up within a day of the exam.

Rarely, patients may experience lightheadedness and feel as though they are going to faint. Known as vasovagal syncope, these symptoms are caused by anxiety and apprehension rather than by some underlying health problem. Vasovagal syncope usually subsides within a few hours after the procedure.

Digital Rectal Exams and Cancers

The American Cancer Society recommends that men over 50 receive an annual digital rectal exam to screen for prostate cancer. When DREs are specifically used to screen for prostate cancer, doctors pair this test with a distinct blood test known as the prostate-specific antigen (PSA) blood test. Together, the DRE and PSA can help doctors properly diagnose prostate cancer.

To diagnose colon cancer, doctors use the DRE as the most preliminary diagnostic tool. If abnormalities are detected during the DRE, doctors will call for the patient to receive further testing to confirm or rule out colon cancer.

Resources

Nissl, Jan RN (updated November 28, 2006). Digital Rectal Exam. Retrieved October 10, 2007 from the WebMD Web site:
http://www.webmd.com/colorectal-cancer/Digital-Rectal-Examination-DRE.

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