Rectal examination

Usage

• for the diagnosis of prostatic disorders, benign prostatic hyperplasia and the four types of prostatitis. Chronic prostatitis/chronic pelvic pain syndrome, chronic bacterial prostatitis, acute bacterial prostatitis, and asymptomatic inflammatory prostatitis. The DRE has a 50% specificity for benign prosthetic hypoplasia. Vigorous examination of the prostate in suspected acute prostatitis can lead to seeding of septic emboli and should never be done. Its utility as a screening method for prostate cancer however is not supported by the evidence;
• for the evaluation of certain clinical symptoms: a male with change in urinary ability, impotence, or dysuria, pain with bowel movements;
• a DRE with a FOBT might have value for the anemic patient in the emergency room who has no other identifiable cause for anemia, is not actively bleeding, and you are concerned that Gastrointestinal malignancy may be the cause for their anemia;
• a true active gastrointestinal bleed: vomiting blood, vomiting coffee-grind like material, defecating blood or black tarry stools that can not be easily attributed to facial trauma or oral surgery, eating beets or anything with red food dye or overuse of NSAIDS/over the counter pain medication. Doing a rectal exam to examine stool color may provide a clue as to the location of the bleed but is not a reliable indicator;
• for the diagnosis of appendicitis or other examples of an acute abdomen. Although a Journal of Emergency Medicine paper concludes: "We found the DRE to have a limited role in the diagnosis of acute, undifferentiated abdominal pain and acute appendicitis.";
• for the estimation of the muscle tone of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries;
• traditionally, the digital rectal examination was considered an essential part of the physical examination for all trauma patients. However, the sensitivity of the DRE for injuries of the spinal cord, pelvis, and bowel is poor, and false positive and negative results are common. Thus, routine performance is unnecessary and generally unhelpful. The examination is warranted in cases where urethral injury or penetrating rectal injury is suspected;
• in females, for the limited gynecological palpations of internal organs when you are unable to access the vaginal vault or it is too painful ;
• for examination of the hardness and color of the feces ;
• prior to a colonoscopy or proctoscopy;
• to evaluate hemorrhoids although internal hemorrhoids are often too soft to be felt, a visual inspection may be more useful;
• in newborns to exclude imperforate anus;
• through the insertion of medical devices including thermometers or specialized balloons; to identify digestion problems, parasites, organ damage, anal bruising, and foreign objects in the rectal cavity;

  Usage as a screening tool

In [colorectal cancer screening] of asymptomatic adults aged 50 to 75

• Even though 1 in 4 colorectal cancers is located in the rectum, little evidence supports the effectiveness of using the DRE for rectal cancer detection and it is not recommended in the colorectal cancer screening guidelines. The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; sigmoidoscopy is preferred.
• Although the DRE is commonly used as a way to obtain a stool sample for a FOBT in an office based setting, this is an insufficient way of screening for colorectal cancer and is not recommended. A single office-based FOBT performed following a digital rectal examination is not an adequate screen due to low sensitivity for advanced tumor and colorectal cancer. Screening for colon cancer this way does not meet HEDIS, Medicare or American Cancer Society standards. The FOBT has never been validated for any purpose other than as a take home colon cancer screening test. A paper published in the Journal of General Internal Medicine states, "While FOBT done appropriately is an important screening option, in-office FOBT may be worse than no screening at all because it misses 95% of cases of advanced tumor, giving many patients a false sense of reassurance."

  In [prostate cancer screening] of asymptomatic men aged 55 to 69

• In men aged 55–69 who have been counseled on the known harms and potential benefits of prostate cancer screening, the U.S. Preventive Service Task Force May 2018 statement states, "The use of digital rectal examination as a screening modality is not recommended because there is a lack of evidence on the benefits." The American Academy of Family Physicians states, "Digital Rectal Exam does not improve detection of prostate cancer and should not be performed as a part of screening." The American Urology Association 2013 guideline panel states, "The literature supporting the efficacy of digital rectal exam for screening with the goal of reducing prostate cancer mortality provide limited evidence to draw conclusions." "The guideline panel could find no evidence to support the continued use of DRE as a first-line method of screening." Although DRE has long been used to diagnose prostate cancer, no controlled studies have shown a reduction in the morbidity or mortality of prostate cancer when detected by DRE at any age.
• A meta-analysis published in the Annals of Family Medicine concluded: "Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting."

  Procedure

Society and culture

Veterinary medicine