Digital rectal exam

Definition
A digital rectal exam is an examination of the lower rectum to check for hemorrhoids, anal fissures, and stool abnormalities such as frank (evident) or occult (hidden) blood. The term “digital” refers to the clinician’s use of a lubricated finger (digit) to conduct the exam. This examination is also used to evaluate the prostate gland in males.

How the test is performed
The doctor will first examine the exterior of the anus for hemorrhoids or fissures. Then he or she will put on a latex glove and insert a lubricated finger into the rectum and obtain a small amount of stool on the gloved finger. The stool is then applied to a hemoccult test, which is a way of evaluating for occult rectal bleeding.

In female patients, this exam may be done together with a pelvic exam. In male patients, it is also done to feel the prostate gland. This exam is done in the doctor’s office and may lead to a diagnosis of a prostate abnormality or rectal bleeding.

How to prepare for the test
The doctor will ask you to try to relax before the test and to take a deep breath during the actual insertion of the finger into the rectum.

How the test will feel
There may be mild discomfort felt during this test.

Why the test is performed

This test is performed for various reasons. A doctor may use this test in an evaluation for rectal or prostatic problems. In men, the test is used to screen for prostate cancer along with blood and other tests, because the doctor can palpate the prostate gland for abnormalities. It is also used to evaluate for an enlarged prostate.

It is also done as one of the initial screening tests for colorectal cancer.

If a patient complains of rectal bleeding or appears to have an acute hemorrhage, the stool should always be evaluated for obvious or occult blood. Patients needing blood thinners, such as heparin for a medical emergency like a stroke or suspected heart attack, will also be pre-screened with a rectal exam to rule out obvious rectal bleeding.

This procedure is also done before other tests to make sure nothing is blocking the rectum before an instrument is inserted.

Normal Values
This examination is usually treated as an initial screening examination. It is usually done in conjunction with other tests to rule out abnormalities. If the doctor does not feel any abnormalities, that would be considered a “normal” finding - but this test does NOT definitively rule out potential problems.

What abnormal results mean
If a patient is currently bleeding in the gastrointestinal tract, this warrants emergency care, and the patient should be evaluated in the emergency department for a gastrointestinal hemorrhage. If occult blood is revealed but the patient does not appear to be hemorrhaging, the patients will generally undergo blood tests for anemia, followed by colonoscopy. If a male patient has an enlarged or nodular prostate, he will undergo a serum test of prostate specific antigen, and then possibly prostate ultrasound and biopsy after referral to a urologist.

What the risks are

The exam itself generally caries no risk, but a patient may have a normal exam and still have an occult source of bleeding.

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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