The Digital Rectal Exam (DRE) is a quick physical assessment used to check the prostate gland and the lower rectum. This procedure involves a healthcare professional gently inserting a lubricated, gloved finger into the rectum to feel for any abnormalities. Although it may cause a brief feeling of pressure or minor discomfort, the DRE is a straightforward and generally well-tolerated initial screening tool.
Medical Reasons for the Examination
The DRE is often performed to assess the prostate gland, a small organ situated just beneath the bladder in men. A primary reason for the exam is to screen for prostate cancer, as the professional feels for hard nodules or irregular areas on the gland’s surface. The examination can also detect Benign Prostatic Hyperplasia (BPH), a common non-cancerous condition causing urinary symptoms in aging men. Assessing the size and contour of the prostate provides information about potential obstructions to urine flow.
Beyond prostate health, the DRE is used to investigate symptoms, including changes in bowel habits, rectal bleeding, or lower abdominal pain. The examination allows for the identification of issues like hemorrhoids, anal fissures, or masses and tumors in the lower rectum. The DRE is also used to assess the function of the anal sphincter, which is relevant for individuals experiencing fecal incontinence.
Patient Preparation and Positioning
Before the examination, the healthcare professional explains the procedure and obtains verbal consent. Privacy and comfort are prioritized; the patient is typically asked to disrobe from the waist down and put on a gown. No specific preparation, such as fasting or an enema, is required for a DRE.
The positioning is designed to allow optimal access to the prostate while keeping the patient comfortable. Two common positions are used: standing and leaning forward over the table with hips flexed, or lying on the side with knees drawn toward the chest (the left lateral position). The professional ensures the patient is properly situated and relaxed before proceeding.
The Digital Rectal Exam Procedure
The procedure begins with a visual inspection of the perianal area to check for external conditions like skin tags, hemorrhoids, or fissures. The professional then puts on a fresh glove and applies a generous amount of sterile, water-based lubricant to the index finger. The patient is often instructed to relax and take a slow, deep breath, which helps relax the anal muscles.
The lubricated finger is gently inserted through the anus and into the rectum, following the natural curve of the lower spine. The professional first assesses the tone of the anal sphincter muscles and then rotates the finger to feel the rectal walls for growths or tenderness. The prostate gland is located on the anterior wall of the rectum, toward the patient’s abdomen. The professional then uses the fingertip to palpate the surface of the prostate, noting its size, shape, and consistency.
The goal of the palpation is to feel the posterior surface of the gland, which should normally feel smooth, firm, and rubbery, similar to the tip of a nose. The entire procedure is brief, often lasting only a few seconds to a minute. The patient may experience a sensation of needing to urinate or a feeling of fullness caused by the pressure on the prostate.
Interpreting Findings and Next Steps
The findings from a DRE are often discussed immediately with the patient. A normal prostate is typically described as being approximately 3.5 centimeters wide, with a smooth and uniform surface. Findings that deviate from this texture, such as distinct hard areas or nodules, can raise suspicion for prostate cancer.
An enlarged prostate that feels smooth and resilient is consistent with BPH, whereas an area that feels boggy or tender may suggest a prostate infection (prostatitis). DRE results are not definitive alone and are frequently used in combination with a blood test measuring Prostate-Specific Antigen (PSA) levels. If the DRE reveals an abnormality or the PSA test shows elevated levels, the next step involves further evaluation, such as an ultrasound or a prostate biopsy.