Digital rectal examination
Digital rectal examination (DRE) is an important investigation in the evaluation of the prostate, rectal bleeding, constipation, and faecal incontinence. Some advocate for its performance in all cases where the patient presents with a gastrointestinal or abdominal complaint, but the use of DRE as a routine examination is recently disputed[1][2].
Procedure and evaluation
Digital rectal examination must be performed with adequate lubrication and ideally while wearing two gloves on the hand to be used. The patient should lie on their side. The perianal area should be inspected before insertion of the finger; if the patient has a perianal fissure, DRE should not be performed.
Once inside, the whole circumference of the anal canal should be palpated for masses or irregularities. The prostate should be palpated for irregularities, consistency, and tenderness. The patient should be asked to tighten the sphincter, so the examiner can feel for proper tone.
The patient should be examined for Blumer’s sign, the presence of a mass in the Douglas pouch, which may indicate metastasis.
After the examination, the glove should be inspected for faeces or blood. If no blood is visible, the residue on the glove should be tested with a faecal occult blood test.
Distal rectal cancers may be palpable, as may be prostatic pathologies like malignancy, BPH, and prostatitis.