Rectal examination

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A rectal examination or rectal exam is an internal examination of the rectum by a physician or other healthcare professional.

The digital rectal examination (DRE, Latin palpatio per anum or PPA) is the simplest procedure. The patient is placed in a position where the anus is accessible and relaxed (lying on the side, squatting on the examination table, bent over the examination table, etc). The physician inserts a gloved and lubricated finger into the rectum through the anus and palpates the insides.

The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; coloscopy is preferred. However, it's an important part of a general examination, as many tumors or other diseases manifest themselves in the distal part of the rectum.

This examination may be used:

for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease);
for the diagnosis of rectal tumors and other forms of cancer;
for the estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases;
in males, for the diagnosis of prostatic disorders, notably tumors and benign prostatic hyperplasia;
in females, for gynecological palpations of internal organs
for examination of the hardness and colour of the faeces (ie. in cases of constipation, and fecal impaction);
prior to a coloscopy or proctoscopy.

The DRE is frequently combined with a FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.

Sometimes proctoscopy may also be part of the rectal examination.

Rectal examination

See also