Digital Rectal Exam

What is a digital rectal exam?

A digital rectal examination (DRE) is a test that healthcare providers do to examine your lower rectum and anus (butthole). They also do DREs to examine the prostate gland in people assigned male at birth (AMAB). A healthcare provider will insert a gloved, lubricated finger into your rectum through your anus to check for any abnormalities. A DRE may be part of a routine physical examination for people AMAB and part of a routine gynecological exam for people assigned female at birth (AFAB).

Why would I need a digital rectal exam?

A digital rectal exam is a diagnostic tool for many different medical issues. Therefore, a healthcare provider may perform it outside of your routine health evaluation. These medical issues may include:

• Inflammatory bowel disease (IBD).
• Hemorrhoids.
• Anal fissures.
• Prostate infection.
• Rectal or colon cancer.
• Trauma.
• Neurological disorders.

Symptoms that could indicate a health concern include:

• Bleeding from your rectum.
• Blood in your poop (stool).
• Change in bowel movements, such as constipation or diarrhea.
• Blood, mucus or discharge in your pee (urine).
• Urinary incontinence.
• Fecal (stool) incontinence.

Your provider may perform a DRE to check the health of your prostate or if you have symptoms that could be signs of serious issues.

Disease of the prostate

During a DRE, your healthcare provider will examine your prostate. While the U.S. Preventive Services Task Force doesn’t recommend DRE as a screening tool for prostate cancer, it can be used to identify signs of a prostate infection. Your provider will look for an enlarged prostate or abnormal bumps or changes on your prostate. The exam can indicate whether more testing needs to be done.

If they think you may have an infection, your provider may massage your prostate to release fluid (secretions) into your urine. A lab technician (pathologist) can examine the secretions under a microscope to help guide your treatment.

Blood in your stool/rectal bleeding

If you discover blood in your poop, in the toilet or on toilet paper after you wipe, a DRE can be an important tool. Blood within your stool may be a sign of disease in your upper or lower intestinal tract. It’ll prompt further studies (such as a colonoscopy) to look for cancer, internal hemorrhoids or inflammation of your bowel wall.

Changes in bowel habits

If you have abnormal changes in your bowel habits (such as poop that’s pencil-thin, flat or difficult to pass), a provider can perform a DRE to check for a physical obstruction like a tumor.

Who performs a digital rectal exam?

Several healthcare providers may perform a DRE to help them diagnose your condition. These providers include:

• Primary care providers.
• Surgeons.
• Gastroenterologists (physicians who specialize in your gastrointestinal tract).
• Obstetricians and gynecologists.
• Oncologists (physicians who treat cancer).

How often should I get a digital rectal exam?

Your healthcare provider may recommend you get a digital rectal exam as part of your annual physical examination. In addition to a DRE, your provider may also recommend prostate-specific antigen (PSA) testing as a screening tool for prostate cancer. The PSA is a protein in your blood that can also give some information about the health of your prostate.

How do I prepare for a digital rectal exam?

You don’t have to do anything to prepare for a digital rectal exam. If you have any tears in your anal tissue (anal fissures) or swollen veins in your anus or rectum (hemorrhoids), be sure to alert your healthcare provider. A DRE can make these conditions worse.

Your healthcare provider will explain how the procedure works, and you’ll have a chance to ask them any questions you may have.

What should I expect during a digital rectal exam?

Your healthcare provider will perform the digital rectal exam in a private exam room at their office. You’ll need to undress from the waist down, and you’ll be given a gown or cloth to cover yourself. The procedure only takes a few minutes. It’s typically painless, but you may be slightly uncomfortable. Some people may feel a need to pee (urinate).

For people AMAB

Your healthcare provider will ask you to get in one of two positions for the DRE. They may ask you to stand and lean forward over the exam table or lie on your side on the exam table with your knees pulled up into your chest.

First, they’ll examine the outside of your anus to check for hemorrhoids or anal fissures. Once you’re ready, they’ll ask you to relax and take a deep breath. They’ll gently insert a gloved, lubricated index finger into your rectum.

Your healthcare provider will feel for your prostate gland, checking the size and the surface of the gland. If your prostate is enlarged, you may feel some discomfort or mild pain/pressure during the exam. Finally, your provider will examine the wall of your lower colon and rectum, checking for any abnormalities.

For people AFAB

Your healthcare provider may perform a digital rectal exam as part of your gynecological exam (pelvic exam). They’ll ask you to lie on your back on an exam table with your feet in raised stirrups.

Once you’re ready, they’ll ask you to relax and take a deep breath. They’ll gently insert a gloved, lubricated index finger into your rectum. During this process, your provider will examine the wall of your lower colon and rectum, checking for any abnormalities.

What should I expect after a digital rectal exam?

After a digital rectal exam, you may return to normal activities immediately. Light bleeding from your rectum is rare but may occur. If you have anal fissures or hemorrhoids, bleeding is more likely. Let your healthcare provider know if you have a lot of rectal bleeding after the DRE.

Are there any risks or complications associated with DRE?

While digital rectal exams (DREs) are generally considered safe and discomfort is the most common experience during the procedure, there are a few potential risks and complications to be aware of:

• Discomfort or pain: Some people may experience discomfort or mild pain during the insertion of the gloved, lubricated finger into their rectum. This discomfort is usually temporary and goes away shortly after the exam.
• Rectal bleeding: In rare cases, people may experience light bleeding from their rectum after a DRE, particularly if they have preexisting conditions such as anal fissures or hemorrhoids. It’s essential to inform your healthcare provider if you experience significant rectal bleeding after the exam.
• Infection: While rare, there’s a minimal risk of infection associated with any procedure that involves the insertion of instruments into the body. Healthcare providers take precautions to minimize this risk by using sterile gloves and lubricants during the exam.

When should I know the results of a digital rectal exam?

Your healthcare provider should be able to tell you the results of the digital rectal exam immediately.

What do the results of a digital rectal exam mean?

Normal results of a digital rectal exam mean your healthcare provider didn’t find anything abnormal during the exam. However, they may recommend additional tests to confirm the results.

An abnormal digital rectal exam may mean many different things. There may be blood present, palpable nodules, tears in your rectum, hemorrhoids or significant pain with the exam. Your provider will discuss this more with you during your visit, as well as any next steps.

Are digital rectal exams performed during colonoscopies?

Your healthcare provider may perform a digital rectal exam as a first step during a colonoscopy. However, they don’t usually perform a prostate exam during this type of DRE. They just use this type of DRE to evaluate and lubricate your anal canal in preparation for the colonoscopy. So, ask your provider if they could check your prostate during the DRE for a colonoscopy.

A note from Cleveland Clinic

Look, we get it. A digital rectal exam sounds embarrassing and downright uncomfortable. While the thought of a DRE may not be pleasant, the procedure is typically quick and painless. And your healthcare provider has seen it all before. Nothing to be embarrassed about. If your provider says it’s time to get a DRE, it’s important to listen to them. DREs can help determine what’s going on up there and may help with the early diagnosis of certain diseases and conditions.