How to give a rectal exam

This article was co-authored by Gary Hoffman, MD. Dr. Gary Hoffman is a board certified Colorectal Surgeon and the Clinical Chief of the Division of Colon and Rectal Surgery at Cedars Sinai Medical Center. With over 35 years of experience, Dr. Hoffman has helped to advance laparoscopic and robotic surgery for the treatment of colon and rectal cancer. Dr. Hoffman holds a BS from the University of California, Irvine, and a Doctor of Medicine (MD) from Vanderbilt University. He completed his surgical internship at Los Angeles County-USC Medical Center and his surgical residency at Louisiana State University-Charity Hospital of New Orleans Medical Center. Dr. Hoffman is an Attending Surgeon in the Division of General Surgery and Colon and Rectal Surgery at Cedars Sinai Medical Center. He is also an Associate Clinical Professor of Surgery at The David Geffen School of Medicine, University of California, Los Angeles. Dr. Hoffman is a member of The American Society of Colon and Rectal Surgeons, The Southern California Society of Colon and Rectal Surgeons, The American College of Surgeons, and The American Medical Association.

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A rectal exam is a screening test for both genders that helps to detect abnormalities in the rectum, anus, and prostate gland (men only), such as cancer, infections and various injuries. [1] X Research source These exams should be done fairly regularly (yearly or so) as part of your health physical. Trained medical professionals are the only people who should give rectal exams since untrained individuals can injure the delicate rectal/anal tissues while probing.

How to give a rectal exam

Physicians may have to examine the rectum and anus for a range of reasons. Officially called a digital rectal examination (DRE), this test can give a cursory indication of whether certain medical problems might need a closer look with a light and camera. The exam involves the insertion of a gloved index finger into the rectum for about a minute, during which the patient can be in one of several positions. A rectal examination helps to inspect the tissue and identify any potential growths or areas of inflammation.

A rectal examination can be performed in a few positions. For a woman, it may be performed in conjunction with a broader gynecological exam, with the patient lying on her back and her legs spread and attached to stirrups. Otherwise, a doctor may just ask a patient to lean over the side of the examining table. Another common position is with the patient lying on his side and pulling his top leg to the chest.

A range of symptoms could lead a doctor to perform a rectal examination — or none at all. During a prostate gland, uterus or ovarian cancer screening, the rectum offers the best angle for doctors to identify growths and other abnormalities. When patients complain of symptoms like excessive pain, digestive disorders, or rectal bleeding, however, doctors may perform a quick digital test to feel whether the source of the problem lies with hemorrhoids or polyps in the rectum near the anus. Often, this examination will involve tissue palpation and a check for tumors on major organs.

If the cause of pain or bleeding is not identified during a rectal examination, doctors may use more exacting equipment to identify the culprit. A sigmoidoscopy may be performed to inspect the lower part of the large intestine, or rectum, with a lighted camera and remove most growths that are found. Colonoscopies can be used to inspect and clear the entire large intestine, or colon. Once removed, any suspect tumors, polyps or other growths are routinely screened for malignancy.

These latter two tests require advance preparation, primarily a one- to three-day liquid diet to clear a path for the equipment and best reveal abnormal tissue. A rectal examination, however, requires no advance preparation. The American Society of Clinical Oncology recommends that patients tell doctors about any inflammation ahead of time, so he or she can best avoid tender areas. Nevertheless, some discomfort is to be expected.

Assessing the Benefits and Limitations of the Procedure

Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health.

A rectovaginal examination is a manual physical examination of the rectum and the vagina, It is not a standard part of a medical or gynecological evaluation, but you might need it if there is a concern about issues such as rectal involvement of endometriosis, a rectovaginal fistula (an abnormal connection between the rectum and vagina), or rectal or vaginal cancer.

A pelvic exam is typically recommended for females for the purpose of evaluating symptoms such as irregular bleeding or discharge, and for screening for malignancy (cancer). Components of a pelvic exam can include a speculum exam, bimanual exam, and rectovaginal exam.

How to give a rectal exam

Purpose of a Rectovaginal Exam

A rectovaginal exam can allow your healthcare provider to examine and identify abnormalities in your pelvic area, including the cervix, uterus, ovaries, fallopian tubes, anus, and rectum.

The recto-vaginal exam is not a particularly accurate screening exam and is usually reserved for people who either have rectal or pelvic pain or are experiencing symptoms related to the genitourinary tract (such as pain, urinary urgency, or abnormal bleeding).

Other reasons for the exam can include:

  • Identifying scarring or a mass that could indicate cancer or another disease
  • Obtaining a fecal blood sample (blood in the stool)
  • Diagnosing a tilted pelvis

Although a pelvic exam is considered important for identifying and treating cancer, sexually transmitted infections (STIs), and other genitourinary tract disorders, a rectovaginal exam offers uncertain benefits.

According to a 2016 review of studies in the Journal of the American Association of Nurse Practitioners, a rectovaginal exam has a low sensitivity in detecting uterosacral nodules, rectal compression, cervical involvement of endometrial cancer, and colorectal cancer. This means it misses many of these problems.

How a Rectovaginal Exam Is Performed

Normally, there is no special preparation needed before having a rectovaginal exam. As with any pelvic exam, you should not engage in sexual intercourse (including anal sex) for 24 hours prior to your appointment. In some cases, your healthcare provider may want you to take a laxative and will advise you about this beforehand.

A rectovaginal exam typically lasts for less than a minute, but it may last longer if your medical professional finds something concerning. It can be a little uncomfortable, but should not produce any real pain. Deep breathing and relaxing your pelvic muscles can help. If you feel any pain, let your healthcare provider know.

There are no risks involved with the procedure.

To do your rectovaginal exam, your practitioner will:

  • Insert a gloved, lubricated finger into your vagina
  • Insert another finger from the same hand into your rectum
  • Palpate (examine by feeling) your abdomen with the other hand

During this procedure, your healthcare provider will evaluate the tissues in your rectum and vagina, the tone and alignment of your pelvic organs, including the ovaries and fallopian tubes, and the ligaments that hold the uterus in place.

When a Rectovaginal Exam Is Indicated

Your healthcare provider might consider doing a rectovaginal exam if you have pain, discomfort, or pressure that seems like it is coming from the anal or rectal area. They might also do this exam if they detect a possible growth or abnormality in or near your rectum while they are doing other parts of your pelvic exam.

In general, a rectovaginal exam is considered when symptoms or other examination findings raise the possibility of a problem involving both the rectum and the vagina. You and your medical professional will discuss this part of the exam and why it is being done.

Even if you have a rectovaginal exam, there is a high chance that your symptoms are not caused by a serious problem and that your symptoms can be effectively treated.

Other Female Rectal Exams

Besides a rectovaginal exam, there are other types of rectal exams, typically for evaluation of gastrointestinal problems.

  • Stool sample: Generally, one of the most common reasons for a rectal exam is testing for blood in the stool. This could be a concern if you have obvious blood streaks in the toilet, blood on the toilet paper, black tarry stools, unexplained weight loss, vomiting blood, or diarrhea. : Additionally, you might have a rectal exam if you have experienced stool incontinence or if you are unable to control your stool. In this case, your healthcare provider would do a rectal exam to check your anal sphincter tone, which can affect your control over your stool.

Pelvic Exam Recommendations

The American Congress of Obstetricians and Gynecologists (ACOG) guidelines include the following recommendations:

  • The decision to have a pelvic exam should involve shared decision making between the patient and practitioner.
  • A pelvic exam is recommended for people who have symptoms of an STI or other pelvic conditions.
  • For people who do not have symptoms of illness, a pelvic exam is necessary before placement of an intrauterine device (IUD) but is not necessary before prescription of other forms of birth control.

Frequently Asked Questions (FAQs)

When is a rectovaginal exam indicated?

You may need to have a rectovaginal exam if you have an abnormal appearance, sensation, or control of your rectal and vaginal areas.

What is a healthcare provider checking for during a rectovaginal exam?

During this exam, your healthcare provider is checking for tenderness, structural irregularities, discharge, blood, and altered muscle tone.

Do I have to let my gynecologist perform a rectovaginal examination?

You do not have to agree to any exam you don't want. Discuss alternate approaches that might help in diagnosing your problem.

Does a recotovaginal exam hurt?

It shouldn't hurt, but it can be uncomfortable or even painful if you have a medical problem affecting your rectum or vagina.

A Word From Verywell

Gynecological examinations are often needed for screening or to evaluate symptoms. These physical examination techniques can help your healthcare provider decide about the next steps in your diagnostic evaluation or treatment plan.

If you have any questions or if you are hesitant about any part of your exam, be sure to talk about it either with your practitioner or with someone else on your medical team until you feel that your concerns and questions have been addressed to your satisfaction.

A digital rectal exam is performed in order to diagnose any problems with organs and structures in the pelvis and lower belly. In men, digital rectal exam is done to check the prostate glands where as in women it is done to check the uterus and the ovaries. Most of us would want to take this test by ourselves as it could be quite embarrassing for you as well as the other person to conduct the test. However, undergoing a rectal exam by yourself might not be recommended for everyone as most of the times one would not know how to go about the whole procedure. However, you can do this at home by keeping a few things in mind.

Reasons

The digital rectal exam is done to find out any lesions that are present in the rectum and the prostate gland to detect prostate cancer, to find out any hemorrhoids or unusual growth in the rectum or to check for rectal bleeding. In women, this test is done to detect problems in their reproductive organs, vaginal bleeding or any pain in the pelvic region.

Preparation

There are no special preparations required before the test

Procedure

You can do this at home by using your finger to locate the prostate glands located at the base of your rectum. You can feel it with your fingertip and is said to be the size of a walnut. Once you feel the prostate gland, try to feel its round shape and borders. However, if you feel it is very hard it indicates there is a problem. Also, if you feel it is big enough, it probably has enlarged as a result of a swelling. Once you know you have reached the outside of the borders, try to touch the tissues in between as much as possible, while the texture overall is pretty firm. You can also do this self examination with your partner as most people would feel comfortable with each other. You can do it while taking a shower where you can use soap as a lubricant but a better option would be to use a latex glove. You must know that this test is not an alternative to the exam conducted by the physician but should be carried out in between your annual exams. If at any time you feel unsure about how to go about it or feel there is something unusual, consult your doctor immediately.

This article was co-authored by Robert Dhir, MD. Dr. Robert Dhir is a board certified Urologist, Urological Surgeon, and the Founder of HTX Urology in Houston, Texas. With over 10 years of experience, Dr. Dhir’s expertise includes minimally-invasive treatments for enlarged prostate (UroLift), kidney stone disease, surgical management of urological cancers, and men’s health (erectile dysfunction, low testosterone, and infertility). His practice has been named a Center of Excellence for the UroLift procedure, and is a pioneer in non-surgical procedures for ED using his patented Wave Therapy. He earned his undergraduate and medical degrees from Georgetown University and was awarded honors in pre-medical studies, urology, orthopedics, and ophthalmology. Dr. Dhir served as chief resident during his urological surgical residency at University of Texas at Houston / MD Anderson Cancer Center in addition to completing his internship in general surgery. Dr. Dhir was voted Top Doctor in Urology for 2018 to 2019, one of the top three Best Rated Urologists in 2019 & 2020 for Houston Texas, and Texas Monthly has named him to the 2019 & 2020 Texas Super Doctors Rising Stars list.

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A digital rectal exam (DRE) is one of the primary methods a doctor uses to check your prostate. It involves the doctor briefly inserting a finger into your rectum to feel for potential abnormalities. The abnormalities may include symptoms associated with prostate cancer, benign prostate hyperplasia (an enlarged prostate), and prostatitis (an inflamed prostate usually from infection). [1] X Research source Bickley, Lynn S. Techniques of Examination. Chapter 15 The anus, rectum and prostate. Bates Pocket Guide to Physical Examination and History Taking. sixth edition. P 262-264. © 2009 Wolters Kluwer Health- Lippincott Williams & Wilkins. Medical professionals do not recommend trying to perform a self exam due to the training required to reach accurate conclusions based on the exam. However, if you wish to administer your own exam, you should be familiar with the techniques used by an examining physician.

A rectal examination is sometimes needed to investigate:

Men sometimes need a rectal examination to check for problems with the prostate.

What is the prostate?

The prostate is a small gland that only men have. It:

  • produces fluid that mixes with sperm to create semen
  • often gets larger with age
  • may cause problems with how easily you pee and how often you need to go

Before having a rectal examination

Your doctor or nurse should explain what's going to happen and why you need a rectal examination.

They'll know that some people can feel embarrassed, but it's a common procedure.

Let the doctor or nurse know if:

  • you'd prefer a man or woman to perform the examination
  • you'd like someone else in the room – it could be a friend, family member or another doctor or nurse
  • you have severe pain in your bottom – they may be able to use local anaesthetic to numb the area

What happens during a rectal examination

First, you'll be asked to undress from the waist down. If you're wearing a loose skirt, you can usually just remove your underwear.

Let the doctor or nurse know if you'd like to get changed behind a curtain or be alone in the room.

The doctor or nurse will:

  1. Ask you to lie down on your left side, with your knees lifted up towards your chest. This is the easiest position to examine your rectum.
  2. Put on some gloves and look at the outside of your bottom for any problems.
  3. Put some lubricating gel on 1 finger and gently slide it into your rectum. This should not be painful, but may be a little bit uncomfortable.
  4. Sometimes ask you to squeeze around their finger so they can assess how well the muscles are working.

If you're a man, the doctor or nurse may press on your prostate. This can make you feel the urge to pee, but it should not hurt.

Once you're dressed, they'll discuss the results of the examination with you.

Page last reviewed: 23 December 2020
Next review due: 23 December 2023

A digital rectal exam (DRE) is a test that examines a person’s lower rectum, pelvis, and lower belly. This test can help your doctor check for cancer and other health problems, including:

An abnormal mass in the anus or rectum

Uterine cancer or ovarian cancer in women, along with a vaginal examination

When would I need a DRE?

A doctor may do a DRE as part of a routine medical examination. Or you may need a DRE if you have symptoms such as:

Rectal bleeding or blood in the stool

A change in bowel habits

Discharge or bleeding from the urethra, the tube that carries urine out of the body

A change in how your urine flows

About the rectum

The rectum is a part of your digestive system. The digestive system processes the food your body does not use. The colon is the biggest part of your large intestine. It empties into the rectum, where waste collects as bowel movements. The rectum empties into the anus, where bowel movements leave the body.

The drawing below shows the different parts of the colon and rectum.

How to give a rectal exam

What kind of doctor will I see for a DRE?

A primary care doctor or a gynecologist usually does a DRE. A gynecologist is a doctor who specializes in the health of women’s reproductive system. Other types of doctors, including gastroenterologists, surgeons, and oncologists may do DREs. A gastroenterologist is a doctor who specializes in the gastrointestinal (GI) tract. An oncologist is a doctor who treats cancer.

How do I get ready for a DRE?

You do not need to do anything special to prepare for a DRE. But there are a few things to keep in mind.

Tell your health care team if you have hemorrhoids or anal fissures. The DRE may make them worse.

If you are concerned about the cost of your DRE, find out from your insurance provider what costs they will cover beforehand. Ask how much of the cost you will have to pay out of pocket.

You will be asked to sign a consent form before your DRE. The form will state that you understand the benefits and risks of the DRE and agree to have the test. Your doctor or nurse will explain the test before you sign the form, and you can ask questions.

What happens during a DRE?

The DRE will take place in a private exam room at your doctor’s office. The test only takes a few minutes. You will need to take off any clothes below your waist. You will be given a gown to wear or a cloth to wrap around your body.

For men. The doctor will ask you to stand and bend forward at the waist or they will ask you to lie on your side on an exam table with knees pulled up to your chest. As they start the DRE, the doctor may ask you to relax and take a deep breath. Then they will gently insert a lubricated, gloved finger into your rectum. The doctor will feel the size of your prostate gland. They will also feel for bumps, soft or hard spots, or other abnormal areas. The doctor will also examine the wall of your lower colon and rectum.

For women. The doctor will usually ask you to lie on your back on an exam table. Your feet will be in raised stirrups. The doctor may ask you to relax and take a deep breath as they start the DRE. Then they will gently insert a lubricated, gloved finger into your rectum. The goal is to feel your reproductive organs and the bowel. The doctor may also feel for problems in your internal organs. They do this by pressing on your lower abdomen or pelvic area with their other hand.

A DRE usually does not hurt, but you may be uncomfortable. You may also feel the need to urinate. If a man’s prostate is enlarged, there may be some discomfort or mild pain during the exam.

What happens after a DRE?

After your DRE, you can go back to your normal activities right away. You may bleed slightly from the rectum afterward. This is more likely to happen if you have hemorrhoids or anal fissures.

Tell your health care team if you have a large amount of rectal bleeding.

Questions to ask your health care team

Before having a DRE, you may want to ask these questions:

Why do you recommend that I have a DRE?

What happens during the DRE?

Who will do the DRE?

How long will the DRE take?

Can a DRE find cancer?

When and how will I get my test results?

Who will explain them to me?

Will I need more tests, such as a colonoscopy or a barium enema, if the DRE suggests cancer?

Is a prostate self exam something you can do safely and easily? Is it a valid way of knowing if you have a prostate problem?

The answer despite what you read elsewhere is complicated. You can do it if you use the right technique but you just do not have enough experience to know if you have a condition or not.

I will give you a great example!

When my prostate first blocked and I went to my doctor, she did a digital rectal exam after she drained me with a catheter.

Over 800 ml came out, about 80% of a quart. I asked the doctor what she thought was happening. She said it was most likely a bladder infection.

I asked her if it could be the prostate, as my Dad had had a condition of BPH (Benign Prostatic Hyperplasia) or an enlarged prostate condition.

She decided to do a digital rectal exam and said the prostate was enlarged a bit but nothing abnormal for a 55 year old. She started me on antibiotics for the supposed bladder infection, tied the catheter (still in me) to my leg, attached a fluid bag and said to call her on Monday. I did and she had set up an appointment for me with a top urologist in town a few days later.

I was instructed to stop at a pharmacy to buy a new catheter before the appointment. I bought the catheter and went to the urologist’s. He proceeded to remove the catheter (that was painful after 5 days inside me), put in a camera catheter to look around (that was even more painful), pulled it out (ouch!), and then opened the package of the catheter that I had bought with his sterile gloves touching the outer wrapper and without cleaning his hands or catheter from possible contaminates proceeded to put the new catheter in me!

By now I was feeling awful and hurt from the pain so much! Next came the news. He said I had BPH. I said, “What is that?” He explained it stood for extreme Benign Prostatic Hyperplasia, also known as Benign Prostatic Hypertrophy, or simply an enlarged prostate.

I said, “How could that be? My doctor said it was most likely an infection, and my prostate was only normally enlarged.” He said it was definitely enlarged and then did a digital rectal exam of the prostate and again said it is most definitely enlarged. I guess doing that all day made him more expert on the nuances of prostate sizes.

My GP just did not have enough experience to diagnose an enlarged prostate. To my doctor, my prostate did not feel abnormal for a man of my age; however, the urologist did the same test and knew immediately that I had an enlarged prostate.

Family doctors or GPs can easily misdiagnose an enlarged prostate because they are not a specialist who does this prostate check countless times.

So seeing an urologist may be a good idea for a digital rectal exam because urologists have an expertise and skill your general practitioner lacks.

How to give a rectal exam

How to give a rectal exam

Doing A Prostate Self Exam:

With the above warning in mind, then how can you do a prostate self exam and know if you have a problem or not? The answer is not very likely.

You could insert your finger as described in my page on self prostate massage, and you may get some idea but nothing definitive. It should be soft not hard, painless to the gentle touch, and feel smooth not lumpy. Make sure you use gloves and lubrication to make insertion easier. Be gentle!

Getting a DRE or digital rectal exam by a trained urologist will give you the information you want. Just be very hesitant if he wants then to do a biopsy as there are many risks to this procedure that he may downplay including the path to invasive action if he finds the slightest sign of cancer. Go to Prostate Biopsy Procedure to read more.

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