What Is a Digital Rectal Exam (DRE)?

Prostate Cancer Diagnosis (DRE)

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A digital rectal exam (DRE) is a simple procedure in which a doctor inserts a lubricated, gloved finger into the anus to check for abnormalities in the rectum and pelvic area. While commonly associated with the early detection of prostate cancer, a DRE also can be used to check for anal or rectal masses, abnormal growths in women's reproductive organs, and more.

Purpose of Test

A digital rectal exam can help to detect a variety of conditions in both men and women:

  • Prostate cancer: The prostate, a walnut-sized gland that produces semen, is located in front of the rectum, making a DRE a key part of screening for cancer, as it allows a doctor to feel an enlargement or other abnormality.

Prostate cancer is one of the most common types of cancer in men, with 1 in 9 being diagnosed in their lifetime. For this reason, it's recommended men begin having annual routine screenings at age 50 (or sooner for those with a family history of prostate cancer).

A number of important anatomic structures are located in the lower pelvis including the prostate and the rectum/lower colon, which means it's possible a doctor might not catch an abnormality with a DRE alone. For this reason, this exam may also be performed in tandem with other tests, such as a sigmoidoscopy, a diagnostic procedure in which a flexible, lighted tube called a sigmoidoscope is inserted into the rectum to check for cancer or other abnormalities in the rectum and lower colon.

Additionally, while a DRE can detect problems that may be missed with blood tests (such as the prostate-specific antigen, or PSA, test) or imaging tests (such as CT or MRI exams), the same can sometimes be said for performing the DRE without these tests.

Risks

Although a digital rectal exam poses virtually no risks, some people find it briefly uncomfortable. And for a man who has an inflamed prostate (as in prostatitis ), a DRE can even be somewhat painful. Still, as with many preventative procedures, potential discomfort is temporary. Given that, it is not a test that should be skipped or resisted when it's necessary.

Before the Test

There is nothing you need to do prior to a digital rectal exam. You can eat, exercise, and otherwise do what you normally do beforehand.

Timing

A DRE should take no more than a minute or two. Your doctor will be able to tell you immediately if they detected any abnormalities during the exam.

Cost and Health Insurance

Before you go in for the test, you may want to contact your insurance provider and confirm what costs will be covered and what you may have to pay for out of pocket. A DRE is often covered if performed for prostate cancer screening, but this can vary by provider as well as depend on state laws. Men over 50 who have Medicare are covered for a yearly PSA blood test and DRE.

During the Test

To begin the exam, you will be asked to undress completely below the waist. You may be given a hospital gown to wear. If you're a woman who is undergoing the test as part of a vaginal exam it's likely you'll already be undressed and in position.

You will then be asked to get into a position that is both comfortable for you and allows the doctor to most easily perform the DRE. This may mean bending over at the waist with your hands on the examination table, lying on your left side with your knees drawn up toward your chest, lying on your back with your knees raised and your feet in stirrups, or even squatting.

Next, your doctor put on clean gloves and apply a lubricant to the finger they will be using for the exam. They'll then gently insert the lubricated finger into your anus. For men being screened for prostate cancer, a doctor will need to apply firm pressure in order to be able to feel enlargements, nodules, or other abnormalities, which may create the sensation of an urgent need to urinate. This will pass once the exam is completed.

If you're having the exam for a reason other than to screen for prostate cancer, your doctor will feel around your lower rectum for growths, tenderness, or other abnormalities in this region, or in the female reproductive organs if you're having it as part of a vaginal exam to check for ovarian or uterine cancer.

After the Test

You may have a very small amount of bleeding after the exam, particularly if you have hemorrhoids or other rectal problems. Most people have no bleeding.

It is also possible that the uncomfortable nature of the exam could cause you to have a vasovagal response. If this occurs, you may feel very lightheaded or possibly even faint. This, again, is rare.

Interpreting Results

Your doctor should be able to tell you immediately if they felt anything of concern during your digital rectal exam. However, it's important to understand that DRE results aren't definitive. Even if a doctor isn't able to detect a problem digitally doesn't necessarily mean there isn't one.

Follow-up

Given a DRE cannot provide a definitive diagnosis, follow-up tests may be required depending on the condition in question. If prostate abnormalities are detected, more testing will likely be necessary, such as a PSA test, MRI, or core needle biopsy, which involves inserting a hollow-core needle into a growth to remove a small cylinder of prostate tissue.

Other potential follow-up follow-up tests to determine the severity of an enlarged prostate include:

  • Uroflowmetry to measure the volume of urine excreted during urination
  • Urodynamic tests to evaluate how well the bladder, urethra, and urethral sphincters are storing and releasing urine
  • Post-void residual (PVR) studies to determine the amount of urine left in the bladder after urination

To further understand a diagnosis of fecal incontinence, a doctor may order:

  • Anorectal manometry: This test measures the strength of the anal sphincter with a narrow, inflatable anal probe.
  • Proctography: This imaging test uses X-ray video footage taken during a bowel movement.

If a DRE was ordered to diagnose internal hemorrhoids, it may be followed by an anoscopy, a procedure in which a lighted fiberoptic scope records images inside the rectum.

For women, as follow-up to a DRE performed in tandem with a vaginal exam in which abnormalities were detected in reproductive organs, a doctor may request other imaging procedures, such as a transvaginal ultrasound.

A Word From Verywell

There's nothing pleasant about having a digital rectal examination: You may understandably find it uncomfortable and even embarrassing, but it can be as vital to your health-and well-being as having your temperature or blood pressure taken. It also will take no longer to perform than either of those basic tests, and given the wealth of information it can reveal, it's worth taking a deep breath and perhaps imagining yourself on a sunny beach to get you through. Remember too, that for your doctor a DRE is a routine medical procedure and they will be able to help you deal with any discomfort you may be feeling.

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