Rectal Exam


Rectal Exam - (Procedure and Preparation)

A digital rectal examination (DRE) is a simple procedure doctors use to examine the lower rectum and other internal organs. A DRE is done for a number of reasons. It’s a quick, easy way to check the health of a man’s prostate gland. It can detect conditions like an enlarged prostate (benign prostatic hyperplasia) and prostate cancer.

The prostate is a walnut-sized organ that supplies some of the semen released during male ejaculation. This fluid nourishes and protects sperm released during intercourse. In combination with the prostate-specific antigen (PSA) blood test, a DRE can monitor changes in the health of the prostate.

Why is a digital rectal examination performed?

A DRE may be used to:

  • diagnose rectal tumors
  • assess the size of the prostate and check for tumors or infection of the prostate
  • obtain feces for a fecal occult blood test (used to screen for gastrointestinal bleeding or colon cancer)
  • assess the function of the anal sphincter in cases of fecal incontinence
  • assess the extent of hemorrhoids (swollen veins in the anus)
  • check for causes of rectal bleeding
  • check the space between the vagina and the rectum in women

How is the test performed?

To perform a digital rectal examination, your doctor will gently insert a gloved, lubricated finger into your anus. This allows them to feel for any abnormalities. For example, an enlarged prostate feels like a bulge behind the rectum wall. Prostate cancer may feel like bumps on the normally smooth surface of the prostate.

Men may feel pain or the urge to urinate during the exam. This is because your doctor is applying firm pressure to the prostate.

A DRE is typically done as part of a routine physical examination for both men and women. During a gynecological exam, your doctor may perform a DRE to check the space between the rectum and the vagina for any abnormalities. Most men and women feel only minor discomfort during the procedure. People with hemorrhoids or anal fissures may experience a small amount of bleeding.

A DRE isn’t suitable for detecting colon cancer. Only a small portion of the lower colon may be accessed during a DRE. However, a DRE may be used to obtain a stool sample. If blood is present in the stool, it may indicate colon cancer or other problems.

Blood isn’t always visible to the naked eye in a stool sample, so your doctor may wish to conduct a fecal occult blood test to confirm.

What Happens during a Proctologist Exam?

For the purpose of adequate therapy and successful treatment of any colorectal diseases the correct diagnosis is essential. Modern proctology has a wide range of diagnostic methods.

Early diagnosis and treatment of the rectum and anus in proctology become more comfortable and productive thanks to the latest examination methods. Complex instrumental, visual and video examination of rectum and hemorrhoids allow already at the initial examination to make an accurate diagnosis. The proctologist immediately assigns the correct treatment.

Special equipment helps to carry instrumental methods of research of the rectum. These include:

  • anoscopy;
  • rectoromanoscopy;
  • barium enema (an x-ray);
  • colonoscopy.

Video examination at the proctologist with a device (to a depth of 20 cm) relates to endoscopic diagnostic methods. It is carried out by means of videorectoscope: medical device, equipped with a special video optics.

Despite the abundance of high-tech instrumental methods of examination, manual method takes in modern diagnosis not the last place. First, check of the rectum and manually inspection is required during the initial examination. Secondly, finger examination of the anus and the anal pass allows even accurately diagnose a malignant tumor of the anus. After all, in 50% of all cases of cancer proctologic pathology, the tumor is localized within reach of the fingers introduced in the anus.

Proctology is a sensitive area of medical practice. No wonder that every patient is interested in questions, how the rectal examination of a proctologist in the clinic takes place, what and how a proctologist examines, how to examine the rectum with ease and without pain.

In medical center the rectal examination, tests and biopsy are conducted as comfortable as possible for the patient. Proctologist assigns only a biopsy for suspected polyps or tumors.

Full-time diagnosis, the procedure of its conducting

Few people are aware, what is complex proctology examination of the rectum. Meanwhile, even the little knowledge of how to make a diagnosis of colon at the proctologist, will avoid the embarrassing moments.

Most patients are accustomed to think that the only position for proctology examination – is on all fours, leaning on the couch with arms bent in elbows. Either in a gynecological chair. However, the knee-elbow position is not the only possible position for examination. And those who have already visited the medical center is well known in what position the examination at proctologist takes place. It is lying on one’s side on the couch with legs bent in knees. Very comfortable and natural position for the patient, which allows to relax as much as possible: both morally and physically.

The shy fair gender will always worry about the question of how women are passing the proctologic inspection. In fact, there are no significant differences between examination of men and women.

Along with the question of in what position the patients are examined, many are interested in the question: what the proctologist is examining?

Rectal examination of the rectum in proctology allows the doctor to visually assess the state of the anus, anal mucosa and muscle, as well as the distal and sigmoid rectum departments.

In order not to put off a visit to the proctologist for the next day due to lack of preparation, it is necessary to know how to prepare for examination at the proctologist. One need to change for the light meal and get an enema the day before the examination.

Before deciding to pass examination at the proctologist, the patient will take an interest in how much the complex of diagnostic measures necessary for an accurate diagnosis is. The cost of the study at the proctologist is formed taking into account all diagnostic measures which it includes.

Each person should remember that the price of colorectal comprehensive examination is always lower than the price, which one subsequently has to spend on treatment when the disease is already far gone. Therefore, timely diagnosis saves both from complications, and from serious expenses.

Anus examination

Proctology and diagnosis of proctologic diseases plays a crucial role in functioning of the gastrointestinal tract, reproductive system status.

What are the procedures and diagnostic methods of proctologic diseases? Current methods of anus studies include:

  • finger rectal examination;
  • instrumental inspection of the anus (anoscopy);
  • video examination (video anoscopy, video rectoscopy);
  • colonoscopy;
  • ergography (X-ray with contrast agent);
  • US-examination;
  • biopsy, cytology.

Methods of examination in proctology can detect the slightest structural changes in the mucous membrane of the anus (presence of infiltrates, scarring, fistulas), timely diagnose polyps oncological formations.

Sampling of biopsy material usually occurs during rectoromanoscopy, when the doctor looks through an endoscope at the state of the rectum and distal department of the sigmoid colon. Does it hurt to do a biopsy? Experience of a proctologist and successfully selected position for the examination minimize the possibility of discomfort. Moreover, there applied an anesthetic gel during the anus examination.

What procedures are included in examination of the anal canal at the doctor? Usually it is finger examination of the anus, anoscopy and rectoscopy. Forms of examination of the patient are various. Their selection is different and depends on the nature of complaints.

That is included into the deep examination, what is needed for successful implementation of it? Rectoromanoscopy allows to explore the rectum and sigmoid on a depth of 30-35 cm.

What should a proctologist check at the visit? Status of perianal tissues, anus hole and rectum mucous membrane.

How often do you need to be checked? At least once a year. And it’s not just proctology, but any field of medicine. And in presence of anxious disorders (persistent diarrhea or constipation, painful defecation) one should pass the examination immediately.

To pass the first examination at the proctologist – for a person it is always a psychological trial. About the procedure, how the anus is examined, which actions does the proctologist do while the examination, there exist legends among people, embarrassing beginners’ minds. 

A proctologist examination includes:

  • videoanoscopy (examination of the rectum to a depth of 6 cm);
  • rectoscopy (examination of the rectum to a depth of 15 cm);
  • finger examination of the anus.

Complete proctology examination lasts about 40 minutes. There used disposable instruments, the treatment may be started already at the first visit.

Rectal Exam: What to Expect During an Clinic Visit

Colorectal surgeons are specially trained in evaluating the rectum, anal canal and the skin around the anus in order to diagnose and treat the wide range of disorders that affect these areas. Knowing what to expect from an office visit will help you maximize your consultation with your colorectal surgeon and can make the process more comfortable.

Preparing for Your Appointment

During an office visit, the team will update your medical and surgical history and medications. If possible, bring an updated list of medications, medical conditions, and a copy of your most recent colonoscopy. If you have never had a colonoscopy, the surgeon will determine whether one is needed. Before the visit, try to jot down a timeline of your symptoms and what you have tried so far to for treatment. This will be very helpful for your colorectal surgeon.

During Your Visit to Proctologist

Wear comfortable clothing to your office visit. After checking in, you may be asked to complete some paper work and will then be led to an examination room. You will be asked about specific symptoms you are having, including any bleeding, pain, itching and/or difficulty passing stool, or whether you have noticed any lesions in or near your anus. The questions may include an obstetric (birth) history and questions about sexual activity. We take your comfort and confidentiality very seriously. If you don’t understand a question or feel uncomfortable, please let us know so we can better explain our reason for asking.

The Rectal Exam

It’s normal to be apprehensive about a physical exam. Many patients find it useful to remember that colorectal surgeons are professionals who perform these types of examinations dozens of times a day, every day.

The surgeon will assist in getting you in a comfortable position in order to perform a careful visual examination of the skin around the anus. He or she will then perform a digital rectal exam, which involves gently inserting a lubricated gloved finger into the anal canal to feel for any abnormalities. You may be asked to ‘squeeze’ or ‘push’ to help the surgeon get a good sense of the muscle function. Based on the exact reason for your visit, the surgeon may proceed with an anoscopy. An anoscope is a small, lighted instrument that is used to look directly into the anal canal and the last part of the rectum. It is about the same size as a finger, and normally does not cause discomfort.

Depending on the reason for your visit, an office-based procedure, such as hemorrhoidal banding, may be offered. The surgeon will discuss this with you if it is an option.

At that point, your examination will be complete. The nurse will help you off the examination table and you will be asked to change back into your clothing.

Next Steps and Treatment

After your exam, the surgeon will review his or her findings with you and will discuss a treatment plan. Many anorectal disorders are treatable without surgery, but the surgeon may determine that an examination under anesthesia is necessary for further work-up. It is also possible that further testing such as MRI or colonoscopy will be necessary. You may be given instructions on taking over-the-counter therapy such as fiber powder to address the problem, or be prescribed other medication. You will be given an opportunity to ask as many questions as you like about your treatment plan.

Reviewed by the QSota Medical Advisory Board