Digital rectal examination
A rectal examination is a type of physical examination during which a doctor or nurse inserts a finger into your rectum (back passage) to feel for abnormalities.
It's sometimes known as a digital rectal examination (DRE).
Some people find having a rectal examination embarrassing, but it only takes a few minutes and isn't usually painful.
What it's used for
One of the most common reasons for having a rectal examination is if a man has a suspected problem with his prostate gland (see below), which could be a sign of prostate disease or prostate cancer.
A rectal examination may also be needed if a person develops changes in their normal bowel habits, which could indicate a problem with their digestive system. These changes could include:
bleeding from your rectum
loss of normal bowel function, also called bowel incontinence (and occasionally urinary incontinence)
pain in your bottom (proctalgia)
The prostate gland
The prostate gland is a small gland found only in men. It's located in the pelvis, between the penis and bladder, and surrounds the urethra (the tube that carries urine from the bladder to the penis).
The prostate gland can be examined by placing a finger into the rectum. The doctor carrying out the examination will be able to feel any changes in the prostate, such as swelling and hardening.
The prostate gland often becomes larger in older men. This can place pressure on the bladder and urethra, causing symptoms such as:
difficulty beginning to urinate
a flow of urine that's weak or stops and starts
having to push or strain to pass urine
a frequent need to urinate
waking up frequently during the night to urinate
Prostate enlargement can be troublesome to live with, but it doesn't pose a threat to health. However, its symptoms are similar to thesymptoms of prostate cancer, and a rectal examination is one way of finding out whether the symptoms are caused by prostate enlargement or prostate cancer.
Prostate cancer can cause the surface of the prostate gland to become hard and bumpy, while prostate enlargement doesn't usually affect the surface.
A rectal examination isn't a guaranteed way of diagnosing prostate cancer, so it's usually used in combination with other tests, such as ablood test and a biopsy (where a small sample of the prostate gland is removed for further testing).
How a rectal examination is performed
A rectal examination (digital rectal examination or DRE) can be carried out by your GP, a nurse who specialises in treating bowel problems, or a specialist doctor.
For convenience, the rest of this page will refer to your GP carrying out the rectal examination.
Many people find rectal examinations embarrassing, and your GP will be fully aware of this. Some people may also be sensitive about having a rectal examination for religious or cultural reasons.
Therefore, you may prefer a rectal examination to be carried out by a GP of the same sex, or you may want to have a friend or relative present during the examination. Let your GP know in advance if you have any particular preferences.
You should also tell your GP if you've experienced severe pain, because it may indicate an underlying health condition. If this is the case, a rectal examination may need to be carried out using a local anaesthetic (where medication is used to numb the area).
Before having a rectal examination, your GP will explain the procedure to you. You'll be asked to remove your lower clothing. Your GP may suggest you get changed behind a curtain, or they may leave the room if you want them to.
You'll be asked to lie on a couch, on your left side, and to bring your knees up towards your chest. Your GP will begin by making a careful visual examination of your anus. They'll look for any abnormalities, such as:
swollen blood vessels around the anus or rectum, known as haemorrhoids or piles
damage to the bottom, such as a tear in the lining (anal fissure)
Your GP will put a glove on one hand and use a gel to lubricate one of their fingers. They'll gently push the finger into your bottom and then up into your rectum. You may feel a little discomfort or pain at this stage of the examination.
During the rectal examination, you may be asked to squeeze your rectum around their finger so that they can assess how well the muscles in your rectum and bowels are working.
If examining a man, the GP may also firmly press against the prostate gland. A healthy prostate gland should be smooth to the touch, so they'll check for any hard or lumpy areas, which may indicate the presence of prostate disease, such as prostate cancer.
Pressing on the prostate gland doesn't hurt, but it may make you feel like urinating. If there's an infection, the prostate may feel tender when it's pressed.
After a rectal examination
A rectal examination will usually take one to five minutes to complete, depending on whether your GP finds anything unusual.
After your GP has completed the rectal examination, they'll gently remove their finger from your anus. There may be a small amount of bleeding from your rectum, particularly if you have haemorrhoids.
Your GP will clean any gel or blood from your rectum before leaving the room so that you can get dressed in privacy.
Once you're dressed, your GP will return to discuss the results of the rectal examination with you.
Digital rectal examination