Rectal examination
Encyclopedia
A rectal examination or rectal exam is an internal examination of the rectum
such as by a physician
or other healthcare professional.
is accessible (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups).
If the patient is lying on their side, the physician will usually have them bring one or both legs up to their chest. If the patient bends over the examination table, the physician will have them place their elbows on the table and squat down slightly. If the patient uses the supine position, the physician will ask the patient to slide down to the end of the examination table until their buttocks are positioned just beyond the end. The patient then places their feet in the stirrups.
The physician spreads the buttocks apart and will usually examine the external area (anus and perinium) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient relaxes, the physician slips a gloved and lubricated finger
into the rectum through the anus and palpates
the insides for approximately sixty seconds.
The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia
and/or confirming a gastrointestinal bleed.
The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; sigmoidoscopy
is preferred. However, it is an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum
.
Sometimes proctoscopy
may also be part of a rectal examination.
rectal examination is useful in dog
s for analysis of the prostate
(as in men), pelvic urethra
, sublumbar lymph node
s, and anal glands
. In horses it is a vital component of the clinical examination for colic, to determine the presence or absence of bowel torsion, impaction
, or displacement. When horses undergo a rectal examination there is a small risk of a rectal tear occurring, which can be a life-threatening event, rapidly leading to peritonitis
and septic shock
. It is also a common procedure in cattle, and is one method of diagnosing pregnancy in both the horse and the cow.
The procedure in dogs and cats is similar to humans. For the horse, the patient stands in a stock and may be sedated. The examiner puts on a long glove that extends to the shoulder. The examiner inserts the hand and arm into the rectum as far as necessary.
. Generally, it is not shown directly, but implied as the examiner dons and lubricates a glove while behind the patient. The body cavity search
is frequently used the same way.
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
such as by a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
or other healthcare professional.
Procedure
The digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple procedure. The patient undresses, then is placed in a position where the anusAnus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
is accessible (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups).
If the patient is lying on their side, the physician will usually have them bring one or both legs up to their chest. If the patient bends over the examination table, the physician will have them place their elbows on the table and squat down slightly. If the patient uses the supine position, the physician will ask the patient to slide down to the end of the examination table until their buttocks are positioned just beyond the end. The patient then places their feet in the stirrups.
The physician spreads the buttocks apart and will usually examine the external area (anus and perinium) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient relaxes, the physician slips a gloved and lubricated finger
Finger
A finger is a limb of the human body and a type of digit, an organ of manipulation and sensation found in the hands of humans and other primates....
into the rectum through the anus and palpates
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...
the insides for approximately sixty seconds.
Usage
This examination may be used:- for the diagnosis of rectal tumorTumorA tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s and other forms of cancerCancerCancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
; - for the diagnosis of prostaticProstateThe prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
disorders, notably tumorTumorA tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s and benign prostatic hyperplasiaBenign prostatic hyperplasiaBenign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
; - for the diagnosisMedical diagnosisMedical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
of appendicitisAppendicitisAppendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
or other examples of an acute abdomenAcute abdomenThe term acute abdomen refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. It is in many cases a medical emergency, requiring urgent and specific diagnosis...
(i.e. acute abdominal symptoms indicating a serious underlying disease); - for the estimation of the tonicityTonicityTonicity is a measure of the osmotic pressure gradient of two solutions separated by a semipermeable membrane. It is commonly used when describing the response of cells immersed in an external solution...
of the analAnusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
sphincterSphincterA sphincter is an anatomical structure, or a circular muscle, that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning...
, which may be useful in case of fecal incontinenceFecal incontinenceFecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...
or neurologic diseases, including traumatic spinal cord injuries; - in femaleFemaleFemale is the sex of an organism, or a part of an organism, which produces non-mobile ova .- Defining characteristics :The ova are defined as the larger gametes in a heterogamous reproduction system, while the smaller, usually motile gamete, the spermatozoon, is produced by the male...
s, for gynecological palpations of internal organs - for examination of the hardness and color of the feces (ie. in cases of constipation, and fecal impactionFecal impactionA fecal impaction is a solid, immobile bulk of human feces that can develop in the rectum as a result of chronic constipation.-Symptoms:Symptoms include chronic constipation. There can be fecal incontinence and paradoxical or overflow diarrhea as liquid stool passes around the obstruction. ...
); - prior to a colonoscopyColonoscopyColonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
or proctoscopyProctoscopyProctoscopy is a common medical procedure in which an instrument called a proctoscope is used to examine the anal cavity, rectum or sigmoid colon. A proctoscope is a short, straight, rigid, hollow metal tube, and usually has a small light bulb mounted at the end...
. - to evaluate hemorrhoids
- In newborns to exclude imperforate anus
The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
and/or confirming a gastrointestinal bleed.
The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; sigmoidoscopy
Sigmoidoscopy
Sigmoidoscopy From Greek Sigma - eidos - scopy, to look inside an s-like object, is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. There are two types of sigmoidoscopy, flexible sigmoidoscopy, which uses a flexible endoscope,...
is preferred. However, it is an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
.
Sometimes proctoscopy
Proctoscopy
Proctoscopy is a common medical procedure in which an instrument called a proctoscope is used to examine the anal cavity, rectum or sigmoid colon. A proctoscope is a short, straight, rigid, hollow metal tube, and usually has a small light bulb mounted at the end...
may also be part of a rectal examination.
Veterinary medicine
In veterinary medicineVeterinary medicine
Veterinary Medicine is the branch of science that deals with the prevention, diagnosis and treatment of disease, disorder and injury in non-human animals...
rectal examination is useful in dog
Dog
The domestic dog is a domesticated form of the gray wolf, a member of the Canidae family of the order Carnivora. The term is used for both feral and pet varieties. The dog may have been the first animal to be domesticated, and has been the most widely kept working, hunting, and companion animal in...
s for analysis of the prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
(as in men), pelvic urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
, sublumbar lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s, and anal glands
Anal glands
The anal glands or anal sacs are small glands found near the anus in many mammals, including dogs and cats. They are not found in humans or other primates. They are paired sacs located on either side of the anus between the external and internal sphincter muscles. Sebaceous glands within the...
. In horses it is a vital component of the clinical examination for colic, to determine the presence or absence of bowel torsion, impaction
Impaction
Impaction, from the Latin impingere, is a medical term used to describe several different types of blockage.- In Reptiles : Impaction occurs in reptiles when they consume something that they cannot digest. Common causes of impaction are rocks and sand which might be accidentally consumed when the...
, or displacement. When horses undergo a rectal examination there is a small risk of a rectal tear occurring, which can be a life-threatening event, rapidly leading to peritonitis
Peritonitis
Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
and septic shock
Septic shock
Septic shock is a medical emergency caused by decreased tissue perfusion and oxygen delivery as a result of severe infection and sepsis, though the microbe may be systemic or localized to a particular site. It can cause multiple organ dysfunction syndrome and death...
. It is also a common procedure in cattle, and is one method of diagnosing pregnancy in both the horse and the cow.
The procedure in dogs and cats is similar to humans. For the horse, the patient stands in a stock and may be sedated. The examiner puts on a long glove that extends to the shoulder. The examiner inserts the hand and arm into the rectum as far as necessary.
Popular culture
Due to the taboos surrounding the anus, and the potential for discomfort and embarrassment, the rectal exam is a common comedic deviceComedic device
A comedic device is used in comedy to write humor in a common structure. They can become so common that they are difficult for writers to use without being perceived as cheesy.-Double entendre:...
. Generally, it is not shown directly, but implied as the examiner dons and lubricates a glove while behind the patient. The body cavity search
Body cavity search
A body cavity search is either a visual search or a manual internal inspection of body cavities such as for prohibited material , such as illegal drugs, money, jewelry, or weapons...
is frequently used the same way.