The Prostate

Digital Rectal Exam: Explanation and Benefits

A digital rectal exam may be something that you have been dreading.

And because of this, you may not have asked the important questions, such as Do I need a digital rectal exam? How old do I have to be? How often should I be getting them? Are there risks involved?

In this article, we break down everything you need to know about digital rectal exams.

What is a digital rectal exam?

A digital rectal exam is a physical examination used to assess the health of the rectal canal and the prostate.

The prostate can be felt through the rectal wall. Your health care practitioner will be checking for the lobes of the prostate and their symmetry and will check for any nodules, growths, enlargement, or pain.

They will also be assessed for any anal fissures or masses that could indicate an enlarged prostate, colorectal cancer or rectal cancer.

How are digital rectal exams performed?

There are two different methods for performing a digital rectal examination: side-lying or standing.

In the standing practice, you will lean forward, flexing at the hip, with your forearms supported on the table. In the side-lying method, you will be on the table on your side, with your knees pulled up towards your chest. For both scenarios, your health care practitioner will be inserting a gloved and lubricated finger into the rectal canal to assess the health of the prostate as well as the rectum itself. Your Doctor will likely run PSA testing at this time as well, as an additional measure for prostate cancer screening.

Who needs a digital rectal exam?

For men with an average risk level, they should be getting digital rectal exams at 50 years of age and up. For men at higher risk, digital rectal exams should begin at age 45. How do you know if you’re at higher risk? This includes men of African descent, as well as anyone with a family history of prostate cancer.

How often should you get a digital rectal exam?

You should be getting a digital rectal exam every five years once you reach the age of 50 (or 45 if you fall into a high-risk category).

Risks and benefits of digital rectal exams

What are the risks associated with digital rectal exams?

One of the risks associated with digital rectal exams is the discomfort and pain that can result from the test. There is also a possible risk for infection if local wounds become contaminated during the examination.

There is also the risk of injury to the rectal wall or worsening of rectal defects that already exist. Just like with most medical tests, there are risks of false positive results (a diagnosis of prostate cancer when you don’t truly have cancer) and false negative results (a result that is negative for prostate cancer when you do have it).

It is also possible that the uncomfortable nature of the exam could cause you to have a vasovagal response. This can cause you to feel lightheaded and possibly even faint.

What are the benefits of getting a digital rectal exam?

The benefits of this exam are that it can catch conditions such as prostatitis. It can also act as a prostate cancer screening tool. The digital rectal exam also makes sure that causes of rectal bleeding, such as hemorrhoids, for example, are not missed.

How reliable are digital rectal exams?

We are not entirely sure of the reliability of digital rectal examinations on their own (i.e., without PSA testing incorporated). This is because digital rectal examination screening on its own has not been properly reviewed in the literature.

Most cancers that are detected through a digital rectal examination are curable. However, they could have worse outcomes by the time the PSA level reaches the threshold for prostate biopsy.

A biopsy can have a number of severe side effects, including bleeding, fecal incontinence, and sexual incontinence. Before undergoing a biopsy, discuss the side effects with your Doctor.

Safety and effectiveness of digital rectal exams

Who can perform a digital rectal exam?

A digital rectal exam can only be performed by a licensed Medical Doctor or Naturopathic Doctor.

What conditions can digital rectal exams detect?

Digital rectal exams can detect prostate cancer, prostate infections, benign prostatic hyperplasia, rectal masses, and structural abnormalities of the prostate and rectal wall, such as rectal prolapse. According to clinical trials, the risk of death from prostate cancer can be prevented with radical prostatectomy.

How often should you get a digital rectal exam?

You should be getting a digital rectal screening exam every five years once you reach the age of 50 (or 45 if you fall into a high-risk category). You should also be getting a regular PSA test to check your PSA levels, as well as a genitourinary and pelvic examination. Don’t be afraid to talk to your doctor about the rectal exam risks and benefits and to have an open conversation about it.

Alternatives to digital rectal exams

What can you do if you don’t want a digital rectal exam?

If you don’t want a digital rectal exam, you can take a PSA blood test. This is another prostate cancer screening tool, where your doctor will check your PSA levels. If you have an elevated PSA, your doctor may perform a prostate biopsy. If this comes back as positive, then your doctor may consider a radical prostatectomy.

You should also be taking a Fecal Occult Blood Test annually, a flexible sigmoidoscopy every five years, and a colonoscopy every ten years. These are all the tools used to check for diseases of the colon and rectum.

How long does a digital rectal exam take?

A digital rectal exam takes just a few minutes for your doctor to perform.

What does a digital rectal exam feel like?

A digital rectal exam is uncomfortable. You may feel the urge to have a bowel movement in the process of the examination, but not to worry! This is considered a normal sensation, and you won’t actually have one. Similarly, you may feel the urge to urinate during palpation of the prostate gland. But chances are you don’t actually need to urinate.

Sources

  1. Okotie OT1, Roehl KA, Han M, Loeb S, Gashti SN, Catalona WJ.. (2007). Characteristics of prostate cancer detected by digital rectal examination only.. Urology. 70 (6), p1117-1120.
  2. Quinn J, Zeleny T, Rajaratnam V, Ghiurluc DL, Bencko V. Debate: the per rectal/digital rectal examination exam in the emergency department, still best practice?. Int J Emerg Med. 2018;11(1):20. Published 2018 Mar 27. doi:10.1186/s12245-018-0165-z
  3. https://stanfordmedicine25.stanford.edu/the25/rectal.html
  4. Task Force FINAL Recommendation . (2012). Screening for Prostate Cancer. Available: file:///C:/Users/user/Downloads/prostate cancer fact.pdf. Last accessed 14th May 2019.

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