Digital Rectal Exam


Digital Rectal Exam, Rectal Tone, Rectal Exam

  • Indications
  1. Colon Cancer Screening (low efficacy)
  2. Prostate Cancer Screening (low efficacy)
  3. Benign Prostatic Hyperplasia (assess size of Prostate)
  4. Cauda Equina Syndrome (low efficacy)
  5. Gastrointestinal Bleeding (or occult acute blood loss)
  • Technique
  • Finger Insertion
  1. Lubricate gloved index finger
  2. Patient bears down as if straining at stool
  3. Gently insert finger after sphincter relaxes
  • Technique
  • Evaluation
  1. Assessment of 360 degree sweep of Rectum
    1. Anal sphincter tone
    2. Tenderness
    3. Nodularity or masses
  2. Assessment of anterior Prostate surface (males)
    1. Evaluate lateral lobes of Prostate
      1. Normal Prostate is Rubbery, non-tender
      2. Assess for nodularity (Prostate Cancer)
    2. Evaluate median sulcus
      1. Absent sulcus suggests Benign Prostatic Hypertrophy
  3. Assessment of Rectal Tone (evaluation of S2-S4 function, e.g. cauda equina evaluation)
    1. Resting tone applies pressure to inserted finger without patient bearing down
    2. Patient tries to resist Defecation
      1. Puborectalis Muscle contracts and applies pressure to the anterior inserted finger
      2. External anal sphincter contracts and applies pressure circumferentially around the inserted finger
    3. Patient bears down
      1. Pressure on inserted finger increases
    4. Overall poor efficacy of Rectal Tone to diagnose S2-S4 neurologic deficit
      1. Tabrah (2022) Musculoskelet Sci Pract 58:102523 +PMID: 35180641 [PubMed]
  • Technique
  • Completing Examination
  1. Observe for grossly bloody stool
  2. Consider test for Stool Occult Blood