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Digital rectal examination

Digital rectal examination (DRE) refers to an internal examination of the rectum.

 

This examination may be used for the diagnosis of prostatic disorders, benign prostatic hyperplasia and the four types of prostatitis. 

 

DRE has a 50% specificity for benign prostatic hyperplasia.

DRE has its largest effect on the positive predictive value for clinically significant prostate cancer and people with the PSA level of greater than 3 ng/mL.

A DRE should be performed for anyone with an elevated PSA to aid in decisions regarding biopsy.

The number of clinically significant prostate cancer is found by DRE in individuals with a PSA less than 3 ng/L is small, possibly around .2% of all individuals screened.

Vigorous examination of the prostate in suspected acute prostatitis can lead to seeding of septic emboli and is contraindicated.

 

DRE useful for the evaluation of certain clinical symptoms: a male with change in urinary ability, impotence, dysuria, hematuria and pain with bowel movements

In general an uncomfortable experience for both patient and examiner.

Only one patient in three with a positive exam has a prostate cancer.

Exam is limited to the examination of the posterior prostate and can be insensitive for diagnosing prostate cancer.

Data from the Prostate Cancer Prevention Trial DRE associated with a low sensitivity for prostate cancer (16%) (Thompson IM).

In prostate cancer screening of asymptomatic men aged 55 to 65 the use of digital rectal examination as a screening modality is not recommended because there is a lack of evidence on the benefits.

 

DRE has long been used to diagnose prostate cancer, no controlled studies have shown a reduction in the morbidity or mortality of prostate cancer when detected by DRE at any age.

 

In prostate cancer screening of asymptomatic men aged 55 to 69  the use of digital rectal examination as a screening modality is not recommended because there is a lack of evidence on the benefits.

 

DRE has long been used to diagnose prostate cancer, no controlled studies have shown a reduction in the morbidity or mortality of prostate cancer when detected by DRE at any age.

 

An stablished part of the physical exam in patients with gastrointestinal bleeding.

An internal examination of the rectum.

The digital rectal examination is a relatively simple procedure.

The patient is placed in a position where the anus is accessible such as lying on the side, squatting on the examination table, bending over the examination table, or lying down with feet in stirrups.

During this procedure, areas which can be palpated are: the bulb of the penis in a male, the urogenital diaphragm, the anorectal ring, and other nearby anatomical landmarks.

The physician spreads the buttocks apart and will usually examine the external area of the anus and perineum for any abnormalities such as hemorrhoids, lumps, or rashes.

The physician slips a lubricated finger into the rectum through the anus and palpates the insides for about 5 to 60 seconds.

This examination may be used:

for the diagnosis of rectal tumors and prostatic disorders, notably tumors and benign prostatic hyperplasia, for the diagnosis of appendicitis or other examples of an acute abdomen, for the estimation of the tonicity of the anal sphincter, in females, for gynecological palpations of internal organs, for examination of the hardness and color of the feces in cases of constipation, and fecal impaction, prior to a colonoscopy or proctoscopy, to evaluate hemorrhoids, in newborns to exclude imperforate anus, the insertion of medical devices including thermometers or specialized balloons, to identify digestion problems, parasites, organ damage, anal bruising, and foreign objects in the rectal cavity.

A rectal exam is useful to estimate the muscle tone of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries.

 

In trauma patients DRE sensitivity for injuries of the spinal cord, pelvis, and bowel is poor, and false positive and negative results are common.

Routine DRE is unnecessary and generally unhelpful in trauma.

 

The examination, however,  is warranted where urethral injury or penetrating rectal injury is suspected.

DRE frequently misses more early-stage tumors than prostate-specific antigen (PSA) among African American and Caucasian men.

Frequently combined with a fecal occult blood test, which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.

DRE with a fecal occult blood test might have value for the anemic patient in the who has no other identifiable cause for anemia, and is not actively bleeding.

 

A rectal examination to examine stool color may provide a clue as to the location of the bleed, but is not a reliable indicator.

 

It has a limited role in the diagnosis of acute, undifferentiated abdominal pain and acute appendicitis..

It is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the Colorectal mucosa.

There is little evidence supporting  the effectiveness of using the DRE for rectal cancer detection, and it is not recommended in the colorectal cancer screening guidelines.

 

Fecal occult blood testing (FOBT)  may be worse than no screening at all because it misses 95% of cases of advanced tumor, giving many patients a false sense of reassurance.

 

DRE is commonly used as a way to obtain a stool sample for a fecal occult blood test (FOBT) but  is an insufficient way of screening for colorectal cancer and is not recommended.

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.

With digital rectal exam the size, location, and degree of fixation of most low and some middle third rectal tumors can be detected and assessed.

 The digital rectal examination is performed with a patient in a position where the anus is accessible: lying on the side, squatting on the examination table, bent over it, or lying down with feet in stirrups.

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