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A digital rectal exam (DRE) is one of the basic techniques doctors use to examine the prostate. During this procedure, the doctor inserts a finger into the rectum to feel for abnormal areas. These abnormalities could be related to prostate cancer, benign prostatic hyperplasia (BPH), or prostatitis (infection). Medical experts do not recommend performing self-exams at home, as you lack the necessary knowledge to draw accurate conclusions. However, if you wish to examine yourself, it’s important to familiarize yourself with the techniques doctors use.
Steps
Prostate Examination
Consider having a doctor perform the exam. While the prostate examination may seem straightforward, it requires correct technique and knowing exactly what to feel for.
- Complications may include bleeding from fingernails puncturing cysts or other tissue, which can lead to infections or other complications that you cannot manage at home, and eventually, you will need to visit a doctor.
- Additionally, if you discover an abnormality during a self-exam and consult a doctor, they will likely need to conduct a re-examination to confirm the results.
Choose the correct position. In a clinic, the doctor will ask you to lie on your side with your knees bent or to bend forward while standing. This position allows the doctor easier access to the rectum and prostate.
Check the skin condition in that area. This can be done with your hands and a handheld mirror, or with the help of your partner. Examine the skin around the rectal area for any cysts, pimples, or hemorrhoids.
Wear sterile gloves. You or your partner should wear sterile rubber gloves when performing the DRE. Be sure to wash your hands thoroughly before putting on the gloves. Use only the index finger for the examination, but gloves are still necessary.
- Remember to trim your fingernails before washing your hands and wearing the gloves. Even with gloves, you might accidentally scrape or puncture a cyst or other tissue in that area.
Lubricate the gloves. Lubricants such as Vaseline or KY Jelly will make it easier to insert the finger into the rectum with less discomfort. Apply plenty of lubricant to the index finger of the glove.
Palpate the rectal wall. You or your partner will insert the index finger into the rectum. Rotate the finger in a circular motion to feel for lumps or masses that may indicate cancer, tumors, or cysts along the rectal wall. If nothing unusual is found, the rectal wall should feel smooth and uniform.
- Use gentle pressure while palpating.
Palpate the rectal wall toward the belly button. The prostate is located above/in front of this section of the rectal wall. Abnormal findings when you palpate toward the prostate include hard spots, lumps, unevenness, swelling, and/or tenderness during palpation.
Withdraw your finger. During the exam at the clinic, the entire procedure typically takes about 10 seconds, so you shouldn’t palpate for too long as prolonged examination can cause discomfort. Dispose of the gloves and be sure to wash your hands immediately afterward.
Consult a doctor. Afterward, you should see a doctor for additional tests or consultations. If you detect any abnormalities, you should schedule an appointment with your doctor as soon as possible. If you visit the doctor within two days, let them know about your self-exam, as it could elevate your PSA levels in subsequent tests.
Determine if you need prostate cancer screening
Assess the need for screening based on age. The American Cancer Society recommends prostate cancer screening for all men aged 50 and above. However, some individuals may need to start screening earlier. These include:
- Men aged 40 with multiple first-degree relatives (son, brother, or father) who had prostate cancer before the age of 65.
- Men aged 45 with one first-degree relative who had prostate cancer before the age of 65.
- Men of African descent, starting at age 45, due to their higher risk of developing prostate cancer.
Be mindful of any symptoms related to the urinary system. Issues concerning the bladder, urethra, and penis can potentially be linked to prostate problems. Since the prostate is located near these organs, its growth can lead to compression, resulting in dysfunction. If you have prostate issues, you may experience the following symptoms:
- Slow or weak urine stream
- Difficulty urinating
- Frequent urination at night
- Burning sensation during urination
- Blood in urine
- Difficulty achieving an erection
- Painful ejaculation
- Lower back pain
Schedule a doctor's appointment. If you experience any symptoms in the urinary tract, the underlying cause could be related to various conditions, and a DRE alone cannot provide a diagnosis. Additionally, DRE is just one of the tests your doctor may use to assess prostate health.
- Your doctor might recommend a transrectal ultrasound (TRUS) to examine suspicious tissue in the rectum.
- You may need a biopsy to confirm or rule out cancer as the cause.
Request a Prostate-Specific Antigen (PSA) test. Your doctor may suggest testing for PSA levels (a type of protein produced by the prostate) if there are abnormalities with the prostate. Most doctors consider a PSA level of 4 ng/ml or lower to be normal.
- PSA levels can sometimes result in false positives or negatives. The U.S. Preventive Services Task Force advises against prostate screening using PSA due to these risks.
- Factors like ejaculation (from sexual activity), prostate infections, digital rectal exams, and cycling (due to pressure on the prostate) can cause a spike in PSA levels. Individuals without prostate symptoms but with elevated PSA levels may need to retest after two days.
- If PSA levels continue to rise alongside symptoms, a DRE or prostate biopsy (using a needle to take prostate tissue for analysis) may be necessary.
- Men with PSA levels under 2.5 ng/mL should retest every two years, but annual screening is advised for those with PSA levels of 2.5 ng/mL or higher.
Warning
- Note that it is still possible to have cancer even with normal PSA and DRE test results.
- First, trim your nails.
- There is disagreement over the reliability of screening, with some doctors supporting it and others not. Discuss your family history, age, and symptoms with a healthcare provider to make an informed decision.
Items You Will Need
- Surgical gloves
- Lubricant
