How to Perform a Rectal Examination

A rectal exam is a screening procedure for both men and women designed to detect abnormalities in the rectum, anus, and prostate (for men), such as cancer, infections, and other damages. This test should be performed regularly (annually) during health checkups. Only trained healthcare professionals should conduct rectal exams, as untrained individuals might harm the delicate tissues of the rectum/anal area during the examination.

Explain the procedure to the patient and obtain their consent. If you are a healthcare professional performing a rectal exam on a patient, the first step is to explain the procedure to them. Then, ask them to sign a consent form if they agree to undergo the exam. You may explain it as follows, 'For this test, I will wear gloves and insert a finger into your rectum to check for any abnormalities. You may feel discomfort or pressure, but the procedure will only take one or two minutes.'

Sanitize hands and wear gloves. Before performing any procedure on a patient or another person, you must wash and sanitize your hands to avoid transmitting bacteria, viruses, or parasites. Washing with warm water and soap is sufficient to sanitize hands, but it is recommended to use alcohol-based hand sanitizer. Dry your hands thoroughly and put on a new pair of non-latex medical gloves, free from nitrile rubber.

Reassure the patient and ask them to lie on their side. Both doctors and patients may find rectal exams uncomfortable or embarrassing, so it is important to remain professional and reassure them. After explaining the procedure, ask the patient to undress the lower part of their body, lie on their left side, bend their knees toward their chest, and place their hands near their chest, resembling the fetal position. Cover them with a gown or blanket to maintain warmth and privacy. Place a protective pad under their hips.

Warm lubricant on your finger. As a courtesy and to prevent discomfort or shock to the patient, you should warm the lubricant slightly before applying it to your finger. Even room-temperature gel may cause discomfort for the patient and cause the anal sphincter to contract, making the examination more difficult. Your goal is to ensure the anal tissue is relaxed to avoid discomfort or pain when inserting the finger.

Gently insert your finger into the anus. After applying lubricant to your finger and the anus, gently separate the patient's buttocks and slowly insert your index finger. It is helpful to ask the patient to take a deep breath while inserting the finger, which helps them relax and prevents the anal sphincter from tightening. To ease the insertion, slowly rotate your hand back and forth.

Palpate for abnormalities.

Once your finger is inside the rectum, palpate for any abnormalities such as lumps, hard spots, soft areas, or fissures. Rotate your finger clockwise and counterclockwise to feel the entire circumference of the rectum. You can also gently tap on the prostate through the rectal wall. Palpate the front of the body to locate the prostate, which has two lobes and a groove in the center.

• A healthy prostate should feel flat and painless when palpated.
• If you feel pain when pressing on the prostate, it could indicate a benign tumor, infection, or cancer.
• During prostate examination through the rectum, you may feel a sensation similar to needing to urinate.

Remove your finger and clean the area after the examination. Once the examination is complete, gently remove your finger and inspect the gloves for blood and/or mucus. Clean the lubricants around the anus, remove and discard the gloves, and then wash your hands thoroughly. Allow the patient to use soft tissue to clean themselves in private, and inform them they can now get dressed again.

• To remove the dirty gloves, use the index finger of your other (clean) hand to place it under the cuff of the glove, then pull the glove towards the fingertips and remove it.
• The examination itself won't cause bleeding, so if you notice blood on the gloves, it could be a sign of hemorrhoids or other issues.
• After the procedure, ask the patient how they feel, especially if they seemed anxious beforehand. Keep in mind that transitioning from a lying position to standing might make some individuals feel dizzy, so remind the patient to stand slowly and observe them for a few minutes.

Get checked if you see blood in your stool. If you notice blood in the toilet bowl when passing stool or while wiping, it’s important to see a doctor. If the doctor suspects internal bleeding, particularly in the colon or rectum, they may recommend a colonoscopy. Common causes of blood in the stool include hemorrhoids, small fissures in the anus, and ruptured blood vessels from straining or wiping too hard.

• More serious causes may include rectal or colon cancer, or conditions such as ulcerative colitis or Crohn’s disease.
• If the doctor doesn’t find any obvious signs, the issue may be benign, but rectal exams can’t rule out all causes, so further tests like a colonoscopy or x-rays may be necessary.
• Digital Rectal Exams (DRE) are typically performed without any medication since they rarely cause pain, and the exam itself takes only a few minutes.

Seek a doctor’s advice if you’re a man with urinary difficulties. Another common reason for a rectal exam is to check the prostate for abnormalities or pain. The prostate, about the size of a walnut, produces fluid that nourishes and protects sperm during ejaculation. It is located near the bladder and in front of the rectum, making it easy to check via a DRE. An enlarged or inflamed prostate can cause pelvic pain and urinary issues such as dribbling or difficulty urinating initially.

• In men, DRE is performed to assess the size of the prostate and detect any abnormal lumps or painful areas. Benign prostate growth is common but not serious in men over 50, but malignant tumors are more dangerous, and early testing can significantly improve treatment outcomes. Annual or more frequent checks are recommended if you suspect problems.
• If the doctor suspects an issue with your prostate, they may order a blood test to check for Prostate-Specific Antigen (PSA). Elevated PSA levels can sometimes indicate prostate cancer.
• Another diagnostic test for prostate issues is a transrectal ultrasound, often performed alongside a prostate biopsy (tissue sample collection).

Request a rectal exam during your annual check-up. You should have regular rectal exams instead of waiting for symptoms to appear in your gastrointestinal system. Most doctors recommend adding a DRE to your annual physical exam, regardless of whether you're male or female. Men should consider DRE during their annual prostate screening, especially over the age of 40. A finger exam and stool blood tests (fecal sample collection) are recommended for individuals over 40. Women should include these tests with their yearly gynecological exams.

• For men, DRE is typically done while standing and bending forward, as this position makes it easier to access the prostate.
• For women, ovarian and uterine cancers may be detected during a DRE combined with a pelvic exam.
• In addition to symptoms like rectal bleeding and urinary problems, other reasons for DRE include changes in bowel habits, pelvic and/or abdominal pain, and abnormal discharge or bleeding from the urinary tract.

• No special preparation is needed before a rectal examination, and you can resume normal activities after the procedure. It might be more comfortable if you have a bowel movement beforehand.
• A DRE can be performed to collect a stool sample for colorectal cancer screening.
• Using a finger to explore the rectum may trigger the urge to defecate, so it's recommended to use the restroom prior to the DRE.