Examination: Digital Rectal Examination (DRE / PR)

Always do a DRE on patients who are admitted with lower abdominal pain and/or prostatism (males)


  • Ensure there is a chaperone (if patient doesn't mind, then write that one was offered on the notes)
  • Wash hands
  • Introduce and explain. Warn patient this is an uncomfortable examination
  • Permission
  • Expose - from knees to mid-back (trousers and underwear)
  • Reposition - left lateral position with knees up to tummy (similar to foetal position)
Inspection:
  • Warn the patient before touching them
  • Begin by lifting up right buttock with your right hand and look for:
    • Fistulae
    • Skin tags
    • Sores
    • Masses/swellings (e.g.: warts, hemorrhoids, tumours)
    • Rashes
    • Fissures
    • Faeces (incontinence), bleeding or other discharge
    • Scars
    • Sinuses
    • Foreign bodies
    • Rectal prolapse

Palpation:
  • Put gloves on both hands
  • Put lubricant containing local anaesthetic on gloves (e.g.: Aquagel)
  • Ask the patient to relax 'as if they were sitting on the toilet'
  • Warn the patient before inserting your finger
  • Use the index finger of the right hand and gently insert into their rectum
  • Feel the posterior wall
  • Gently turn finger round
  • Feel the anterior wall
  • Your should be feeling for:
    • Polyps (soft and attached to the mucosa)
    • Faeces (is it very firm or soft?)
    • Tumours (hard and irregular masses)
    • Foreign bodies
    • On the anterior wall, you are also feeling for the prostate (males) and the cervix or for fibroids (females)
      • When palpating for the prostate, feel for:
        • 2 lobes and sulcus (right lateral lobe, left lateral lobe and median sulcus)
        • A normal prostate is flat and smooth. You can get above it.
        • Malignant prostate = craggy, large, cannot feel the median sulcus.
          • If someone has an abnormal feeling gland, they may warrant a 'Prostate Specific Antigen' blood test (this will be articifically high for a few days after carrying out a digital rectal examination) and possibly transrectal ultrasound imaging with biopsies of the prostate.

  • Remove finger and inspect for mucous, blood and faeces
  • Clean any excess lubricant from around anus using a tissue
  • Remove gloves carefully and wash hands
  • Thank patient and offer them assistance to get dressed again

    • written by: celine_lakra; saaid_sufi, first posted on: 19/03/12, 21:28

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