This document provides information on performing a digital rectal examination (DRE). It discusses the reasons for conducting a DRE, including identifying anal lesions and confirming stool color. It outlines the preparation of the patient and equipment. Steps of the examination are described, including inspecting the anus, inserting the lubricated finger into the rectum to examine the walls and assess the prostate or cervix. Findings should be fully described and recorded.

1. MUHAMMAD RAFAY
Sindh Medical College, JSMU

2. DRE
DRE IS THE INTERNAL
EXAMINATION OF THE
RECTUM BY USING
YOUR INDEX FINGER.

3. WHY WE DO DRE?
DIGITAL RECTAL EXAMINATION
(DRE) IS AN ESSENTIAL STEP IN
EVALUATION AND SERVES TO
IDENTIFY ANORECTAL LESIONS AND
CONFIRM STOOL COLOR.

4. AN ANOSCOPY IS AN
EXAMINATION USING A
SMALL, RIGID, TUBULAR
INSTRUMENT CALLED
AN ANOSCOPE (ALSO
CALLED AN ANAL
SPECULUM).
ANOSCOPY

7. INDICATIONS
oURINARY SYMPTOMS IN OLD MAN (TO ASSESS THE SIZE OF THE
PROSTATE)
oBLEEDING PER RECTUM
oCONSTIPATION
oCHRONIC DIARRHEA
oANAL PAIN, RECTAL PAIN TENESMUS* OR LOWER ABDOMINAL
PAIN
TENESMUS: A SENSATION OF INCOMPLETE EVACUATION

8. CONTRAINDICATIONS
• ABSOLUTE:
• IMPERFORATE ANUS
• IMMUNOCOMPROMISED PATIENT
• STRICTURE
• MODERATE TO SEVERE ANAL PAIN
• PROLAPSED THROMBOSED INTERNAL HEMORROIDS
• RELATIVE:
• SEVERE RECTAL PAIN MAY PRECLUDE AN AWAKE
ANOSCOPY AND REQUIRE SEDATION
• RECENT ACUTE MYOCARDIAL INFARCTION
• ACUTE ABDOMEN
• UNWILLING PATIENT
• MAJOR RECTAL TRAUMA
• POST-OPERATIVE STATUS (ANAL SURGERY)

9. PREPARING THE PATIENT
1. INTRODUCE YOURSELF.
2. THE REASON AND NATURE OF THE TECHNIQUE OF RECTAL EXAMINATION SHOULD BE
EXPLAINED TO THE PATIENT.
3. INFORMED CONSENT CAN THEN BE GAINED.
4. REASSURE THE PATIENT THE THAT EXAMINATION MAY BE UNCOMFORTABLE, BUT IT
SHOULD NOT BE PAINFUL.
5. THE CLINICAL ROOM MUST BE APPROPRIATE FOR AN INTIMATE EXAMINATION AND A
CHAPERONE PRESENT FOR THE DURATION
6. PATIENT PRIVACY SHOULD BE MAINTAINED

10. PREPATION OF POSITION
LEFT LATERAL POSITION
• Patient should be put in
left lateral position.
• Legs and spine being
flexed.
• Buttocks should be at the
edge of the bed

11. SIM’S POSITION

12. GATHER EQUIPMENT
1.GLOVES
2.APRON
3.LUBRICANT (PETROLEUM JELLY)
4.PAPER TOWEL

13. INSPECTION OF THE ANUS
• WASH YOUR HAND & DON A PAIR OF DISPOSABLE
GLOVES.
• GENTLY SEPARATE THE BUTTOCKS & INSPECT NATAL
CLEFT AND ANAL VERGE.
• LOOK FOR FISSURE , RASHES , FISTULA
HAEMORRHOIDS , WARTS, ABSCESS
• THE POSITION OF AN ANAL LESION DESCRIBED IN
RELATION TO THE FACE OF A CLOCK
• THE ANTERIOR ASPECT OF ANUS ASSIGNED TO 12
O’CLOCK

14. RECTAL EXAMINATION
1. LUBRICATE (GLOVED) INDEX FINGER.
2. PLACE PULP OF INDEX FINGER ON POSTERIOR ANAL VERGE SO A SMALL ANGLE
EXISTS BETWEEN THE PALMAR SURFACE OF THE FINGER AND THE NATAL CLEFT.
3. PRESS GENTLY ON THE ANUS AND SLIP THE TIP OF THE INDEX FINGER INTO THE
ANAL CANAL BY INCREASING THE ANGLE OF THE FINGER.
4. AVOID USING FORCE, WAIT FOR THE SPHINCTER TO RELAX, IF STILL DIFFICULT
DO NOT CONTINUE WITH THE EXAMINATION.
5. INSERT THE INDEX FINGER INTO THE RECTUM AS FAR AS IT WILL GO, FOLLOWING
THE SACRAL CURVE
6. IF THERE IS BELIEVED TO BE A PROBLEM WITH THE ANAL SPHINCTER, ASK THE
PATIENT TO SQUEEZE THE EXAMINING FINGER TO ASSESS ANAL TONE

15. RECTAL EXAMINATION
7. EXAMINE THE POSTERIOR AND LATERAL WALLS OF THE RECTUM FOR PALPABLE
LUMPS OR TEARS (RECTAL WALLS SHOULD BE SMOOTH).
8. ASSESS THE PRESENCE OR ABSENCE OF FAECES.
9. ROTATE WRIST SO THAT FINGER PULP FACES ANTERIORLY AND EXAMINE THE
ANTERIOR RECTAL WALL.
10. IN THE MALE EXAMINE THE PROSTATE GLAND (SEE SLIDE 10) MAY BE PALPATED.
IN THE FEMALE THE CERVIX MAY BE PALPABLE.
11. ROTATE WRIST, SO THAT YOUR EXAMINING FINGER IS FACING POSTERIORLY
AGAIN AND THEN WITHDRAW FINGER.
12. ON WITHDRAWAL CHECK GLOVED FINGER FOR STOOL (NORMAL COLOUR, PALE
STOOL, MALENA ETC) AND ANY BLOOD OR MUCUS
13. CLEAN PATIENT, DISPOSE OF GLOVES AND WASH HANDS

16. • THE PROSTATE GLAND IS EXAMINED DURING A MALE RECTAL EXAMINATION
• A NORMAL PROSTATE MEASURES APPROXIMATELY 3.5CM FROM SIDE TO SIDE AND
PROTRUDES 1CM INTO THE RECTUM. IT CAN BE FELT THROUGH THE ANTERIOR RECTAL
WALL AND HAS A MEDIAN SULCUS SEPARATING THE TWO LOBES
• THE PROSTATE SHOULD NOT BE TENDER TO PALPATION BUT THE PATIENT MAY
EXPERIENCE DISCOMFORT OR AN URGE TO URINATE
• PALPATION OF THE PROSTATE GLAND AIMS TO ASSESS
* SIZE
* PRESENCE OF TWO EQUALLY SIZED LOBE
* CONSISTENCY (FIRM)
* SURFACE (SMOOTH OR NODULAR)
* TENDERNESS
PROSTATE EXAMINATION

17. COMMENT:
ANUS INSPECTION
ANUS TONE
RECTAL WALL
PROSTATE
ANY ABNORMAL MASS PALPATED
*REMEMBER TO DESCRIBE YOUR FINDINGS AS FULLY
AS POSSIBLE:
SIZE
POSITION(RELATIVE TO FACE OF CLOCK)
SHAPE OF SWELLING
RECORDING YOUR FINDINGS

18. THANK
YOU