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Concept
Rectal examination
Summary
Digital rectal examination (DRE), also known as a prostate exam (palpatio per anum (PPA)), is an internal examination of the rectum performed by a healthcare provider.
Prior to a 2018 report from the United States Preventive Services Task Force, a digital exam was a common component of annual exams for older men, as it was thought to be a reliable screening test for prostate cancer.
This examination may be used:
for the diagnosis of prostatic disorders, benign prostatic hyperplasia and the four types of prostatitis. Chronic prostatitis/chronic pelvic pain syndrome, chronic bacterial prostatitis, acute (sudden) bacterial prostatitis, and asymptomatic inflammatory prostatitis. The DRE has a 50% specificity for benign prostatic hyperplasia. Vigorous examination of the prostate in suspected acute prostatitis can lead to seeding of septic emboli and should never be done. Its utility as a screening method for prostate cancer however is not supported by the evidence;
for the evaluation of certain clinical symptoms: a male with change in urinary ability, impotence, or dysuria (blood in the urine), pain with bowel movements;
a DRE with a FOBT might have value for the anemic patient in the emergency room who has no other identifiable cause for anemia, is not actively bleeding, and there is concern that gastrointestinal malignancy may be the cause for their anemia;
a true active gastrointestinal bleed: vomiting blood, vomiting coffee-grind like material, defecating blood or black tarry stools that can not be easily attributed to facial trauma or oral surgery, eating beets or anything with red food dye or overuse of NSAIDS/over the counter pain medication. Doing a rectal exam to examine stool color may provide a clue as to the location of the bleed but is not a reliable indicator;
for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease). Although a Journal of Emergency Medicine paper concludes: "We found the DRE to have a limited role in the diagnosis of acute, undifferentiated abdominal pain and acute appendicitis.
Official source
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