Digital rectal examination (DRE), also known as a prostate exam, 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.

Usage

This examination may be used:

Usage as a screening tool

In colorectal cancer screening of asymptomatic adults aged 50 to 75

In prostate cancer screening of asymptomatic men aged 55 to 69

Procedure

The digital rectal examination is a relatively simple medical procedure. The patient undresses and is then placed in a position where the anus is accessible (lying on the side, squatting on the examination table, bent over it, or lying down with feet in stirrups). If the patient is lying on their side, the physician will usually have them bring one or both legs up to their chest. If the patient bends over the examination table or the back of a chair, the physician will have them place their elbows on the table and squat down slightly. If the patient uses the supine position, the physician will ask the patient to slide down to the end of the examination table until their buttocks are positioned just beyond the end and then place their feet in the stirrups. The physician spreads the buttocks apart and will usually examine the external area (anus and perineum) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient relaxes and bears down (as if having a bowel movement), the physician slips a lubricated finger into the rectum through the anus and palpates the insides for a short time.

Society and culture

Due to the taboos surrounding the anus and the potential for discomfort and embarrassment, the rectal exam is a common comedic device, including in episodes of Saturday Night Live, Impractical Jokers, Futurama, Family Guy, South Park, Letterkenny, and the movie Fletch, with M. Emmet Walsh as the general practitioner and Chevy Chase as the patient being examined. Similar activities to the rectal exam are attributed to extraterrestrials in video games such as Saints Row IV, Gaia Online and Destroy All Humans!. The practice of rectal exams without prior consent by medical students has been an area of concern. In 2024, the US Department of Health and Human Services banned rectal examination (and pelvic and breast exams) without written informed consent, when such exams are done by medical students, nurse practitioners, or physician assistants for “educational and training purposes”.

Veterinary medicine

In veterinary medicine rectal examination is useful in dogs for analysis of the prostate (as in men), pelvic urethra, sublumbar lymph nodes, and anal glands. In horses it is a vital component of the clinical examination for colic, to determine the presence or absence of bowel torsion, impaction, or displacement. When horses undergo a rectal examination there is a small risk of a rectal tear occurring, which can be a life-threatening event, rapidly leading to peritonitis and septic shock. It is also a common procedure in cattle, and is one method of diagnosing pregnancy in both the horse and the cow. The procedure in dogs and cats is similar to humans. For the horse, the patient stands in a stock and may be sedated. The examiner puts on a long glove that extends to the shoulder. The examiner inserts the hand and arm into the rectum as far as necessary.