Rectal examination
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Digital rectal exam
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Rectal examination | |
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ICD-9-CM | 89.34 |
MeSH | D051517 |
MedlinePlus | 007069 |
Digital rectal examination (DRE), also known as a prostate exam (
healthcare provider
.
Prior to a 2018 report from the
Usage
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.[3] 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;[4]
- 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;[5]
- a DRE with a
- 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;[10][11][6][7][8]
- for the
- for the estimation of the muscle tone of the neurologicdiseases, including traumatic spinal cord injuries;
- traditionally, the digital rectal examination (DRE) was considered an essential part of the physical examination for all trauma patients. However, the sensitivity of the DRE for injuries of the spinal cord, pelvis, and bowel is poor, and false positive and negative results are common. Thus, routine performance is unnecessary and generally unhelpful. The examination is warranted in cases where urethral injury or penetrating rectal injury is suspected;[13][14]
- in gynecological palpations of internal organswhen the vaginal vault cannot be accessed or it is too painful (vaginal atrophy);
- for examination of the hardness and color of the feces (i.e. in cases of constipation, and fecal impaction);
- prior to a colonoscopy or proctoscopy;
- to evaluate hemorrhoids although internal hemorrhoids are often too soft to be felt, a visual inspection may be more useful;[15]
- in newborns to exclude imperforate anus;
- through the insertion of medical devices including thermometers or specialized balloons; to identify organdamage, anal bruising, and foreign objects in the rectal cavity;
Usage as a screening tool
In colorectal cancer screening of asymptomatic adults aged 50 to 75
- Even though 1 in 4 colorectal cancers (CRC) is located in the rectum, little evidence supports the effectiveness of using the DRE for rectal cancer detection[16][17] and it is not recommended in the colorectal cancer screening guidelines.[18] The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; sigmoidoscopy is preferred.[citation needed]
- Although the DRE is commonly used as a way to obtain a stool sample for a FOBT (HEDIS, Medicare or American Cancer Society standards.[23] The FOBT has never been validated for any purpose other than as a take home colon cancer screening test.[9] A paper published in the Journal of General Internal Medicine states, "While FOBT done appropriately (taken home and used according to the instructions) is an important screening option, in-office FOBT may be worse than no screening at all because it misses 95% of cases of advanced tumor, giving many patients a false sense of reassurance."[24]
In prostate cancer screening of asymptomatic men aged 55 to 69
- In men aged 55–69 who have been counseled on the known harms and potential benefits of prostate cancer screening, the U.S. Preventive Service Task Force May 2018 statement states, "The use of digital rectal examination as a screening modality is not recommended because there is a lack of evidence on the benefits."[25] The American Academy of Family Physicians states, "Digital Rectal Exam does not improve detection of prostate cancer and should not be performed as a part of screening."[26] The American Urological Association 2013 (reviewed and validity confirmed 2018) guideline panel states, "The literature supporting the efficacy of digital rectal exam (DRE) for screening with the goal of reducing prostate cancer mortality provide limited evidence to draw conclusions."[27] "The guideline panel could find no evidence to support the continued use of DRE as a first-line method of screening."[28] Although DRE has long been used to diagnose prostate cancer, no controlled studies have shown a reduction in the morbidity or mortality of prostate cancer when detected by DRE at any age.[28][29]
- A meta-analysis published in the Annals of Family Medicine concluded: "Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting."[4]
Procedure
The digital rectal examination is a relatively simple medical procedure. The patient undresses and is then placed in a position where the
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.[medical citation needed
]
Society and culture
Due to the taboos surrounding the anus and the potential for discomfort and embarrassment, the rectal exam is a common
Destroy All Humans!.[31] The practice of rectal exams without prior consent by medical students has been an area of concern.[32]
Veterinary medicine
This article needs additional citations for verification. (November 2018) |
In
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.[citation needed
]
The procedure in dogs and cats is similar to humans. For the horse, the patient stands in a
long glove that extends to the shoulder. The examiner inserts the hand and arm into the rectum as far as necessary.[citation needed
]
See also
References
- ^ "Recommendation: Prostate Cancer: Screening | United States Preventive Services Taskforce". www.uspreventiveservicestaskforce.org. Retrieved 2022-11-19.
- ^ "It may be time to abandon dreaded digital rectal exam, research shows". ScienceDaily. Retrieved 2022-11-19.
The dreaded finger exam to check for prostate cancer used to be a mainstay of check-ups for older men.
- ISBN 978-0-323-08438-3.
- ^ PMID 29531107.
- ^ "Pri-Med | Put That Finger Down! The End of the..." Pri-Med.
- ^ a b c "FOBT and DRE's in the ED (June 2018) » Emergency Medicine | Blog Archive | Boston University". www.bumc.bu.edu. Retrieved 2019-02-20.
- ^ S2CID 5046971.
- ^ S2CID 20602869.
- ^ PMID 28699947.
- ^ "UpToDate". www.uptodate.com. Retrieved 2019-11-13.
- PMID 3263294.
- PMID 22883714.
- ^ "UpToDate". www.uptodate.com. Retrieved 2019-10-22.
- PMID 17391807.
- ^ "Hemorrhoids - Diagnosis and treatment - Mayo Clinic". Mayo Clinic.
- S2CID 639158.
- ^ "UpToDate". www.uptodate.com. Retrieved 2019-02-18.
- ^ "Final Recommendation Statement: Colorectal Cancer: Screening - US Preventive Services Task Force". www.uspreventiveservicestaskforce.org. Retrieved 2019-02-07.
- PMID 16734049.
- S2CID 22573405.
- S2CID 24639260.
- S2CID 29833684.)
{{cite journal}}
: CS1 maint: numeric names: authors list (link - ^ "Colorectal Cancer Screening Tests". www.cancer.org. Retrieved 2019-10-12.
- PMID 20383599.
- PMID 29801017.
- ^ "Prostate Cancer - Clinical Preventive Service Recommendation". www.aafp.org. Retrieved 2019-02-18.
- ^ "American Urological Association -". www.auanet.org. Retrieved 2019-02-20.
- ^ a b Hoffman, Richard M (Jun 25, 2018). "Screening for prostate cancer". UpToDate.
- ^ Epstein JI (2002). "Pathology of prostatic neoplasia". In Walsh PC (ed.). Campbell's Urology (8th ed.). Philadelphia: Saunders.
- ^ New York Magazine - Vol. 28, No. 11. "Saturday Night Live at twenty"
- ^ "Alien anal probe saw Saints Row IV refused classification in Australia". IGN Entertainment Inc. June 25, 2013. Retrieved July 19, 2014.
- S2CID 3372919.