What is a Digital Rectal Examination?

Digital Rectal Examination (DRE) is a procedure used by healthcare professionals to assess the prostate gland's size, texture, and condition.

During a digital rectal examination, a doctor inserts a lubricated, gloved finger into the rectum to feel the prostate gland. By doing so, they can detect any abnormalities, such as enlargement, nodules, or irregularities, which may indicate conditions like BPH or prostate cancer.

Who is Suitable for a Digital Rectal Examination?

• Men experiencing urinary symptoms suggestive of an enlarged prostate may be suitable candidates for a digital rectal examination. Symptoms include:
• Frequent urination, especially at night (nocturia).
• Difficulty starting or maintaining a urine stream.
• Weak urine stream.
• Urinary urgency or the sudden need to urinate.
• A feeling of incomplete bladder emptying.
• Individuals with certain risk factors may benefit from a digital rectal examination, even if they are not experiencing symptoms. Risk factors for prostate conditions, including BPH and prostate cancer, include:
• Age: The risk of developing BPH increases, especially after age 50.
• Family History: Having a close relative, such as a father or brother, with prostate problems increases the risk.
• Ethnicity: Certain ethnicities have a higher risk of developing prostate conditions.
• Lifestyle Factors: Obesity, lack of physical activity, and poor dietary habits may increase the risk.
• Individuals with a history of abnormal findings on previous prostate examinations, such as an enlarged prostate, nodules, or elevated prostate-specific antigen (PSA) levels, may require regular follow-up examinations, including digital rectal examinations.
• Digital rectal examination is one component of prostate cancer screening, along with PSA testing. Men undergoing routine prostate cancer screening may receive a digital rectal examination to assess the prostate gland's condition.
• Other conditions, such as prostate infections (prostatitis) or urethral strictures, can cause urinary symptoms in addition to BPH. A digital rectal examination can help identify the underlying cause of urinary problems.

Benefits of Digital Rectal Examination

• Early Detection: DRE allows doctors to detect early signs of prostate conditions, such as benign prostatic hyperplasia (BPH) or prostate cancer. Early detection facilitates timely intervention and management, which can improve treatment outcomes.
• Assessment of Prostate Size and Texture: By feeling the prostate gland through the rectal wall, doctors can assess its size, shape, and texture. Enlargement, nodules, or irregularities detected during the examination can indicate underlying prostate issues.
• Complementary to Other Tests: DRE complements other diagnostic tests for prostate conditions, such as prostate-specific antigen (PSA) blood tests and imaging studies. Combined with PSA testing, DRE enhances the accuracy of prostate cancer screening and helps differentiate between benign and malignant conditions.
• Guidance for Treatment Decisions: The findings of a digital rectal examination can guide treatment decisions for prostate conditions. Depending on the examination results and other diagnostic findings, doctors may recommend watchful waiting, medication, minimally invasive procedures, or surgery.
• Monitoring Disease Progression: For individuals with known prostate conditions, regular digital rectal examinations enable doctors to monitor disease progression, response to treatment, and the need for adjustments in management strategies.

Alternative Options to Digital Rectal Examination

While digital rectal examination remains a valuable tool in assessing prostate conditions, alternative options may be considered based on individual patient characteristics, preferences, and clinical indications.

• Prostate-Specific Antigen (PSA) Testing
• Uroflowmetry
• Transrectal Ultrasound (TRUS)
• MRI of the Prostate
• Prostate Biopsy
• Cystoscopy

Preparation Before a Digital Rectal Examination

Before a DRE, there are a few steps you can take to ensure the procedure goes smoothly:

• Discuss Any Concerns: If you have any concerns or questions about the procedure, don't hesitate to discuss them with your doctor beforehand. They can provide information and address any anxieties you may have.
• Empty Your Bladder: Before the examination, emptying your bladder is advisable. This can help make the procedure more comfortable and reduce the likelihood of feeling the urge to urinate during the examination.
• Relax: While feeling anxious about the procedure is natural, try to relax as much as possible. Tension in the pelvic muscles can make the examination more uncomfortable. Deep breathing exercises or relaxation techniques may help alleviate anxiety.
• Follow Any Instructions: Your doctor may provide specific instructions before the examination, such as avoiding certain medications or dietary restrictions. Adhering to these instructions is essential to ensure accurate results.

Digital Rectal Examination Procedure

• Positioning: You will be asked to lie on your side with your knees drawn up towards your chest or to assume a standing position with your upper body leaning forward onto a support surface, such as an examination table or chair.
• Gloved Finger Insertion: The doctor will wear a lubricated, disposable glove and gently insert one lubricated finger into your rectum. They may also use a lubricant to make the insertion more comfortable.
• Palpation of the Prostate: The doctor will palpate the prostate gland through the rectal wall using the finger. They will assess the size, shape, consistency, and prostate gland abnormalities.
• Description of Findings: During the examination, the doctor may verbally describe their findings, such as the size and texture of the prostate gland and any abnormalities detected.

What to Expect After Digital Rectal Examination?

• Feedback and Discussion: After the examination, your doctor may discuss their findings with you and answer any questions. They may also provide further evaluation or management recommendations based on the examination results.
• Resumption of Normal Activities: You can typically resume your normal activities immediately after a digital rectal examination. There are no specific restrictions or limitations following the procedure.
• Follow-Up: Depending on the examination findings and your medical history, your doctor may recommend follow-up appointments, additional tests, or treatments as necessary.
• Monitoring for Symptoms: Following the examination, it's essential to monitor for any new or worsening symptoms, such as urinary problems or rectal discomfort. If you experience any concerning symptoms, don't hesitate to contact your doctor for further evaluation.

Digital Rectal Examination Risks

While DRE is generally considered safe, there are some potential risks and discomforts associated with the procedure:

• Discomfort or Pain: Some individuals may experience discomfort or mild pain during the examination, particularly if the prostate gland is enlarged or tender.
• Rectal Bleeding: In rare cases, the examination may cause minor rectal bleeding, particularly if the rectal mucosa is irritated or there are haemorrhoids.
• Emotional Discomfort: Some individuals may feel embarrassed or anxious about undergoing a digital rectal examination, which can contribute to emotional discomfort or distress.

What if a Digital Rectal Examination is Delayed?

Delaying the examination may result in the progression of symptoms associated with prostate enlargement, such as urinary problems or discomfort.

Early detection through DRE allows timely intervention and management to alleviate symptoms and prevent complications. Delaying the examination may also contribute to increased anxiety or uncertainty about one's prostate health. 

Addressing concerns promptly through evaluation and examination can reassure and facilitate appropriate management.

While delaying a DRE may not necessarily lead to immediate adverse outcomes, it is essential to prioritise timely evaluation and monitoring of prostate health to ensure optimal outcomes and quality of life. 

Regular screening and proactive management can help detect and address prostate conditions early, leading to better prognosis and treatment outcomes.