Digital rectal examination

The digital rectal examination is a test used to:

• Help detect growths on or enlargement of the prostate gland in men.
• Investigate the cause of symptoms such as rectal bleeding (blood in the stool), abdominal or pelvic pain, or a change in bowel habits.
• Help, in conjunction with a vaginal examination, to evaluate some abnormalities of a woman's reproductive system (such as the uterus or ovaries).
• Collect a sample of stool to test for blood.
• Check for haemorrhoids (piles) or other growths in the rectum.

If necessary, a digital rectal examination can be carried out during a standard physical examination for men or during a pelvic examination for women.

Who should have a digital rectal examination?

• Your doctor may recommend a digital rectal examination if you are experiencing rectal bleeding, abdominal or pelvic pain, blood in your stools, constipation, incontinence, or other changes in your bowel habits.
• Men considered at increased risk of prostate cancer, or with symptoms of disturbances of urination that might suggest changes in their prostate gland, may be offered a digital rectal examination.
• Women experiencing problems with their reproductive organs may be offered a digital rectal examination as part of their investigations.

What happens during a digital rectal examination?

This depends on the extent of any other examination that may be required. In a GP’s surgery, men may only need to pull down or remove their trousers and underpants, with a blanket or paper drape used to help preserve modesty. The same applies to women if they are only having a rectal examination, who may be asked only to lift their dress or pull down or remove trousers and underclothes. A chaperone will normally be present, if appropriate, and if none is offered, you may ask for one to attend. In hospital, the patient may be asked to undress below the waist and put on a gown. Most people are examined while lying on their left side with their knees drawn up. Occasionally, in a hospital outpatient department, women will be asked to lie back, as for a pelvic examination, and have their feet supported by stirrups.

After carrying out a careful visual check of the area, the doctor or specialist nurse will insert a lubricated, gloved finger into the rectum and feel for tenderness or other abnormalities. Often pressure is applied to the lower abdomen or pelvic area with the other hand to improve the ability to detect any abnormalities (such as enlargement or hardness of the prostate gland, or growths). For men, the doctor or nurse may press firmly over the surface of the prostate gland. The test normally takes less than a minute to complete.

You may experience slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.

What happens after the digital rectal examination?

You may continue your normal activities after a digital rectal examination.

After you’re dressed, your doctor or nurse will discuss the test results with you. This is what they may find:

• no abnormalities
• abnormal growths or enlargement of an organ (such as the prostate, cervix, uterus, ovaries, rectum or bladder)
• haemorrhoids, abscesses or anal fissures (breaks in the skin around the anus
• polyps, or tissue growths (often non-cancerous), in the rectum. 

Note: Although the digital rectal examination is often part of the procedure to check for bowel cancer, this test alone is not used to diagnose the disease. If the rectal examination suggests the possibility of bowel cancer, further tests such as flexible sigmoidoscopy, colonoscopy or a barium enema may be needed.