Rectal examination

Role

Digital rectal examination (DRE) remains a simple, informative bedside test - assessing anal sphincter tone, prostate (in men), rectal masses, and stool character (including occult/overt blood) - though it should be targeted, not performed reflexively on every patient regardless of presentation
Indicated for specific presentations (rectal bleeding, unexplained anaemia, suspected prostatic disease, faecal incontinence, and as part of a focused abdominal/pelvic assessment for relevant symptoms) rather than as a routine component of every general examination

Provides direct information unavailable by other simple bedside means: sphincter tone (relevant to incontinence and to safe examination/treatment planning), palpable rectal masses (a proportion of rectal cancers are within reach of a examining finger), prostate size/consistency in men, and stool character on the glove (colour, presence of blood - melaena vs fresh blood vs normal)

A normal DRE does not exclude significant pathology higher in the rectum or colon - the examining finger reaches only the distal rectum, and a normal finding should not be used to reassure against more proximal disease requiring endoscopic evaluation
Findings should be interpreted alongside the clinical context - e.g. a tender prostate on DRE in a febrile patient supports prostatitis, but vigorous prostate massage/examination should be avoided in this context given bacteraemia risk

Findings directly inform next steps - a palpable mass warrants endoscopic/imaging follow-up regardless of other findings; melaena on the glove in an appropriate clinical context supports an upper GI bleeding source and should escalate urgency of further assessment

Rectal bleeding workup, faecal incontinence assessment, benign prostatic hyperplasia/prostatitis (in men), rectal/anal malignancy

DRE is a useful, low-risk, high-yield test when targeted to an appropriate clinical indication, but a normal result has real limits (distal rectum only) and should never be used alone to exclude more proximal colorectal pathology requiring endoscopy

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