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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Juan A. Villanueva Herrero ; Abdullah Abdussalam ; Anup Kasi .
Last Update: February 18, 2023 .
The rectal exam is an oft-overlooked part of the physical exam. For those practitioners who understand how to interpret it, a lot of information can is obtainable from this simple exam. Anecdotally, we have all heard during our training from experienced physicians about the utility of the rectal exam and how it should be a part of the physical exam on every patient. And while it is true that in the era of the focused physical exam, the rectal exam is no longer performed on every patient, it still has many utilities and is definitely underutilized. It is a valuable diagnostic process in cases including, but not limited to, gastrointestinal bleeding, inflammatory bowel disease, hemorrhoids, constipation, trauma, and neurological disorders.
Describe the indications for a rectal exam. Review the preparation for a rectal exam. Summarize the steps and expected normal and abnormal findings in performing a rectal exam.Outline how the interprofessional team can facilitate communication to optimize the care of patients needing a rectal exam.
The rectal exam is an oft-overlooked part of the physical exam. For those practitioners who understand how to interpret it, a lot of information can is obtainable from this simple exam. Anecdotally, we have all heard during our training from experienced physicians about the utility of the rectal exam, and how it should be a part of the physical exam on every patient. And while it is true that in the era of the focused physical exam the rectal exam is no longer performed on every patient, it still has many utilities and is definitely underutilized. It is a valuable diagnostic process in cases including, but not limited to, gastrointestinal bleeding, inflammatory bowel disease, hemorrhoids, constipation, trauma, and neurological disorders.
The rectum is the terminal segment of the large bowel. It is approximately 12 cm long and runs along the concavity of the sacrum. [1]
In males, the anterior rectum peritoneum reflects on the surface of the bladder base.In females, the anterior rectum peritoneum forms the pouch of Douglas (rectouterine pouch), which is filled with bowel loops.
In males, anterior to the rectum lies the bladder base, prostate, and seminal vesicles In females, anterior to the rectum lies the vagina, and at the fingertip, the cervix and uterus. The anus is 3-4 cm long and connects the rectum to the perineum.The anal wall and anal canal are supported by voluntary external sphincter muscles and involuntary internal anal sphincter muscles, with are essential for defecation and maintenance of continence.
This is an uncomfortable procedure for the patient. It is most often done when disease is suspected. It may also be done as part of a screening process. [2]
The examiner should explain the reasons for the procedure and obtain verbal consent. Reasons to perform the procedure include:
Change in bowel habit Prostate evaluation Rectal bleeding Urinary or fecal incontinence A secondary approach to vaginal and cervical examIt is, of course, useful and should be performed in patients with a GI bleed, where the practitioner can look for hemorrhoids, fissures, and gross blood. It is also helpful in evaluating constipation, to evaluate sensation, tone, and coordination of contraction. For fecal incontinence, again, evaluating rectal tone is essential.
Rectal Exam in Children
This exam should be avoided; if essential, use the fifth rather than the index finger.
Rectal Exam in Elderly
Rectal examination is more often required in elderly patients because diseases affecting the bowel arise more often in elderly patients. The left lateral position may be uncomfortable. Time should be taken to achieve a comfortable position that allows examination.
The main contraindication to the digital rectal exam is if a patient is immunocompromised, which runs the risk of introducing infection in these patients and can be potentially life-threatening.
