Digital rectal examination

Page last reviewed: 13/07/2011

A rectal examination is a type of physical examination where a doctor or nurse puts one of their fingers into your rectum (back passage).

Some people find having a rectal examination embarrassing, but it only takes a few minutes and is not usually painful. 

Read more about how a rectal examination is performed.

What is it used for?

One of the most common reasons for having a rectal examination is if a man has a suspected problem with his prostate gland, which could be a sign of  prostate disease or prostate cancer.   

The prostate gland is found just below the bladder and can be touched by placing a finger into the rectum. Changes in the prostate, such as swelling and hardening, can be felt in this way.

A rectal examination may also be required if a person develops changes in their normal bowel habits, which could indicate a problem with their digestive system. These changes could include:

  • constipation loss of normal bowel function, also called bowel incontinence. 

Read more about why a rectal examination is used.

Page last reviewed: 13/07/2011

The prostate gland

One of the most common reasons for a rectal examination is if a man has symptoms that suggest there may be a problem with his prostate gland.

The prostate is a small gland found only in men. It is located in the pelvis, between the penis and bladder, and surrounds the urethra (the tube that carries urine from the bladder to the penis).

It is common for the prostate gland to become larger in older men. This can place pressure on the bladder and urethra and cause symptoms such as:

  • difficulty beginning to urinate
  • flow of urine that is weak or stops and starts
  • having to push or strain to pass urine
  • a frequent need to urinate
  • waking up frequently during the night to urinate

Prostate enlargement can be troublesome to live with but does not pose a threat to health. However, it causes similar symptoms to prostate cancer and a rectal examination is one way to tell whether the symptoms are caused by prostate enlargement or prostate cancer.

Prostate cancer can cause the surface of the prostate to become hard and bumpy, while prostate enlargement will not usually affect the surface.

A rectal examination is not a guaranteed way of diagnosing prostate cancer, so it is normally used in combination with other tests such as a blood test and sometimes a biopsy,where a sample of the prostate gland is removed for further testing.

Digestive symptoms

A rectal examination may also be recommended if you have symptoms that suggest there may be a problem with your digestive system, such as:

  • bleeding from your rectum
  • constipation
  • bowel incontinence
  • and occasionally bladder incontinence)
  • pain in your rectum or anus (the hole through which your stools pass when you go to the toilet)

In women

In rare cases, a rectal examination may be carried out in women to assess the state of their womb and cervix (the opening to the womb) when it is not possible to do a direct vaginal examination, for example if a woman is having her period.

Page last reviewed: 13/07/2011

A rectal examination can be carried out by:

  • your GP
  • a nurse who specialises in treating bowel problems
  • a specialist doctor

For convenience, the rest of this section will refer to your GP carrying out the rectal examination.

Many people find rectal examinations embarrassing, and your GP will be fully aware of this. Some people may also be sensitive about having a rectal examination for religious or cultural reasons.

Therefore, you may prefer a rectal examination to be carried out by a GP of the same sex, or you may want to have a friend or relative present during the examination. If you have any particular preferences, tell your GP in advance.

Also tell your GP if you have had severe pain as this may indicate an underlying health condition. If this is the case, a rectal examination may need to be carried out under a local anaesthetic, where medication is used to numb the area.

The procedure

Before you have a rectal examination, your GP will ask you to remove your lower clothing. Your GP may suggest that you get changed behind a curtain, or they may leave the room if you want them to.

You will be asked to lie on a couch, on your left side, and bring your knees up towards your chest. In some cases, women may be asked to lie on their back and have both their feet raised and supported by stirrups.

Your GP will start by making a careful visual examination of your anus. They will look for any abnormalities, such as:

  • warts
  • rashes
  • swollen blood vessels around the anus or rectum, known as haemorrhoids or piles
  • damage to the anus such as a tear in the lining, the medical name for which is anal fissure

Your GP will put a glove on one hand and use a gel to lubricate one of their fingers. They will then gently push the finger into your anus and then up into your rectum. You may feel a little discomfort or pain in this stage of the examination.

During the rectal examination, your GP may ask you to squeeze your rectum around their finger so that they can assess how well the muscles in your rectum and bowels are working.

If you are a man, your GP may also firmly press against your prostate gland. A healthy prostate should be smooth to the touch, so they will check for any hard or lumpy areas on your prostate. This may indicate the presence of prostate disease such as prostate cancer.

Pressing on the prostate gland does not hurt, although it may make you feel like urinating. If there is an infection in the prostate, it may feel tender when the prostate is pressed.

What happens after a rectal examination?

A rectal examination usually takes one to five minutes to complete, depending on whether your GP finds anything unusual.

Once the rectal examination has been completed, your GP will gently remove their finger from your anus. You may have a small amount of bleeding from your rectum, particularly if you have haemorrhoids.

Your GP will clean any gel or blood from your rectum, and will then leave the room so that you can get dressed in privacy.

Once you are dressed, your GP will return to discuss the results of the rectal examination with you.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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