Editing Rectal examination (section)

==Usage==
This examination may be used:
* for the diagnosis of [[prostate|prostatic]] disorders, [[benign prostatic hyperplasia]] and the four types of [[prostatitis]]. Chronic prostatitis/chronic pelvic pain syndrome, chronic bacterial prostatitis, acute (sudden) bacterial prostatitis, and asymptomatic inflammatory prostatitis. The DRE has a 50% [[Sensitivity and specificity|specificity]] for benign prostatic hyperplasia.<ref>{{Cite book|title=Rapid Review Pathology Third Edition|last=Goljan|first=Edward|publisher=Mosby Elsevier|year=2011|isbn=978-0-323-08438-3|pages=429}}</ref> Vigorous examination of the prostate in suspected [[acute prostatitis]] can lead to seeding of [[Sepsis|septic]] emboli and should never be done. Its utility as a screening method for [[prostate cancer]] however is not supported by the evidence;<ref name=pmid29531107>{{cite journal |doi=10.1370/afm.2205 |pmid=29531107 |pmc=5847354 |title=Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis |journal=The Annals of Family Medicine |volume=16 |issue=2 |pages=149–154 |year=2018 |last1=Naji |first1=Leen |last2=Randhawa |first2=Harkanwal |last3=Sohani |first3=Zahra |last4=Dennis |first4=Brittany |last5=Lautenbach |first5=Deanna |last6=Kavanagh |first6=Owen |last7=Bawor |first7=Monica |last8=Banfield |first8=Laura |last9=Profetto |first9=Jason }}</ref>
* for the evaluation of certain clinical symptoms: a male with change in urinary ability, [[Erectile dysfunction|impotence]], or dysuria (blood in the urine), pain with bowel movements;<ref name=":0">{{Cite web|url=https://www.pri-med.com/online-education/podcast/rectal-exam-frankly-speaking-73|title=Pri-Med &#124; Put That Finger Down! The End of the...|website=Pri-Med|access-date=2022-01-09|archive-date=2022-08-12|archive-url=https://web.archive.org/web/20220812212956/https://www.pri-med.com/online-education/Podcast/rectal-exam-frankly-speaking-73|url-status=dead}}</ref>
* a DRE with a [[Faecal occult blood (FOB) test|FOBT]] might have value for a person with anemia in the emergency room who has no other identifiable cause for anemia, is not actively bleeding, and there is concern that gastrointestinal malignancy may be the cause for their anemia;<ref name=":1" /><ref name="pmid29601803">{{cite journal|last1=Gupta|first1=Arjun|last2=Tang|first2=Zhouwen|last3=Agrawal|first3=Deepak|year=2018|title=Eliminating In-Hospital Fecal Occult Blood Testing: Our Experience with Disinvestment|journal=The American Journal of Medicine|volume=131|issue=7|pages=760–763|doi=10.1016/j.amjmed.2018.03.002|pmid=29601803|s2cid=5046971}}</ref><ref name="pmid11316179">{{cite journal|last1=Sharma|first1=Virender K.|last2=Komanduri|first2=Sri|last3=Nayyar|first3=Sanjay|last4=Headly|first4=Anna|last5=Modlinger|first5=Paul|last6=Metz|first6=David C.|last7=Verghese|first7=Vino J.|last8=Wanahita|first8=Anna|last9=Go|first9=Mae F.|last10=Howden|first10=Colin W.|year=2001|title=An audit of the utility of in-patient fecal occult blood testing|journal=The American Journal of Gastroenterology|volume=96|issue=4|pages=1256–1260|doi=10.1111/j.1572-0241.2001.03709.x|pmid=11316179|s2cid=20602869}}</ref><ref name="auto">{{Cite journal|last=Monash|first=Bradley|date=2017-07-01|title=Fecal occult blood testing in hospitalized patients with upper gastrointestinal bleeding|journal=Journal of Hospital Medicine|language=en|volume=12|issue=7|pages=567–569|doi=10.12788/jhm.2773|pmid=28699947|doi-access=free}}</ref>
* a true active gastrointestinal bleed: vomiting blood, vomiting [[Coffee ground vomiting|coffee-grind like material]], [[Hematochezia|defecating blood]] or ''black'' tarry stools that can not be easily attributed to facial trauma or oral surgery, eating beets or anything with red food dye or overuse of NSAIDS/over the counter pain medication. Doing a rectal exam to examine stool color may provide a clue as to the location of the bleed but is not a reliable indicator;<ref>{{Cite web|url=https://www.uptodate.com/contents/approach-to-acute-upper-gastrointestinal-bleeding-in-adults#H684000|title=UpToDate|website=www.uptodate.com|access-date=2019-11-13}}</ref><ref>{{Cite journal|last1=Jensen|first1=D. M.|last2=Machicado|first2=G. A.|date=December 1988|title=Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge|url=https://pubmed.ncbi.nlm.nih.gov/3263294/|journal=Gastroenterology|volume=95|issue=6|pages=1569–1574|doi=10.1016/s0016-5085(88)80079-9|issn=0016-5085|pmid=3263294}}</ref><ref name=":1" /><ref name="pmid29601803" /><ref name="pmid11316179" />
* for the [[medical diagnosis|diagnosis]] of [[appendicitis]] or other examples of an [[acute abdomen]] (i.e. acute abdominal symptoms indicating a serious underlying disease). Although a ''[[Journal of Emergency Medicine]]'' paper concludes: "We found the DRE to have a limited role in the diagnosis of acute, undifferentiated abdominal pain and acute appendicitis.";<ref name="pmid22883714">{{cite journal |doi=10.1016/j.jemermed.2012.06.015 |pmid=22883714 |title=Utility of the Digital Rectal Examination in the Emergency Department: A Review |journal=The Journal of Emergency Medicine |volume=43 |issue=6 |pages=1196–1204 |year=2012 |last1=Kessler |first1=Chad |last2=Bauer |first2=Stephen J. }}</ref><ref name=":1">{{Cite web|url=https://www.bumc.bu.edu/emergencymedicine/2018/05/28/fobt-and-dres-in-the-ed-june-2018/|title=FOBT and DRE's in the ED (June 2018) » Emergency Medicine {{!}} Blog Archive {{!}} Boston University|website=www.bumc.bu.edu|access-date=2019-02-20}}</ref>
* for the estimation of the muscle tone of the [[Human anus|anal]] sphincter, which may be useful in case of [[fecal incontinence]] or [[neurologic]] diseases, including traumatic spinal cord injuries;
* traditionally, the digital rectal examination (DRE) was considered an essential part of the physical examination for all trauma patients. However, the sensitivity of the DRE for injuries of the spinal cord, pelvis, and bowel is poor, and false positive and negative results are common. Thus, routine performance is unnecessary and generally unhelpful. The examination is warranted in cases where urethral injury or penetrating rectal injury is suspected;<ref>{{Cite web|url=https://www.uptodate.com/contents/initial-management-of-trauma-in-adults?search=TRAUMA&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H11715737|title=UpToDate|website=www.uptodate.com|access-date=2019-10-22}}</ref><ref>{{Cite journal|last1=Shlamovitz|first1=Gil Z.|last2=Mower|first2=William R.|last3=Bergman|first3=Jonathan|last4=Crisp|first4=Jonathan|last5=DeVore|first5=Heather K.|last6=Hardy|first6=David|last7=Sargent|first7=Martine|last8=Shroff|first8=Sunil D.|last9=Snyder|first9=Eric|last10=Morgan|first10=Marshall T.|date=July 2007|title=Poor test characteristics for the digital rectal examination in trauma patients|url=https://pubmed.ncbi.nlm.nih.gov/17391807/|journal=Annals of Emergency Medicine|volume=50|issue=1|pages=25–33, 33.e1|doi=10.1016/j.annemergmed.2007.01.022|issn=1097-6760|pmid=17391807}}</ref>
* in [[female]]s, for the limited [[gynecology|gynecological]] [[Rectovaginal examination|palpations of internal organs]] when the vaginal vault cannot be accessed or it is too painful (vaginal atrophy);
* for examination of the hardness and color of the feces (i.e. in cases of constipation, and [[fecal impaction]]);
* prior to a [[colonoscopy]] or [[proctoscopy]];
* to evaluate [[hemorrhoids]] although internal hemorrhoids are often too soft to be felt, a visual inspection may be more useful;<ref>{{Cite web | url=https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc-20360280 | title=Hemorrhoids - Diagnosis and treatment - Mayo Clinic| website=[[Mayo Clinic]]}}</ref>
* in newborns to exclude [[anal atresia|imperforate anus]];
* through the insertion of medical devices including thermometers or specialized balloons; to identify [[digestion]] problems, [[parasite]]s, [[organ (anatomy)|organ]] damage, anal bruising, and foreign objects in the rectal cavity;