At a glance
A digital rectal examination (DRE) is one of the most common examinations in colorectal medicine. It involves the doctor inserting a gloved, lubricated finger into the rectum to feel for abnormalities. It is brief, usually mildly uncomfortable rather than painful, and provides important clinical information.
For many people, the anxiety about the examination is worse than the examination itself. This guide covers exactly what happens, how to prepare, and what your rights are during the process.
Why it is done
A rectal examination allows a doctor to:
- Feel for hemorrhoids — particularly internal hemorrhoids
- Assess the sphincter — muscle tone, tenderness, and function
- Check for fissures — though examination may be limited if a fissure is very painful
- Feel for masses — lumps or growths that need further investigation
- Assess the prostate — in men
- Evaluate the pelvic floor — muscle tension and coordination
- Check for prolapse — rectal wall laxity
It provides information that cannot be obtained any other way and is a standard part of colorectal assessment.
What happens
Before the examination
Your doctor will:
- Explain why the examination is needed
- Ask about your symptoms and medical history
- Ask about any conditions that might affect the examination (fissures, recent procedures)
- Gain your consent
- Offer a chaperone if you would like one present
Positioning
You will typically be asked to lie on your left side with your knees drawn up toward your chest. This is the most common position and provides good access while being reasonably comfortable. A sheet or drape is used to maintain your privacy.
The examination
- External inspection — the doctor looks at the area around the anus for any visible issues (skin tags, fissures, hemorrhoids, swelling)
- Lubrication — a generous amount of lubricating gel is applied
- Insertion — a single gloved finger is gently inserted. The doctor will ask you to bear down slightly, which helps relax the sphincter
- Assessment — the doctor feels around the rectal wall, checking for abnormalities, tenderness, and muscle tone
- Withdrawal — the finger is gently removed
- Cleaning — tissue is provided to clean the area
The entire physical examination typically takes less than a minute.
After the examination
Your doctor will discuss their findings with you. They may recommend further investigations or provide reassurance depending on what they found.
How it feels
Most people describe the sensation as:
- Pressure — a feeling of fullness or pressure, similar to needing to open the bowels
- Mildly uncomfortable — but not typically painful for most people
- Brief — over quickly
- Bearable — most people say it was better than they expected
If you have an active condition:
- Fissure — the examination may cause pain. Tell your doctor about the fissure beforehand. They may use extra lubrication, be especially gentle, or defer the examination if the pain is too severe
- Hemorrhoids — swollen hemorrhoids may make the examination more sensitive
- Abscess — the area may be very tender. Your doctor will be aware and adjust their approach
Reducing anxiety
- Breathe — slow, deep breathing helps relax the sphincter and reduces discomfort
- Bear down gently — when asked, this helps the sphincter open naturally
- Communicate — tell the doctor if you need them to pause or stop
- Ask questions — understanding what is happening reduces anxiety
- Remember it is routine — the doctor performs these examinations regularly and is not uncomfortable; the only person likely to feel awkward is you
- Bring support — you can have someone in the room with you if it helps
Your rights
- You can ask for a chaperone to be present
- You can request a doctor of a specific gender if available
- You can stop the examination at any time
- You can ask questions before, during, or after
- You can decline the examination entirely, though the doctor will explain why they recommend it
- Your dignity and privacy should be maintained throughout