digital rectal examination (DRE)
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Indications
- anal pain, perianal pain or abdominal pain
- rectal bleeding
- anorectal mass
- perianal pruritus
- fecal incontinence
- constipation
- weight loss[7]
- allows for assessment of anal sphincter tone
- allows for testing of fecal occult blood
- initial evaluation of anorectal dyssynergia[10]
Contraindications
- NOT a reliable screen for prostate cancer[3][6]
- may allow for estimate of prostate size
- not a useful screen for colorectal carcinoma[3]
- evidence is mixed on whether digital rectal exam is beneficial alone or in combination with serum PSA[5]
* tubular adenoma > 10 mm, villous adenoma, high-grade dysplasia or colorectal cancer
* DRE superfluous with use of MRI during active surveillance of prostate cancer[8]
Procedure
Notes
- does NOT significantly affect serum prostate-specific antigen (PSA)
- hospitals performing digital rectal exams with explicit patient consent will not be eligible for Medicare & Medicaid reimbursement[7]
More general terms
Additional terms
- fecal occult blood; fecal immunochemical testing; fecal immunofluorescence testing, multitarget stool DNA (mt-sDNA, FOB, FIT, iFOBT, ColonCARE, Hemoccult, ICT, InSure)
- screening for colon cancer
- screening for prostate cancer
References
- ↑ nlmpubs.nlm.nih.gov/hstat/ahcpr/
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 3.0 3.1 3.2 US Preventative Services Task Force
- ↑ 4.0 4.1 Journal Watch 25(4):30, 2005 Collins JF, Lieberman DA, Durbin TE, Weiss DG; Veterans Affairs Cooperative Study #380 Group. Accuracy of screening for fecal occult blood on a single stool sample obtained by digital rectal examination: a comparison with recommended sampling practice. Ann Intern Med. 2005 Jan 18;142(2):81-5. Summary for patients in: Ann Intern Med. 2005 Jan 18;142(2):I23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15657155
- ↑ 5.0 5.1 Qaseem A et al Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 9 April 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23567761 <Internet> http://annals.org/article.aspx?articleid=167618
- ↑ 6.0 6.1 Naji L, Randhawa H, Sohani Z, et al Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med March/April 2018 vol. 16 no. 2 149-154 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29531107 Free full text <Internet> http://www.annfammed.org/content/16/2/149
- ↑ 7.0 7.1 7.2 7.3 Rajab TK, Bordeianou LG, von Keudell A et al Digital Rectal Examination and Anoscopy. N Engl J Med 2018; 378:e30. May 31, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29847759 https://www.nejm.org/doi/full/10.1056/NEJMvcm1510280
- ↑ 8.0 8.1 Remaly J Omit Digital Rectal Exam in Prostate Cancer Surveillance? Medscape. February 06, 2023 https://www.medscape.com/viewarticle/987915
- ↑ 9.0 9.1 Merelli A New HHS guidance requires consent for pelvic, breast, and other sensitive examinations. STAT. April 1, 2024 https://www.statnews.com/2024/04/01/informed-consent-pelvic-exam-new-hhs-guidelines/
- ↑ 10.0 10.1 Tantiphlachiva K, Rao P, Attaluri A, Rao SS. Digital rectal examination is a useful tool for identifying patients with dyssynergia. Clin Gastroenterol Hepatol. 2010 Nov;8(11):955-60. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20656061