Physical Exam

Digital Rectal Exam

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Video coming September 2026

How to Perform

With the patient standing and the buttocks and perianal area exposed, position the feet apart with the hips flexed and the forearms supported on the examination table. Inspect the perianal skin, anus, and perineum. Lubricate a gloved index finger, place the fingertip against the anus, and ask the patient to relax while gently advancing the finger toward the umbilicus. Assess resting sphincter tone, then sweep the finger circumferentially along the rectal walls, noting any masses or tenderness. In men, palpate the prostate for size, contour, consistency, tenderness, and nodules. As the finger is withdrawn, note any stool or blood on the glove.

How to Interpret

Cauda Equina Syndrome

Reduced resting anal sphincter tone

Rule in

InconclusiveWide CI

Rule out

Not helpful

Evidence:Limited

Prostate Cancer

Abnormal prostate on palpation

Rule in

Not helpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:Strong

Upper Gastrointestinal Bleeding

Melena on the examining glove

Rule in

Very helpful

Rule out

Minimally helpful

Evidence:Limited

References

Naji L, Randhawa H, Sohani Z, Dennis B, Lautenbach D, Kavanagh O, Bawor M, Banfield L, Profetto J. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med. 2018 Mar;16(2):149-154. doi:10.1370/afm.2205. PMID 29531107.
Dionne N, Adefolarin A, Kunzelman D, Trehan N, Finucane L, Levesque L, Walton DM, Sadi J. What is the diagnostic accuracy of red flags related to cauda equina syndrome (CES), when compared to magnetic resonance imaging (MRI)? A systematic review. Musculoskelet Sci Pract. 2019;42:125-133. doi:10.1016/j.msksp.2019.05.004. PMID 31132655.
Takada T, Nishiwaki H, Yamamoto Y, Noguchi Y, Fukuma S, Yamazaki S, Fukuhara S. The Role of Digital Rectal Examination for Diagnosis of Acute Appendicitis: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(9):e0136996. PMID: 26332867.
Dixon JM, Elton RA, Rainey JB, Macleod DA. Rectal examination in patients with pain in the right lower quadrant of the abdomen. BMJ. 1991;302(6773):386-388. PMID: 2004144.
Srygley FD, et al. Does this patient have a severe upper gastrointestinal bleed? JAMA. 2012;307(10):1072-1079. PMID: 22416103.
Smith RG, Lewis S. The relationship between digital rectal examination and abdominal radiographs in elderly patients. Age Ageing. 1990;19(2):142-144. PMID: 2337011.
Grucela A, Salinas H, Khaitov S, Steinhagen RM, Gorfine SR, Chessin DB. Prospective analysis of clinician accuracy in the diagnosis of benign anal pathology: comparison across specialties and years of experience. Dis Colon Rectum. 2010;53(1):47-52. doi:10.1007/DCR.0b013e3181bbfc89. PMID: 20010350.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.