Physical examination maneuver

Physical Exam

Digital Rectal Exam

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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 As the finger is withdrawn, note any stool or blood on the glove.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

Showing 3 of 9 findings

Cauda Equina Syndrome

Reduced resting anal sphincter tone
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Strong

Prostate Cancer

Abnormal prostate on palpation
Rule in
Somewhat helpfulNo CI
Rule out
Minimally helpfulNo CI
Evidence:Moderate

Upper Gastrointestinal Bleeding

Melena on the examining glove
Rule in
Very helpful
Rule out
Minimally helpful
Evidence:Moderate

Related Bedside Tests

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Abdomen Palpation
Rule in:VHExtrahepatic Biliary Obstruction, VHIntussusception, VHPyloric Stenosis +32 more
Rule out:VHHepatocellular Jaundice, HAppendicitis, SHDiverticulitis +32 more
🎬Video coming soon
Abdomen Auscultation
Rule in:VHRenovascular Hypertension, MHBowel Obstruction, IEAbdominal Aortic Aneurysm +9 more
Rule out:MHRenovascular Hypertension, NHBowel Obstruction, IEAbdominal Aortic Aneurysm +9 more
🎬Video coming soon
Abdomen Percussion
Rule in:SHAscites, NHHepatomegaly, IEPerforated Viscus +2 more
Rule out:SHAscites, NHHepatomegaly, IEPerforated Viscus +2 more
🎬Video coming soon
Abdomen Inspection
Rule in:VHBowel Obstruction, SHAscites, ICCushing Syndrome +3 more
Rule out:SHAscites, SHBowel Obstruction, NHCushing Syndrome +3 more
🎬Video coming soon
Achilles Deep Tendon Reflex
aka Ankle jerk
Rule in:VHPeripheral Neuropathy, SHHypothyroidism, NHLumbosacral Radiculopathy +5 more
Rule out:VHPeripheral Neuropathy, MHHypothyroidism, NHLumbosacral Radiculopathy +5 more
🎬Video coming soon
Rebound Tenderness
aka Blumberg sign
Rule in:SHAppendicitis, MHDiverticulitis, MHPeritonitis +1 more
Rule out:SHAppendicitis, SHPeritonitis, MHDiverticulitis +1 more

Related Systems / Regions

GastrointestinalGenitourinaryPelvisReproductive

Related Diagnoses

Acute ProstatitisAnorectal DiseaseBowel ObstructionCauda Equina SyndromeConstipationFecal ImpactionPeritonitisProstate CancerUpper Gastrointestinal Bleeding

Related Chief Complaints

Back PainBlood in UrineBone PainDifficulty UrinatingNighttime UrinationUrinary FrequencyUrinary HesitancyWeak Urinary Stream

References

  • Jones D, Friend C, Dreher A, Allgar V, Macleod U. The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review. BMC Fam Pract. 2018;19(1):79. doi:10.1186/s12875-018-0765-y. PMID: 29859531. PMCID: PMC5985061.
  • 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. Corrigenda: Musculoskelet Sci Pract. 2019;43:128, PMID: 31300389; Musculoskelet Sci Pract. 2021;53:102355, doi:10.1016/j.msksp.2021.102355.
  • 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):142-143. 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.