The DRE (aka Digital Rectal Exam) can invoke fear in the eyes of even the toughest man. Why wouldn’t it, after all who really knows what happens behind the closed door of the doctor’s office.
So What Really Happens in a DRE Exam?
The exam itself is usually just one component of a full male genitourinary health exam, essentially we are checking the plumbing out. The entire exam takes less than 10 minutes and involves only three steps.
Step 1: External Genital Inspection and Palpation. The clinician will start by visually inspecting the genital hair and skin. Then examining the penis, scrotum and glans by visualizing as well as palpating the structures. Pressure will be applied to each of the structures with enough firmness to determine if there are any lumps, bumps or concerns but not so hard as you should feel any pain.
Step 2: Checking for Inguinal and Femoral Hernias. The clinician will ask the patient to bear down or cough to visually inspect for inguinal and femoral hernias. To palpate, the clinician will draw their pinky or index finger into the inguinal canal by tracing up the scrotum into the canal. The skin is usually lax enough on most males that this causes minimal discomfort. Once in the canal, the clinician will ask the patient to bear down or cough to determine if there is any concern of herniation in the area. To check for a femoral hernia, the clinician will locate their hand on the hip crease and ask the patient to again cough or bear down.
Step 3: Digital Rectal Exam. This exam can be conducted side lying or bent over the table. In both situations the patient will be asked to flex at the hip. Initially, the clinician will conduct a visual inspection of the anal area and then palpate externally to determine if there is any pain or structures that are of concern.
The clinician will apply lubricant to one gloved finger and will ask the patient to bear down placing their finger at the edge of the anal canal. Once released, the finger will slowly be guided inside along the released muscle. The clinician palpates the rectal wall and will ask the patient to bear down then recheck the rectal wall. Then the clinician will palpate the prostate checking firmness, size of lobes and median sulcus. A prostate looks like a half of a peach with two half rounds (lobes) connected by a crease (sulcus). It should feel firm like pressing the tip of someone’s nose and both lobes should be equal in size.
Lastly, the patient will be asked to squeeze the clinician’s finger to check the sphincter tone, and then once relaxed, the finger will be removed and the exam is complete.
What If I Have to Go to the Washroom?
Prior to the exam starting every patient is given an opportunity to visit the washroom. During the exam, it is normal to feel anxious, and even to feel the sensation of needing to have a bowel movement or urinate. It is normal that a pressure sensation applied to the area can initiate this reflexive desire in the body. The exam is quickly completed and then the patients are able to relieve themself, if necessary.
Why Would I Want To Have This Exam Done?
Hernias are extremely common among men, 2% of all men will experience a hernia in their lifetime. Caught early, long term damage and the need for surgery can be avoided. Visual and palpation inspections done at regular intervals on all male genitalia can help to establish baselines, so that abnormal findings can be reported and acted on quickly. Knowing someone has got your back can provide many men with a sense of relief.
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