What is a rectal examination?
A rectal examination is a type of physical examination during which a doctor or nurse inserts a finger into your rectum (back passage) to feel for abnormalities.
Some people find having a rectal examination embarrassing, but it only takes a few minutes and is not usually painful.
Read more about how a rectal examination is performed.
What is it used for?
A rectal examination may also be required if a person develops changes in their normal bowel habits, which could indicate a problem with their digestive system. These changes could include:
- bleeding from your rectum
- loss of normal bowel function, also called bowel incontinence (and occasionally bladder incontinence)
- pain in your rectum or anus
The prostate gland
The prostate gland is a small gland found only in men. It is located in the pelvis, between the penis and bladder, and surrounds the urethra (the tube that carries urine from the bladder to the penis).
It can be examined by placing a finger into the rectum. Changes in the prostate, such as swelling and hardening, can be felt in this way.
It is common for the prostate gland to become larger in older men. This can place pressure on the bladder and urethra and cause symptoms such as:
- difficulty beginning to urinate
- a flow of urine that is weak or stops and starts
- having to push or strain to pass urine
- a frequent need to urinate
- waking up frequently during the night to urinate
Prostate enlargement can be troublesome to live with but does not pose a threat to health. However, it causes similar symptoms to prostate cancer, and a rectal examination is one way to tell whether the symptoms are caused by prostate enlargement or prostate cancer.
Prostate cancer can cause the surface of the prostate to become hard and bumpy, while prostate enlargement will not usually affect the surface.
A rectal examination is not a guaranteed way of diagnosing prostate cancer, so it is normally used in combination with other tests such as a blood test and a biopsy, where a sample of the prostate gland is removed for further testing.
How it is performed
A rectal examination can be carried out by your doctor, a nurse who specialises in treating bowel problems, or a specialist doctor.
For convenience, the rest of this section will refer to your doctor carrying out the rectal examination.
Many people find rectal examinations embarrassing, and your doctor will be fully aware of this. Some people may also be sensitive about having a rectal examination for religious or cultural reasons.
Therefore, you may prefer a rectal examination to be carried out by a doctor of the same sex, or you may want to have a friend or relative present during the examination. If you have any particular preferences, tell your doctor in advance.
Also tell your doctor if you have had severe pain as this may indicate an underlying health condition. If this is the case, a rectal examination may need to be carried out under a local anaesthetic, where medication is used to numb the area.
The rectal examination procedure
Before you have a rectal examination, you will asked to remove your lower clothing. Your doctor may suggest that you get changed behind a curtain, or they may leave the room if you want them to.
You will be asked to lie on a couch, on your left side, and bring your knees up towards your chest. In some cases, women may be asked to lie on their back and have both their feet raised and supported by stirrups.
Your doctor will start by making a careful visual examination of your anus. They will look for any abnormalities, such as:
- swollen blood vessels around the anus or rectum, known as haemorrhoids or piles
- damage to the anus, such as a tear in the lining, known as an anal fissure
Your doctor will put a glove on one hand and use a gel to lubricate one of their fingers. They will then gently push the finger into your anus and then up into your rectum. You may feel a little discomfort or pain in this stage of the examination.
During the rectal examination, you may be asked to squeeze your rectum around their finger so that they can assess how well the muscles in your rectum and bowels are working.
If you are a man, your doctor may also firmly press against your prostate gland. A healthy prostate should be smooth to the touch, so they will check for any hard or lumpy areas on your prostate. This may indicate the presence of prostate disease such as prostate cancer.
Pressing on the prostate gland does not hurt, although it may make you feel like urinating. If there is an infection in the prostate, it may feel tender when the prostate is pressed.
What happens after a rectal examination?
A rectal examination usually takes one to five minutes to complete, depending on whether your doctor finds anything unusual.
Once the rectal examination has been completed, your doctor will gently remove their finger from your anus. You may have a small amount of bleeding from your rectum, particularly if you have haemorrhoids.
Your doctor will clean any gel or blood from your rectum, and will then leave the room so that you can get dressed in privacy.
Once you are dressed, your doctor will return to discuss the results of the rectal examination with you.