The Digital Rectal Examination

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Last updated: June 3, 2018
Revisions: 10

Last updated: June 3, 2018
Revisions: 10

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  • Introduce yourself to the patient
  • Wash your hands thoroughly
  • Explain to the patient what the examination involves
    • Make sure you reassure the patient you can stop if it becomes too painful at any point
  • Ensure verbal consent is adequately obtained
  • Request a chaperone


  • Put on apron and gloves
  • Ask the patient to remove trousers and underwear
    • Cover the patient with a blanket when appropriate to maintain dignity
  • Position patient on their left side and bring their knees to their chest, positioning the buttocks at the edge of the couch
    • Ensure there is adequate lighting available for good visibility during the examination
  • Ask your chaperone to be on the other side of the coach, supporting the patient as they face away from you


  • Gently part the buttocks and expose the natal cleft
  • Inspect the perianal area for:
    • Skin disease (e.g. dermatitis) or skin tags
    • Pilonidal sinus, anal fissures, or anal fistula
    • External haemorrhoids
    • Rectal prolapse

Figure 1 – Findings as seen on DRE (A) Skin Tags (B) Anal Fissure


  • Lubricate your examination finger
  • Press your finger by the posterior anal edge
    • Note any anal fissures that can be felt here
  • Gently insert your finger into the anal canal, following the natural curve of the sacrum
    • Assess anal tone, also confirm by asking the patient to squeeze your finger
  • Carefully rotate your finger to feel all walls of the rectum
    • This is best done by pronating at the wrist
  • In males, palpate the prostate on the anterior wall
  • Withdraw the finger and inspect contents for stool, blood, or mucus

Completing the Examination

  • Clean the patient with paper towel
  • Ask the patient to re-dress
  • Wash your hands
  • Perform a gastrointestinal examination if indicated

Findings are usually described by convention of a clockface, with anterior as 12 o’clock and posterior as 6 o’clock