Digital rectal examination !

Exam technique

An exam with a gloved, lubricated finger inside the rectum to check the anus, the rectum and, in men, the prostate.

Updated 2026-11-01

See it in 3D: Rectum · Anal canal · Prostate · External anal sphincter · Seminal vesicles

What it is

The digital rectal exam completes the abdominal exam when the clinical picture calls for it: gastrointestinal bleeding, a change in bowel habit, anal pain, prostate symptoms or suspected spinal cord compression. It lets you inspect the perianal area, assess sphincter tone, feel rectal masses and, in men, the prostate, and obtain stool to see its color and test for hidden blood. It requires a clear explanation, consent and, preferably, a chaperone.

Landmark anatomy

The anal canal is about 3 to 4 cm long, surrounded by the internal sphincter (involuntary) and the external sphincter (voluntary, supplied by the pudendal nerve, S2–S4).
The pectinate line separates lining with somatic supply (below, painful) from lining with visceral supply (above, barely sensitive): so internal hemorrhoids do not hurt and fissures do.
In men, the prostate and seminal vesicles are felt through the front wall of the rectum; in women, the cervix and the rectouterine pouch.

Technique, step by step

Explain the procedure and why, obtain consent and offer a chaperone; ensure privacy.
Place the patient in the left lateral position, hips and knees flexed, buttocks at the edge of the couch.
With gloves on, part the buttocks and inspect: external hemorrhoids, fissures, fistulas, abscesses, prolapse, skin lesions.
Lubricate the index finger, rest the pad on the anus and ask the patient to bear down gently to relax the sphincter.
Insert the finger slowly toward the umbilicus; assess sphincter tone at rest and when the patient squeezes.
Rotate the finger to feel all rectal walls for masses, tenderness or irregularity.
On the front wall in men, feel the prostate: size, consistency, median groove, nodules and tenderness; in women, the cervix.
Withdraw, check the glove (stool color, blood, mucus), clean the patient and record the findings.

Abnormal findings

A hard, fixed or ulcerated rectal mass: colorectal cancer.
Enlarged, smooth, rubbery prostate: benign prostatic hyperplasia; a hard nodule or stony prostate: prostate cancer; very tender and warm: acute prostatitis (palpate gently).
Reduced sphincter tone: neurological injury (cauda equina, spinal cord).
Melena on the glove: upper gastrointestinal bleeding; red blood: lower bleeding or an anorectal lesion.
Marked pain in the pelvic pouch with an acute abdomen: pelvic peritoneal irritation (pelvic appendicitis, abscess).

Common errors

A normal exam does not rule out disease: it does not replace colonoscopy or prostate testing.
Skipping the perianal inspection before inserting the finger.
Not explaining or offering a chaperone: it causes distress and ethical problems.

Test yourself

Think of the answer, then tap the question to see it.

In which position is the rectal exam most often done?

Left lateral with the hips and knees flexed (Sims position).

What does a normal prostate feel like?

About the size of a chestnut, smooth, rubbery and with a palpable median groove.

Why do internal hemorrhoids not hurt while anal fissures do?

The lining above the pectinate line has visceral, barely sensitive supply, while the lining below it has somatic supply.

What does reduced anal tone suggest in a patient with low back pain and urinary retention?

Cauda equina syndrome or another neurological injury, which is an emergency.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Digital rectal exam: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine, 2025); Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025).

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Representative model, for educational purposes only.