Table 2. Components of Digital Rectal Exam (Reproduced with permission from (22).
Exam Component | Technique | Findings & Grading of response(s) |
---|---|---|
I. Inspection of the anus and surrounding tissue | Place patient in the left lateral position with hips flexed to 90°. Inspect perineum under good light | Skin excoriation, skin tags, anal fissure, scars or hemorrhoids |
II. Testing of perineal sensation and the anocutaneous reflex | Stroke the skin around the anus in a centripetal fashion, in all four quadrants, by using a stick with a cotton bud |
Normal: brisk contraction of the perianal skin, the anoderm and the external anal sphincter Impaired: no response with the soft cotton bud, but anal contractile response seen with the opposite (wooden) end Absent: no response with either end |
III. Digital palpation and maneuvers to assess anorectal function | ||
Digital palpation | Slowly advance a lubricated and gloved index finger into the rectum and feel the mucosa and surrounding muscle, bone, uterus, prostate and pelvic structures | Tenderness, mass, stricture, or stool and the consistency of the stool |
Resting tone | Assess strength of resting sphincter tone | Normal, weak (decreased) or increased |
Squeeze maneuver | Ask the patient to squeeze and hold as long as possible (up to 30 seconds) | Normal, weak (decreased) or increased |
Pushing and bearing down maneuver | In addition to the finger in the rectum, place a hand over the patients' abdomen to assess the push effort. Ask the patient to push and bear down as if to defecate | (i) Push effort: Normal, weak (decreased), excessive (ii) Anal relaxation: normal, impaired, paradoxical contraction (iii) Perineal descent: Normal, excessive, absent |