Digital rectal examination: does it hurt? See how it’s done and when to do it

What is digital rectal examination?

The digital rectal exam, popularly known as a prostate exam, serves to detect benign prostatic hyperplasia (natural enlargement of the prostate) and prostate cancer .

In it, a urologist inserts the index finger, properly lubricated and protected by a latex glove, into the patient’s anus to feel the region of the end of the large intestine.

The exam is painless , fast and is one of the most efficient ways to diagnose cancer of the prostate. It is usually done in conjunction with PSA, a test that measures the levels of an enzyme produced by the prostate in the blood.

It can also be done to detect problems with women’s reproductive organs and to reach gut health by diagnosing hemorrhoids and fissures in the anus.

Despite the taboo, the prostate exam is very important and should be done annually by men over 50, as the risk of prostate cancer increases as we age.

In Brazil, prostate cancer is the second most common among men, affecting 1 in 7 individuals. Still, according to a survey by the Brazilian Society of Urology (SBU), 47% of the men interviewed never underwent digital rectal examination.

It is very important to combat this problem through information, as this is a taboo that takes people’s lives. Check out more details and find out about the Digital Retinal Exam!

  1. What is digital rectal examination?
  2. What is the prostate?
  3. What is it for?
  4. How is done?
  5. When should it be done?
  6. Female rectal examination
  7. Contraindications
  8. Pre-examination and post-examination care
  9. Results of
  10. What can affect the results?
  11. Scratchs
  12. Pricing
  13. Complementary exams
  14. Common questions

What is the prostate?

The prostate is a small gland, about the size of a walnut, found below the bladder.

It surrounds the urethra and has the function of producing a colorless fluid that, together with the sperm produced by the testicles, forms the semen, which is expelled during ejaculation.

What is it for?

Digital rectal examination is part of a regular health check-up and can be used to investigate symptoms such as problems with urination. However, not all prostate problems can be felt through this examination.

It is usually done for:

  • Check the growth of the man’s prostate. A prostate tumor can often be revealed through swelling that is easily detectable by touch;
  • Check if the tumor in the prostate has spread to other tissues or if it has affected the prostate again after treatment;
  • Detect problems in women’s reproductive organs, such as the uterus and ovaries. It is usually done during a common pelvic exam or during a pap smear. It can be done to check for symptoms such as pelvic pain and vaginal bleeding;
  • Assist in the diagnosis of appendicitis (inflammation in the appendix);
  • Prepare the patient for colonoscopy (an examination that examines the small intestine) or proctoscopy (a procedure that examines the anus, colon and rectum);
  • Find the cause of symptoms like blood in your stool, stomach or pelvic pain, changes in your urine or unregulated bowel;
  • Collect a stool sample to check for the presence of blood;
  • Diagnose hemorrhoids or tumors in the rectum. Digital rectal examination alone is not sufficient to diagnose colorectal cancer. Still, it is an effective way to confirm the presence of hemorrhoids, as they are soft and easy to detect;
  • In newborn children, it serves to check for the presence of an anorectal problem known as imperforated anus, a congenital malformation in the rectum.

How is done?

The exam is very simple and painless. The urologist uses a new disposable glove with lubricant and introduces the index finger into the rectum, which is the final portion of the large intestine.

He can ask the patient to apply force, as if to defecate, so that the anus is more accessible, which can increase the speed of the procedure.

The procedure can take from 15 seconds to 2 minutes. During this time, the doctor, through touch, will assess the size, density and shape of the prostate, looking for lumps, soft or hard spots and other abnormalities.

Because prostate cancer usually begins at the back of the gland, which can be felt easily during a digital rectal exam, it can be easily identified. If the prostate is larger than normal, the patient may experience some discomfort or slight pain during the exam.

It is very important that the patient remains as relaxed as possible. It is not necessary to put yourself in a vexing position. The examination can even be done with the patient standing and the result is given on the spot.

When should it be done?

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Even if you live a healthy life, eat well with a diet rich in fruits and vegetables, and exercise regularly, this does not mean that you should stop going to the doctor regularly, at least once a year.

This goes for all types of specialists, from your trusted general practitioner to your dentist. So, why should it be any different with the urologist?

To clear up your doubts about when to take the exam, we have made a list with the main indicators that you should start taking the preventive exams:

If you are over 50

Men over 50 years of age, in particular, should visit the urologist at least once a year to do preventive exams, as, as previously said, prostate cancer is the second leading cause of cancer death among men.

One of the main risk factors for prostate cancer is aging.

Family cancer history

When you have a family history of cancer, whatever it is, your chances of developing prostate cancer are greater. So it is important to be proactive and start doing preventive exams from the age of 40, after all, insurance died of old age, right?

If you have a father or brother who has been diagnosed with prostate cancer, your chances are up to 3 times greater to have the disease, so be responsible, break this taboo and redouble your health care.

Scientific studies also show that prostate cancer develops more easily in men born to mothers who have had breast cancer . This is most likely because of a defective gene inherited from the mother.

In such cases, men develop the disease before  age 65. All the more reason that, if that is your case, you go ahead to the urologist.

In addition to all of these factors, black men are also more likely to develop prostate cancer than Asians and whites . So, double your attention!

Problems urinating

If the urge to urinate strikes with unusual frequency, stay tuned. Frequently waking up in the middle of the night to urinate or excusing yourself during the day to visit the bathroom is a strong indication that your prostate may be in trouble.

This is because as we get older, the prostate gland starts to increase in size, which can have a huge impact on your daily life.

An enlarged prostate shows symptoms such as:

  • Decreased urine flow (weak stream);
  • Difficulty starting to urinate;
  • Urge to urinate increased;
  • Difficulty continuing to urinate once it has started.

So, if you are feeling a greater than normal urge to go to the bathroom to pee, if you have trouble starting or stopping urination and have already ruled out the possibility that this is caused by the natural enlargement of the prostate, schedule an exam like this as possible.

Other symptoms, such as blood in the urine, which are less common, are usually caused by problems much more serious than the natural enlargement of the prostate. In such cases, do not waste time, clear appointments and run to a doctor.

Bone pain and pelvic discomfort

Pains in the pelvis and prostate are more than enough signs for you to schedule an exam. Once the cancer starts to spread, the pain occurs around the hips, the lower back, the pelvis and the upper thighs.

It is very common for them to occur in several locations at the same time. So, if you experience this type of discomfort, see a doctor.

The bone pain grows gradually, showing itself mild at first and increasing in intensity as time goes by. So, if that little pain starts to get more intense, schedule an exam.

Deregulated diet

Eating well, with a diet rich in nutrients from vegetables, and decreasing your intake of high-fat foods is almost a mantra when it comes to healthy living. And in fact, if you eat right, the chances of prostate cancer will be less.

So, if you are a man in your 50s, go to the steakhouse frequently and eat a lot of processed foods , you have an obligation to go to the doctor and get your prostate health. There is no excuse.

Although the influence of diet on the development of prostate cancer is not fully understood, the American Society of Clinical Oncology (Asco) published, in May 2017, a report that links one-third of cancer cases to lifestyle choices that include food.

In addition, some recent studies have raised the suspicion that excessive consumption of fried meat and well-done barbecues is associated with an increased risk of colon, rectal, pancreatic and prostate cancers.

Sedentary lifestyle

Leading a sedentary lifestyle can be a good reason to start worrying about prostate health. Exercise is the best antioxidant out there and can help reduce inflammation by making oxygen circulate better in the blood.

These anti-inflammatory effects can help you ward off cancer and other prostate-related illnesses.

Recent scientific studies show an interesting correlation between weight and the incidence of prostate cancer.

Researchers from the University of Oxford, England, followed 140,000 men, in their 50s, from 8 European countries, for 14 years. In this period, there were about 7 thousand cases of prostate cancer, of which 934 cases were fatal.

The study concluded that obese men, that is, with a high body mass index ( BMI ) and wide waist, have a lower chance of acquiring mild types of prostate cancer, but a greater probability of acquiring the more severe types of the disease.

Although the reasons are still not fully understood and further studies are needed to prove this correlation, here’s the tip: if you lead a sedentary lifestyle, are overweight or obese, go to the urologist and do the preventive exam.

Female rectal examination

The procedure for women is the same as for men. It can be part of a routine gynecological examination. During the consultation, the test can be used to help assess the condition of the woman’s pelvic organs.

As with men, testing in women can help identify problems such as bleeding, constipation, urinary problems and fecal incontinence.

In exceptional cases, when vaginal examination is impossible, it can be done to ascertain the health of the uterus and ovaries.

Contraindications

Although there are no situations in which the digital rectal exam is contraindicated, it is necessary to be careful when performing the exam in children. It is also contraindicated to overuse the prostate of neutropenic patients and patients with abscesses and prostatitis (inflammation in the prostate).

Pre-examination and post-examination care

Digital rectal examination is very safe and easy to perform. Almost no preparation is necessary before the exam, as it is very fast and is done inside the consultation room, taking a very short time.

It is recommended to get there very clean so as not to cause any kind of embarrassment.

As it is painless and very fast, there is also no care to be taken after the exam. You may feel some pain during the procedure if you have a sore on the anus, but this discomfort is minimal and will go away as soon as the exam is over.

Best of all, the test only needs to be performed, in most cases, once a year. They are only small moments of discomfort, once a year, so that you feel calm and safe.

What to do before / during the consultation?

Because it is still a very taboo subject, many men may be uncomfortable and not know how to behave during the exam.

The reality is that there is not much secret. The digital rectal exam is quick, painless and does not affect your sexuality. On the contrary, it helps you stay alert to the signals your body is giving you about your health.

On the other hand, what can greatly affect your sexuality is prostate cancer. In advanced stages, the treatment may end up leaving the patient infertile, impotent, decrease the intensity of the orgasm and even cause pain at that time.

In order to make you a little less nervous when making the appointment with the urologist and to try to break some of this taboo, we have created a list with useful tips to prepare for the exam and how to behave during the exam:

Chat with close friends

Friends who have already taken the exam, who are aware of how it works, can give you a better idea of ​​what it will look like and how to behave. This is because they have already gone through the situation, and left it with their heads held high and full of dignity.

You need not be ashamed of being afraid. The topic is still very controversial, it is true. But close friends can assure you, based on practice, that the exam isn’t all that, that it doesn’t hurt and that it’s nothing too much.

Another valuable tip is to talk to a woman. It can be your wife, your mother, girlfriend or friend. A good partner can help you make the right decision, as women are more used to facing these types of exams, so they usually give strength and explain that nothing is as complicated as it seems.

Ask questions with the doctor

The urologist sees several patients a day. For him, this is a recurring exam and he already knows how to deal with men who are nervous. If you have any  questions or concerns, talk to the doctor before the exam, as he will know how to reassure you.

It is also very important that you inform your doctor if you have hemorrhoids, anal fissures or other problems in the anus . These complications can make the exam more uncomfortable than it already is. Then talk to the doctor and explain all your conditions so that he can assess them and learn how to best proceed.

Take it easy

Taking the consultation in sports, making jokes and jokes, can increase the level of comfort during the consultation. Adding a good dose of humor helps to let go of tensions and make the consultation flow better.

The exam does not hurt your manhood

Put the taboo aside and start thinking about the benefits of taking this exam regularly. Common sense dictates, through jokes and bar conversations, that the prostate exam will hurt your manhood and that it can even affect your sexuality.

As it is very difficult to talk about this topic without touching on the subject of homosexuality, let’s get to the facts: feeling anal pleasure does not define sexuality . On the contrary, what defines sexuality is the sex you are attracted to.

Therefore, regardless of your beliefs, know that a single finger, even more so in a medical context such as digital rectal examination, is far from affecting anyone’s masculinity.

Results of

The digital rectal exam is done to find out whether or not there are problems in the prostate, other structures of the pelvis or at the end of the large intestine. The doctor inserts the indicator into the patient’s anus and, through touch, tries to detect problems in these areas.

When the results are normal, problems such as enlarged organs in the region, such as the prostate, are not felt by the doctor.

For men, abnormal results are detected when the prostate is enlarged, which can mean prostatic hypertrophy, inflammation of the prostate or, in more serious cases, cancer.

In women, abnormal results may indicate cervical or ovarian tumors.

Abnormal growths, such as hemorrhoids, polyps, tumors and abscesses, can be detected in the lower layer of the rectum. Anal fissures can also be found, in addition to bladder problems.

At the end of the exam, the doctor will talk to the patient and clarify what was felt, what are his suspicions and may ask for more tests.

What can affect the results?

Hemorrhoids and anal fissures can make the test more painful and make the doctor’s job more difficult, but they do not affect the result.

Scratchs

There are no major risks related to digital rectal examination. Patients with hemorrhoids or anal fissures may experience minor bleeding. Other than that, the most that can happen is that you feel slight discomfort during the test.

Pricing

Because it is a routine exam, the digital rectal exam can be done free of charge by SUS. Your health insurance prices may vary according to the plan, with the region and city where you are going to do it.

Complementary exams

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PSA

The PSA test is complementary  to the prostate test, that is, it must be done in conjunction with it. This is a blood test that measures levels of PSA, an enzyme produced by the prostate.

When PSA levels in the blood are above normal, it is likely that the prostate has some type of problem. However, high levels of PSA in the blood do not necessarily mean prostate cancer.

There are many factors that can influence an increase in PSA levels in the blood. Are they:

  • Some types of medical procedures;
  • The use of certain medications;
  • The natural enlargement of the prostate;
  • Prostate infections.

However, PSA alone is not sufficient to diagnose prostate cancer and other problems. Often, patients can experience complications without altering their PSA levels in the blood.

Transrectal ultrasound

Through sound waves, an ultrasound machine will generate images of the prostate on a screen. During the test, the doctor inserts a small probe into the patient’s rectum. The test takes, on average, 10 minutes. It can be quite uncomfortable, but it is painless  and has no lasting side effects.

Prostate biopsy

A biopsy is a procedure that involves removing a tissue sample for further microscopic analysis. In the case of prostate biopsy, the doctor uses a needle to remove very small pieces of the prostate.

To perform the exam, the doctor can use transrectal ultrasound to guide the needle to the correct position. The samples go for analysis and are the most effective way to define whether or not cancer is present.

The procedure takes 10 to 15 minutes. The patient may experience hypersensitivity and / or minor bleeding after the procedure.

Flowmetry

Flowmetry is an exam done to measure the force of the jet and the amount of urine expelled in each urination. This test is important, because when changes in the prostate occur, the jet becomes slower and weaker.

To perform the exam, it is necessary to drink at least 1L of water before the exam and be willing to urinate. The patient then urinates and, a device that will make the records.

Laboratory urine test

The urologist may order a urine test. In it, it is necessary to collect a small amount of the liquid to assess whether there is the presence of blood or microorganisms that may be present in cases of urinary infection , for example.

The collection should be done with the first urine in the morning, placing it in a plastic container provided by the clinic. The sample must be taken to the laboratory about 30 to 60 minutes after collection.

Common questions

Does digital rectal examination hurt?

The exam is completely painless , without sequelae and less uncomfortable than the gynecological exam. It is not necessary to be in a vexing position, with the exam being able to be carried out, even, with the man standing.

And the most important: the diagnosis comes out on time. As soon as the exam is done, the doctor already tells you the condition of the prostate.

Should trans women be tested?

Because they are subjected indefinitely to hormonal treatment that blocks testosterone and stimulates the production of estrogen (for breast growth, for example), transgender women  do not need to be tested.

Because of the hormones, the prostate (which is not removed during sex change surgery) stops growing.

However, these patients must continue to do regular monitoring and hormone replacement correctly. Many patients end up taking hormones indiscriminately because they want to see a quick result, and this is dangerous.

Therefore, tests to prevent thrombosis , liver disease and breast cancer are necessary and should be performed regularly.

Isn’t the PSA exam an alternative to the touch exam?

No!  The digital rectal exam and PSA are complementary , that is, they must be done together, to avoid the occurrence of false positives / negatives.

How often do I need to take the exam?

The frequency of the examination will depend on the patient’s health status and the levels of PSA present in the body.

When PSA levels are below 2.5ng / mL, the test should be repeated every 2 years. When they are above 2.5ng / mL, it must be performed annually. And if PSA levels are normal, the touch exam should also be repeated annually.

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