2. Procedure

3. The digital rectal examination:- 1- The patient undresses 2- Then is placed in a position where the anus is accessible (lying on the side, squatting on the examination table, bent over the examination table, or lying down with feet in stirrups). 3-If the patient is lying on their side, the physician will usually have them bring one or both legs up to their chest. If the patient bends over the examination table, the physician will have them place their elbows on the table and squat down slightly. If the patient uses the supine position,

4. the physician will ask the patient to slide down to the end of the examination table until their buttocks are positioned just beyond the end. The patient then places their feet in the stirrups.
4-The physician spreads the buttocks apart and will usually examine the external area (anus and perinium) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient relaxes, the physician slips a gloved and lubricated finger into the rectum through the anus and palpates the insides for approximately sixty seconds.

5. Indications:-
1-Diagnosis of rectal tumors and other forms of cancer; 2-Diagnosis of prostatic disorders, tumors and benign prostatic hyperplasia; 3-Estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries; 4-In females, for gynecological palpations of internal organs

6. 5-Examination of the hardness and color of the feces (i. e
5-Examination of the hardness and color of the feces (i.e. in cases of constipation, and fecal impaction); 6- Prior to a colonoscopy or proctoscopy; to evaluate hemorrhoids. 7-In newborns to exclude imperforate anus.

7. The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; sigmoidoscopyis preferred. However, it is an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum. Sometimes proctoscopy may also be part of a rectal examination.

8. Digital rectal exam
Normal:
No problems such as organ enlargements or growths are felt.
Abnormal:
Problems such as organ enlargements or growths are felt.
For men, the prostate gland may be enlarged. This may mean benign prostatic hypertrophy (BPH) or inflammation of the prostate gland (prostatitis). Tumors are felt.
For women, growths such as tumors of the cervix, uterus, or ovaries are felt.
Growths such as hemorrhoids, polyps, tumors, orabscesses may be found in the lower rectum. Breaks in the skin around the anus (anal fissures) may be found. Problems of the bladder may also be felt.