Don’t Be Afraid of a Rectal Exam

Mention “rectal exam” and many people cringe and even avoid making that doctor appointment. But what exactly does a digital rectal exam entail, and who needs one? Doctors may perform a rectal exam to look for tumors or cancers inside the rectum, assess the functioning of your anal sphincter, evaluate for hemorrhoids or determine other causes of pain or bleeding. Both women and men may find themselves in need of this exam. However, due to the increasing risk of prostate cancer that comes with age, men are the more likely candidates for a rectal exam. 

About one in nine American men will be diagnosed with prostate cancer in their lifetime, and the average age at diagnosis is 66, according to the Prostate Cancer Foundation. The exam itself takes just a few seconds, and yet many men remain reluctant to get one — often due to worries about what the doctor might find, but also about the exam itself. 

Why a Rectal Exam

You may wonder, can’t my doctor just order lab work or an MRI? And the answer is yes, but nothing is a substitute for a simple exam done by your physician, especially because they are not just checking for cancer, but for other issues such as enlarged prostate or urination problems. To get to the prostate, doctors must go through the rectum. 

When to Discuss Screening with Your Doctor

Prostate cancer is the second-most common cancer in men (after skin cancer) and can be treated when caught early. When to start screening depends on your family history and demographic, per these American Cancer Society recommendations: 

• Age 50 for men who are at average risk of prostate cancer 

• Age 45 for men at high risk, including African Americans and men who have a father or brother diagnosed with prostate cancer before 65 

• Age 40 for men at even higher risk, including those with more than one close relative who had prostate cancer before 65

These recommendations can be overwhelming and confusing. At a minimum, you should start asking your doctor about prostate cancer screening by the age of 40. Based on your diagnosis and medical history, your doctor can guide you on what to do next. 

What Happens on Exam Day?  

A common reason patients often are nervous about a rectal exam is because their doctor hasn’t thoroughly explained why it’s necessary. But it’s your doctor’s job to make sure you have a comfortable experience, so ask questions. Remember, this exam is the equivalent of your doctor checking your heart with a stethoscope or looking into your ears with an otoscope. The most important thing you can do is just show up.

The other aspect of why you may be nervous: self-consciousness. Maybe you think you’re too hairy or are reluctant because you’ve just gone to the bathroom, but it doesn’t matter — your doctor won’t judge! All we care about at that moment is how this exam will benefit your future health. 

During the exam, the doctor wears gloves and gently inserts one finger into your rectum with ample lubrication. Your doctor will feel for lumps, bumps and nodules, looking for irregularities on the prostate. 

Patients may sometimes say, "Wait, but my PSA is fine, I'm peeing fine, I don't have cancer." But a lot of prostate cancer can be in small parts of your prostate and not show up on lab work. You may not feel it when urinating or notice any other issues, but doctors can detect it just based on that nodule. It’s similar to how women may not feel any breast irregularity but when they get an exam, their doctor may find a nodule that could be cancerous. 

You may feel the sensation that you have to go to the bathroom. That happens because your urethra goes through your prostate. But because the exam itself is a quick one, the feeling that you need to urinate or empty your bowels should go away. Otherwise, you shouldn't really feel any aftereffects from the exam unless you have prostatitis, a common condition.

Other Advice

Remember, your primary care physician can perform this exam — you don't need to see a urologist. And although you won’t need a rectal exam every year, be sure to visit your doctor annually for a wellness check.