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Above the dentate line, the mucosa is endoderm, has splanchnic innervation, and is insensitive to pain. Below the dentate line, the mucosa is ectoderm, has somatic innervation through the inferior rectal nerve, and is sensitive to pain. Figure 2. The dentate line represents the junction between the endoderm and ectoderm portions of the anal canal.
The internal anal sphincter surrounds the upper two-thirds of the anal canal. It is formed from a thickening of the involuntary circular smooth muscle in the bowel wall. The external anal sphincter surrounds the lower two-thirds of the anal canal and is a voluntary muscle. Figure 3. The internal anal sphincter is a ring of involuntary smooth muscle that surrounds the upper two-thirds of the anal canal, and the external anal sphincter is a ring of voluntary muscle that surrounds the lower two-thirds of the anal canal.
Start by communicating with the patient about why a DRE is necessary, what is involved, and how the exam will be performed. Prepare the patient for a little bit of discomfort with the exam. If possible, have the patient lay on their side in the left lateral decubitus position e. A standing rectal exam can also be performed, but it may not be as comfortable for some patients.
Usually, a standing exam is only performed for a prostate examination. First, inspect the anus. Look for any external hemorrhoids, skin tags, anal fissures, discharge, drainage, and any other abnormalities. Use your index finger of your dominant hand and place some lubricant jelly on it. Ask the patient to take a deep breath in, exhale, and relax. Note the external anal sphincter tone.
Ask the patient to bear down and feel for tightening of the sphincter against your finger. Palpate the rectal wall for masses, nodules, and tenderness. Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment.
As always, you should consult with your healthcare provider about your specific health needs. How is a digital rectal examination DRE performed? How is a speech-reception test performed? David M. The colon is the biggest part of your large intestine. It empties into the rectum, where waste collects as bowel movements. The rectum empties into the anus, where bowel movements leave the body. A primary care doctor or a gynecologist usually does a DRE. A gynecologist is a doctor who specializes in the health of women's reproductive system.
Other types of doctors, including gastroenterologists, surgeons, and oncologists may do DREs. A gastroenterologist is a doctor who specializes in the gastrointestinal GI tract. An oncologist is a doctor who treats cancer. You do not need to do anything special to prepare for a DRE. But there are a few things to keep in mind. Tell your health care team if you have hemorrhoids or anal fissures.
The DRE may make them worse. If you are concerned about the cost of your DRE, find out from your insurance provider what costs they will cover beforehand. Ask how much of the cost you will have to pay out of pocket. You will be asked to sign a consent form before your DRE. The form will state that you understand the benefits and risks of the DRE and agree to have the test. Your doctor or nurse will explain the test before you sign the form, and you can ask questions.
The DRE will take place in a private exam room at your doctor's office. The test only takes a few minutes. You will need to take off any clothes below your waist. You will be given a gown to wear or a cloth to wrap around your body.
For men.
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