• abdomen
• diagnosis

For as long as one can remember, digital rectal examination (DRE) has been the cornerstone of completing the assessment of any patient presenting with any gastrointestinal (GI) symptom, including acute abdomen, as taught in major textbooks in undergraduate and postgraduate curriculum. Nevertheless, it is important to challenge the dogma, and hence recently proponents have argued that given advances in medical technology and investigatory tools, this method of examination is now outdated, specifically given that it is invasive and can be uncomfortable, if not painful, for the patient, as well as demeaning.

In order to determine whether it should be used, it is important to clarify what information can be obtained from a DRE, the indications for undertaking the procedure, the difference between specialty and specialist, the difference between screening and assessment, and the potential legal ramifications of not undertaking the procedure.

What clinical information is gained by undertaking a DRE? It involves initial inspection of the perianal tissues to detect any cutaneous changes, that is, pigmentation, excoriation, fistulae, inflammation and so on. This is followed by the digital component of the examination with assessment of the anal tone, ability to palpate the walls of the anorectum, any evidence of extra luminal ‘bogginess’ or pain, presence of/type of …