All in a Day's Work

"You must do the thing you think you cannot do."-Eleanor Roosevelt

My first month of Internal Medicine is winding down and without fail I've had the opportunity of performing my first Digital Rectal Examination (DRE). Needless to say, I was beyond uncomfortable and although my patient did not let on and was very compliant and accommodating, so was he. 

I've been following this patient now for a week and I must say, there are times when I am exhausted, cold and hungry and would love nothing more than to retreat to my bed with the covers pulled up to my neck and tucked in tightly all around; however, the one thing that disturbs me to the core, disrupting my daydream and selfish retreat is the fact that there is someone, lying in a hospital bed on a ward being attended to by the team I am apart of who will more than likely (or so I would like to believe) take note of my absence. This is the most rewarding part of my Internal Medicine experience. 

Now that I've gotten that off my chest, let's take a look at the DRE as far as when, why and how it is done. 

Let's talk about the DRE.

A Digital Rectal Examination is an examination of the lower rectum and internal organs such as the prostate gland. This procedure can detect any abnormalities of the prostate gland in the male, such as an enlarged prostate; detect the presence of tumors, to obtain feces for a fecal occult blood test which is used to monitor gastrointestinal bleeding or possible colon cancer, to assess the function of the anal sphincter in the presence of fecal incontinence as well as to assess the extent of hemorrhoids. 

The process doesn't require any instruments or fancy equipment; rather gloves and a lubricant are all that are needed. 

The examination will require the patient to be disrobed and also in a comfortable position, such as lying in the fetal position with their knees to their chest/chin. 

As the examiner you will then insert your gloved and lubricated finger into the anus and then into the rectum gently rotating younger finger so as to examine the posterior part of the prostate and the surface. You are to comment in your notes whether or not it is firm (which can be described as the feeling of the tip of your nose) or hard (which can be described as the feeling of the tip of your elbow). You are also to comment on the surface, whether or not it is smooth, bumpy, nodular etc. 

Throughout the examination it may help remove the awkwardness if you would reassure the patient that they are doing fine, and of everything you're going to do and are doing. 

Once you're done and your finger is removed be sure to comment in your notes on the contents that may be on your gloved finger. Be sure to thank the patient, discard all soiled materials and cover the patient. 

I will admit, it helps a lot if you at least appear confident in what you're about to do and if the patient is accommodating and understanding of what you're about to do and why. 

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