Intended for healthcare professionals

Letters Digital rectal examination

Author’s reply

BMJ 2011; 342 doi: (Published 28 June 2011) Cite this as: BMJ 2011;342:d3960
  1. Des Spence, general practitioner1
  1. 1Glasgow G20 9DR, UK
  1. destwo{at}

I have never suggested that rectal examination has no value but merely that clinicians must know its limitations. In primary care the prevalence of rectal and lower urinary tract symptoms is high but the prevalence of sinister disease low, especially in young people. Consequently, even in those with symptoms, digital rectal examination is of unknown sensitivity and specificity with an unknown potential for both false reassurance and false positive outcomes. For example, around 70% of abnormal results on prostate examination were normal a year later.1 Around a quarter of rectal tumours are missed on rectal examination in primary care, and 70% of those diagnosed with a “palpable rectal tumour” on such examination do not have cancer.2

Doctors should have absolute clarity of indication and always question whether rectal examination will change clinical management. Digital rectal examination is indicated for tenesmus and possible faecal impaction and to assess anal tone and prostatitis. But these are rare indications in primary care, and I stand by my conclusion that digital rectal examination has very occasional and limited indication. Routine rectal examination such as in everyone admitted to a care of the elderly or surgical ward is simply not justifiable, despite the protests and anecdotes offered.3 4 Digital rectal examination is what it is: an unpleasant invasive procedure and of questionable benefit. The point of my article was to raise this debate.


Cite this as: BMJ 2011;342:d3960


  • Competing interests: None declared.


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