Whats is a Digital Rectal Examination (DRE)?
A digital rectal examination is a simple procedure conducted by doctors to check for an enlarged prostate. It is done by inserting a lubricated, gloved finger into the rectum, which makes it a quick and easy way to detect an enlarged prostate. It can detect conditions such as benign prostatic hyperplasia (BPH) and prostate cancer.
The prostate is a walnut-sized gland found between the bladder and the penis, which produces part of the fluid in semen. It sits just in front of the rectum, so a doctor can feel the back surface of the gland through the rectal wall. The doctor checks its size, shape and texture, and whether there is any tenderness, hard areas or lumps.
A DRE can also be used to check the rectum and anus for other problems, such as lumps, haemorrhoids (piles), tears or signs of bleeding, and is sometimes used in the assessment of bowel symptoms.
Why You Might Need a DRE?
Your doctor may recommend a DRE if you:
- Have urinary symptoms, such as a weak or slow stream, difficulty starting to pass urine, passing urine frequently (including waking up several times at night), a feeling that your bladder has not emptied fully, or dribbling after passing urine
- Have blood in your urine or semen, or pain in the pelvis, lower back or when passing urine
- Are a man aged 50 or above, or younger with a higher risk, and are discussing prostate checks with your doctor
- Have a family history of prostate cancer, particularly in a father or brother
- Have an abnormal PSA (prostate-specific antigen) blood test, and your doctor needs to examine your prostate
- Have bleeding from the back passage, pain, or a change in bowel habits that needs to be checked
Why This Matters in Singapore
Prostate cancer is the most common cancer in men in Singapore. According to the Singapore Cancer Registry, 6,912 cases were diagnosed between 2017 and 2021, making up about 1 in 6 cancers in men. The risk rises with age, with family history, and is higher in Chinese men than in Malay or Indian men.
Early prostate cancer often causes no symptoms, so it can be missed if men wait for symptoms before seeing a doctor. Registry data cited by Farrer Park Hospital’s own urologists show that around 30% of prostate cancers diagnosed in Singapore between 2018 and 2022 were already at stage 4 when found. This is one reason why many doctors encourage men to discuss prostate checks early.
Singapore does not have a national prostate cancer screening programme. Local guidance recommends that men aged 50 and above, and younger men at higher risk, such as those with a family history of prostate cancer, speak to their doctor about the pros and cons of screening. Screening decisions are individual, because some prostate cancers grow so slowly that they may never cause problems, and your doctor can help you weigh up what is right for you.
Benign prostatic hyperplasia (BPH), the non-cancerous enlargement of the prostate, is very common as men grow older, and often causes urinary symptoms. BPH does not cause prostate cancer, but the two conditions can occur together and cause similar symptoms, which is why urinary symptoms should be properly checked.
What Happens Before a DRE?
- No preparation is needed for the procedure. You can eat, drink and take your medication as usual.
- You may wish to pass urine and empty your bowels beforehand, if you feel the need, so that you are more comfortable.
- You will be asked to remove your clothes below the waist and will be given a gown to change into.
- Tell your doctor if you have piles, an anal fissure (a tear), pain around the back passage, or have had recent surgery in the area, so that the doctor can take extra care.
- If you are also having a PSA blood test, your doctor will advise you on the best timing of the blood test and examination.
- Your doctor will explain what the examination involves, and you are welcome to ask questions or to ask for a chaperone to be present.
- Bring your NRIC (or passport if you are an international patient), any previous test results such as PSA reports, and a list of your medications.
What Happens During a DRE?
- You will lie on the examination bed on your left side, with your buttocks near the edge of the bed, and both knees up and brought close to your chest. Sometimes, you may be asked to stand and bend forward over the examination bed instead.
- Your doctor will put on a glove, apply lubricating gel, and gently insert a finger into your rectum to feel for any abnormalities or hard lumps.
- The doctor will feel the surface of your prostate, checking its size, shape and firmness, and whether any area is hard, uneven or tender.
- You may feel temporary discomfort or pain, or the urge to urinate or open your bowels during the examination. This is normal, as the prostate sits close to the bladder and rectum.
- Try to relax, breathe slowly, and relax your buttock muscles. Tensing up makes it more uncomfortable. If you feel pain, tell your doctor straight away.
What Happens After a DRE?
- You will be able to leave the hospital immediately after the examination, and can go back to your usual activities, including work, eating and exercise.
- You may notice a little lubricating gel when you next wipe, or feel the urge to pass wind. This is normal. A small amount of spotting is possible if you have piles.
- Your doctor may tell you the findings straight away. A follow-up appointment will be given if further tests are needed based on abnormalities present during the examination.
Should you feel unwell or experience pain or bleeding, contact your doctor immediately or call our 24-Hour Medical Urgency Clinic.
Understanding Your Results
Hard, uneven or lumpy areas. A firm area or lump may be a sign of prostate cancer, but can also be caused by other conditions such as inflammation or stones. Your doctor will recommend further tests, which may include a PSA blood test, an MRI scan of the prostate and, if needed, a prostate biopsy, to find out exactly what it is.
- Normal: The prostate feels smooth, firm and of normal size, with no lumps or hard areas. This is reassuring, but a normal DRE does not completely rule out prostate cancer, because the examination can only feel part of the prostate, and early cancers are often too small to feel.
- Enlarged prostate: The prostate feels larger than usual but smooth, which is typical of BPH. Your doctor may suggest tests such as a urine test, a PSA test, and an ultrasound, and may discuss treatment options if you have urinary symptoms.
- Tender or swollen: A prostate that is tender may point to inflammation or infection (prostatitis), which is usually treated with medication.
A DRE is only one part of a prostate assessment. Your doctor will consider the findings together with your symptoms, age, family history and test results, such as your PSA level, to decide what to do next.
Looking After Your Prostate Health
- Speak to your doctor about prostate checks from age 50, or earlier if you have a family history of prostate cancer
- See a doctor early for urinary symptoms, rather than assuming that they are just part of getting older
- Eat plenty of vegetables, fruit and wholegrains, and cut down on red and processed meat and fatty food
- Keep to a healthy weight and stay physically active
- Limit caffeine and alcohol, particularly in the evening, if you are waking at night to pass urine
- Do not smoke
