Digital rectal examination in patients with acute abdominal pain

Generations of medical students and trainee doctors have been taught that digital rectal examination (DRE) is an essential part of the clinical examination required in any patient with abdominal pain suspected of having abdominal or pelvic pathology. The aphorism ‘if you don’t put your finger in it you will put your foot in it is familiar to all. But is this now outdated advice? In these days of advanced and readily available imaging techniques, is it appropriate to subject patients to an undignified and unpleasant examination that may contribute little to the diagnostic process? Before condemning DRE to the history books, it is instructive to consider what information it might provide. In his classical monograph, ‘the early diagnosis of the acute abdomen’ by Sir Zachary Cope first published in 1921, he described rectal examination as ‘ extremely important and informative. Forwards in the male one can detect an enlarged prostate, a distended bladder or disease of the seminal vesicles. In the female one can palpate swellings of Douglas’ pouch, enlargements and displacements of the uterus. By passing a finger upwards, stricture of the rectum or ballooning of the canal below obstruction can be ascertained. The apex of an intussusception may sometimes …