Position for digital rectal exam

When I see drawings or read stories of people getting a digital rectal exam, they seem to be either on all four, either on their back legs open. I do not know whether that's medically accurate.

In my case, I had two DREs when I was a child for suspicion of appendicitis, and each time I was sort of in the same position as for pooping in a squat toilet (and actually was told to bear down as though pooping). If I remember correctly, the physician approached me from the front and put her gloved hand under me. I've never seen anybody else on this site mentioning this position - is it only used for appendicitis diagnosis, only used for children ?

I think your experience is an anomaly.

The traditional positions are Sims (left side with left leg straight, right leg drawn up, or bent over the exam table. On all fours usually just if on an exam table that will move into a jackknife position and in preparation for a rigid sigmoidoscopy (which is rarely done nowadays) or some other procedure.

Jds4med: Two different physician though - our GP and somebody who I assume was the surgeon who was going to operate on me. France, earily 1980s.

(One problem with being a child was that people often did not bother to introduce himself or herself or to explain what they were about to do. So I did not know until the finger came in during the first DRE the reason for the squatting position.)

What caused this interest in squatting?

You have more references to squatting, squat toilets, squatting over regular toilets, squatting for exams, etc., than I can recall in all my years here.

Susie: Perhaps this traumatic experience, and the fact that there exist squat toilets in France (not in private homes, but in some public facilities including my elementary school) ?

Could be just a local (regional or national) anomaly. The only physiological rationalization could be to use gravity to move the appendix closer to the rectum.

Jds4med: Also, in this position the anus "flares" open naturally, especially if "bearing down"... perhaps preferable if one does it without explaining where the finger was going (yes, I was taken by surprise the first time).

It's patently ridiculous to do a rectal exam with the patient in a squatting position. There's no rationale for this. It's also sadistic for the unfortunate pain ridden patient. Besides a rectal exam is no longer used to diagnose appendicitis. It's not specific and it's considered too painful for the patient. Yes I had one too when I had appendicitis forty years ago. It's outmoded now.

Liquidsky: I suspect that if both physicians did the same, then it was probably an approach taught in medical schools back in the days, at least in France.

I did not remember feeling more discomfort in that position than I already had from appendicitis (which meant I was feeling really bad: stomach pains, vomiting, sweating, unlike anything I had experienced). What I remember, though, is that in both cases they did not tell me they were about to put a finger in my bottom. The general practitioner told me that it could be painful when she pressed on the appendix and I should say it immediately, asked me to "bear down"... but neither she nor my mom bothered telling me the trifling detail of WHERE she would press. I seriously assumed she was going to press somewhere on the outside and was baffled. Again, since both physicians did the same, I suspect they taught in medical school not to give too much information to children?!

Most DRE's are done with the patient bending over the exam table. Never heard of one done in the squatting position.

I've had a few rectal exams performed and most of them have been in the sims position. I've only had one doctor have me bend over the exam table while resting on my elbows.

All of mine, from the very first in my early teens, have been done either bending over the table, on all fours (occasionally), or Sims (most often). One doctor like to do it with me bent over in front of him like a baseball shortstop, hands on my knees for stability.

Mine have been done while in the stirrups, as part of my annual exam. I did have a rectal on my side, as part of an evaluation for belly issues.

My first, for a grad school entrance, was by my father's doc, a total surprise, grabbing my ankles.

The vast majority after that, have been bending over the table, with only a handful on my side.

I have never heard of anyone having to bend over and grab their ankles. I would actually like to see that, lol.

I do have to be honest with you though, I really do enjoy telling a man to drop 'em bend over and put your elbows on the table. This will just take a second, just relax now, that's it..........mmmm

Mashie

Does the up on all 4s thing really exist in the medical world? I figured it was like rectal temps... something currently reserved for the fetish world and rarely used beyond that. Which is sad since both things are pretty fun.

Does the up on all 4s thing really exist in the medical world?

I can assure that I have had (and currently have) real doctors that do my prostate exam in that position. Now, to be totally clear, getting into that position has never been their idea. They always suggest either getting on the table on my side (I hate that position), or standing and bent over the exam table. But all you have to do in order to be examined on all 4's is to ask. As they tell you to get into some other position, just ask if it would be OK with them if you use a different position. Tell them that you've had a doctor in the past that did it on all 4's and you found that to be much more comfortable for you. And you can also mention that the doctor told you that position made it easier to reach your prostate. When I mention something like that, I have NEVER had a doctor refuse. On the contrary, they always fall all over themselves agreeing to it, telling me that would be fine with them, that whatever position I find more comfortable is best, etc etc. Just try it sometime -- I really don't think you'll be disappointed.

At my pediatrician i was always flat on my tummy, face down for rectal exams and temps. i dont know why others are not in that position. why some are examined on their back makes no sense. anyone else examined like that?

Susprised to hear of DREs being done in any manner other than sims position.

For some itching, both on my buttocks and one point at the top of my inner thigh, I was asked to lower my trousers and boxers and lie face down on the exam table. The nurse parted my buttocks and touched the sore area, she then asked me to roll over - I held my hands hiding my genitals, moving them out of the way of the slightly sore patch.

A rectal exam should be performed on most patients with abdominal pain and any concern for blood loss. Here, are some important steps of a compete rectal exam.

There are multiple positions that you can ask your patient to stand or lie. These include:

1. Standing position: patient standing with toes pointing in, then leans over a table

2. Left lateral decubitus (Sims position): patient lies on left side with left hip/leg straight and the right hip/knee is bent

3. Knee to chest: patient with lying on table facing down with knees up to chest bent forward

(Both the standing and knee to chest positions are optimal for the prostate exam)

As for the procedure itself :

1. Use a small amount of lubricant on the index finger and ask the patient to take a deep breath and insert the finger facing down (6 o'clock position)

2. Appreciate the external sphincter tone then ask the patient to bear down and feel for tightening of the sphincter

3. For Men Palpate the prostate gland. Note the following:

1. Approximate size of the prostate gland (normally about the size of a walnut, 2-3 cm but wider at the top)

2. Feel for tenderness (prostatitis)

3. Feel for nodules or masses

4. Palpate the rectal wall starting from the 6 o'clock position clockwise to the 12 o'clock position. Then return to the 6 o'clock position and palpate the other half of the rectal wall feeling for masses, nodules and tenderness.

I'm sure most if not all doctors wished their patients would ask to be put into knee chest position for a rectal because it is 100 percent easier to reach a prostate that way, but it is the most embarrassing and again, most doctors try to eliminate as much embarrassment out of an exam as possible, not because they want to but because they are afraid of being called a pervert to be quite honest with you.

So yes, if you want to be examined in that position just ask for it, it's not about kink, you are really doing yourself a favor by doing so.

Mashie

So yes, if you want to be examined in that position just ask for it, it's not about kink, you are really doing yourself a favor by doing so.

All it really takes is a strong disregard for your own modesty and a willingness (or maybe a desire) to get into one of the most embarrassing positions. I'm fine on both of those counts.

Over the years I have had...

-Sims

-the fetal - hug your knees

-Bent over the end of the table

-Grab your ankles

-knee chest

-and in gyno stirrups

My primary doctor always does it to me after he is done examining me for hernias and examining my testicles. While my briefs are already at my ankles, he makes me face the table and step out of my briefs and spread my legs for him. He makes me bend over the exam table for him, reach back with both hands and pull my buttocks apart wide for him, opening my rectum wide for him. Presuming it is easier for him to push his examining finger up me to reach my prostate this way. Maybe this is the way they taught it at his medical school, because my previous doctor did it the same way and he taught at the same med school where my present physician graduated. After reading Mashie's post I will ask my doctor to do me in knee chest position at my next physical when he examines me for the prostate exam. Thank you for posting, Mashie.

When I've had gyno exams it was always while my feet were still in the stirrups. My more recent rectal, done during a routine sexual health screening, was in the Sims position.

In my play exams I do the rectal exam bending over the exam table vor lying on the left side with one knee up. Sometimes I do the rectal exam while my Patient is lying in the exam table with her legs in stirrups.

Just had my annual physical today. The Doc. (Very attractive female) explained the two options and gave me my choice. I chose to stand while bending over the exam table. This is how most of the exams that I have had have been. I must add that today's exam was the most comfortable that I have ever had. She had small fingers and was very gentle.

Just had my annual physical today. The Doc. (Very attractive female) explained the two options and gave me my choice.

And what was the second option that she gave you?

Another visit to the Urologist today. Had to drop my pants and he helped me pull me undies down. He looked at and felt my pad, (I have urine incontinence) and examined the penis and balls. He pushed on the groin on each side and felt the AMS 800 pump that is in the scrotum. He then told me to bend over the table and he lubed his finger and my anus and pushed in and twisted around a bit. He was really fast and it did not hurt at all. Other exams in the past have been uncomfortable, that was not the case today. He put the box of tissues on the exam table for me and said I'll be right back. He opened the door to step out and one of the girls at a desk looked up and saw me starting to wipe. The door shut slowly and I know she got a good look. I do not think she looked in on purpose and why would she really want to see an old man wiping his butt. When the door opened and the Dr. came back in I could see she had moved her chair and was not looking in my direction. By then I was dressed and had washed my hands and was ready for the Dr.. He told me I will have to get a urodynamics test. I have had several of those in the past. That will be another post.

Del