Reason for rectal at young age.

Liquidsky: is there ANY legitimate reason to do a rectal exam for a cold or chest problems? I never heard of that.

Also, several people say the doctor looked at their anus, but didn't do a rectal exam. Does just looking at the outside tell you anything, other than perhaps if they have hemmorhoids?

For a visit for a cold or the flu a rectal exam would be totally inappropriate unless there were symptoms referable to the GI tract. I think there may be some exaggeration about this. I myself had to bend over and spread them for a college physical. They were only interested in external hemorrhoids and a DRE wasn't done. For a complete physical a DRE would be done but in my business time is of the essence. Focused exams are the name of the game. Prevarication is everywhere.

Liquidsky, are you saying that doctors, by reason of saving time, are skipping parts of an exam that were once considered standard practice? I recently changed primary care doctor and upon signing up with my new one, she told me that she would like to 'get a baseline by doing a complete physical'. She immediately went on to say 'but don't worry, I don't do either a rectal or testicular exam'. She said something about it being both uncomfortable, awkward and unnecessary. I don't know whether she meant for her or for me! She did however go on to say that of course, if I ever had a concern in either area she would obviously do those exams.

I am 35 and she is probably a few years younger. Do you think it has as much to do with avoiding awkwardness as it does with saving time?

Liquidsky: I also had to bend over and spread 'em for a pre-op physical. It didn't bother me, but I couldn't imagine what he would or would not have found which would affect my eligibility for the surgery, which was in fact, only wisdom teeth removal (they did all four at once, under anesthesia, thus the need for the pre-op). And in fact, I did have hemmorhoids.

I strongly suspected the last part of your post was the case. But isn't that paradigm contrary to the concept of preventative medicine?

And how do you suggest patients override that tendency?

What kind of doctor are you?

I simply can't comment on the doctor skipping parts of the exam. I think it's totally ridiculous to do rectal exams for teeth extraction. The only pertinent things are airway, heart and lungs. I'm an emergency physician so all of my exams are problem oriented. I believe in cutting to the chase. I wouldn't be able to function otherwise because of time restraints. I also believe that the history guides the physical exam. In my experience doing an extended prolonged exam in the absence of complaints rarely reveals pathology. This may be counter intuitive to non medical people. I was told a long time ago that if you don't know the diagnosis by the end of the history you're in trouble. I've found this to be true.

In my experience doing an extended prolonged exam in the absence of complaints rarely reveals pathology. This may be counter intuitive to non medical people. I was told a long time ago that if you don't know the diagnosis by the end of the history you're in trouble. I've found this to be true.

That sounds quite right. While I am not medically trained except by osmosis by way of my wife and friends,I can see that our family physician seems to know what the matter is after listening to our complaints when we come in.

I'll go one better and say that usually - not always - by often enough, I and my wife know what is wrong when we go to the doctor. It's not always that difficult to draw reasonable conclusions about what you are feeling and the how of it all. I do think that some people get carried away when they feel ill and tend to imagine the worst, especially with ill-defined complaints ... but otherwise most of what I think is wrong with me turns out to be as I thought.

Once I was a bit off course though when I imagined the worst about a swollen thyroid. It was just garden variety hyper-thyroidism and not a recurrence of a tumor problem .. but still ... and anyway this kind of exact diagnosis depends on blood-work anyway.

The other thing to remember is that lab and X-ray add another layer to the work up. It's amazing the things which you can pickup by examining these tests carefully. Often the history and physical are just the beginning of making a diagnosis. I can't tell you the number of times a faint suspicion becomes a diagnosis and plan when an EKG or chest X-ray tells the whole story. Physical diagnosis is a skill but it's often everything together which makes the case. Also I always listen to that little voice which says "something isn't right here".

Liquidsky: I work in the allied healthcare field and agree with you about having a strong suspicion of dx based on hx alone, although I recall reading an article which suggested asking about hx last, so as not to have tunnel vision in coming up with a working dx.

In the ER, a focused exam makes the most sense, as you're not assessing overall health.

One doctor, who was writing about modesty and medical care, specifically with the sports physical, pointed out the literature really doesn't point to a need for a hernia exam for guys. They rarely have hernias and if they have a hernia, nothing is done about it if they're asymptomatic and there's no need to restrict their activity.

On the other hand, in terms of an annual physical, I think it's important to be thorough, even if it rarely reveals a pathology. I suppose I feel strongly about this because my Dad went to a physician who was very thorough. He discovered swollen lymph glands during an annual physical. They caught the Hodgkin's Disease early. I can't imagine how far it would have had to spread before he became symptomatic.

I also agree with you about the value of lab tests and imaging studies, but again, there's a downside. A person was in the ER for abd. pn. and the doctor sent him for an MRI. Legally he's better protected than with a physical exam of the belly, but as a nurse pointed out, doctors aren't developing clinical skills as a result of reliance on tests. I suppose there's a trade-off there. Of course the imaging studies are the second largest cause of increasing health insurance rates. Then again, they may reduce malpractice insurance rates.

I know it isn't the question at hand but since it came up numerous times .......can I ask why it is that they do a rectal exam during suspicion of appendicitis ?

Doing a rectal exam with possible appendicitis helps to see if there is peritoneal pain when the finger is pushed toward the right side. It's a very non specific test since many other conditions may make the pain. It's also acutely painful if positive. Now the diagnosis must be made with a combination of abdominal pain on palpation to the right side of the abdomen, an elevated white blood cell count and a positive imaging study such as a CT scan of the abdomen or ultrasound. It used to be said that you should have 10% negative at surgery to make sure you're performing enough appendectomies. Now one can't afford to get a negative result for a number of reasons including medical legally.

Thank you !

I had my first rectal exam when i was 18 and i didnt really enjoy it that much my male doctor was kinda ruff when he did it but now my female doctor is more gentle when she does that part of the exam

The only proctologic exam that i remember was when I was six years old. I don't know the reason, but I suspect that it was related to my chronic constipation (life-threatening when I was 1.5 yrs old). the doctor put t thermometer into my rectum, and I had a fit, feeling that I absolutely, positively, had to have a bm. When it was removed, I was fine. I also no longer received laxatives, rectal or otherwise from my mother until I was 14. I sure wish that I'd had more self control at the time!

I started self-administering when I was eight.

The first time I had a rectal exam was when I was 16. I was having a lot of stomach issues and my parents made an appointment for me. The doctor ended up giving me my first prostate exam.

I got my first rectal exam when I was 18 during my physical before college. The doctor who was doing it was also by chance a gastroenterologist (all the other doctors in the practice were busy). So after feeling my testicles (with my pants still at my ankles) he had me turn around and gave me my first prostate exam. I immediately got an erection as he pressed on my prostate and it took every ounce of strength not to ejaculate right there.

In my case, I had rectal examinations at a young age following surgery on my lower bowel - the final portion was removed and the end then joined onto the rectum.

I had them at periodic follow-up visits until I was about 8, then nothing until I was 24.

My friend got his first rectal exam when he was 17 but he said he got it only because he had serious issue with his stomach so doctor had to check anus.

I think he was checking hemmoroids. Other way I can't see any other reason why people should get prostate or rectal exam in such a young age.

Rectal exams at young ages can be due to complaints involving bowel movements including blood or incontinence, evaluating potential appendicitis and to check for occult blood in stool. I'm sure there are more valid reasons.

I had my first rectal / prostate exam at the age of 18. it was for an employment physical (civil service) and I wasn't expecting it when I arrived. When the nurse brought me into the room, there was a 4x4 on a metal tray with a glob of KY and a pair of gloves. I asked it that was for me and she just smiled. I was nervous until that part of the exam but ended up enjoying it very much. So started the magic!

there was a 4x4 on a metal tray with a glob of KY and a pair of gloves.

A 4x4 is a four wheel drive vehicle. Are you saying there was a truck on the tray in the exam room? I'm confused.

A four by four is a piece of gauze. Perhaps not quite four inches square.

Yes once at 21 I was went in for a physical and did not complain about any stomach issues. The doctor at the end of the physical said it was common practice for her to do a rectal.

I had my first rectal at the age of 16 by female-doc, during the visit to proctologist because of hemorrhoids; she also touched my prostate (i think by accident) and i got huge erection, but i was already in to medfet

There is no reason to get a rectal exam before you are around 40 years

Age 10 due to possible gastroenteritis (turned out to be constipation. Solution: suppos til I birthed a telephone pole).

On my back on the exam table, knees bent and raised with feet flat on the table. Much older (50s) male pediatrician (who I always suspected to be a perv anyway) inserted his enormous well lubed and gloved ham hand middle finger all the way in it would go and started feeling around. "Well I can feel a stool..." he said and I was so young and naive I didn't even know what the hell that was.

What I did know was I felt like I was shitting myself right there on the table in front of him and my mother. It didn't happen but his cock size middle finger sure made it seem like it would.

Relloz: Prostate issues are not the only reasons for a rectal exam. I got rectal exams at 9. I suggest reading the thread. ;-)

A 4x4 is a four wheel drive vehicle. Are you saying there was a truck on the tray in the exam room? I'm confused.

That's hilarious!

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A four by four is a piece of gauze. Perhaps not quite four inches square.

What about a 2x2 or a 3x3?

Are you saying they aren't a bike and a trike? 😁 😁 😁

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There is no reason to get a rectal exam before you are around 40 years

Plead ignorance on this topic. There are many reasons a rectal exam could be needed at any age.

New doc at age 25 for a routine physical. After the testiculr and hernia exam he had me turn over on my side and did a quick prostate exam. Didn't expect that and still not sure why that was necessary at that age!

@Nick "Didn't expect that and still not sure why that was necessary at that age!"

Maybe he just wanted to stick his finger up your butt.

New doc at age 25 for a routine physical. After the testiculr and hernia exam he had me turn over on my side and did a quick prostate exam. Didn't expect that and still not sure why that was necessary at that age!

Likely to establish a baseline for you as a new patient.