"There are only two reasons not to do a rectal exam: no rectum and no fingers."
So said a source (who will remain nameless) last month on a lively Veterinary Information Network thread on the topic of digital rectal examinations in small animal veterinary medicine.
You know how I’m always carrying on about complete physical examinations? Well … I consider the rectal exam an essential component of any complete physical examination in the intact male dog. Cats and female dogs tend to get a pass unless very specific information is being sought. But boy dogs with testicles? No doubt about it. They need to get digitized.
I know it sounds gross. OK, so it is gross. Unfortunately, there’s no substitute for the human finger when it comes to evaluating a dog’s prostate, a cat’s functional pelvic morphology, an anal tumor’s margins, the extent of an anal gland abscess, etc. …
But not all pet owners agree. And I get that, really I do. I’m sensitive to the fact that a) most owners don’t want to feel that their pet is being "violated" in such an uncomfortable fashion; and that they b) feel more than a little bit awkward about attending such an event.
"Do what you have to do, but I don't want to know about it," they probably think. And how could I blame them?
The knowledge of which leaves me feeling sheepish when I’ve got to perform a rectal on a patient in the exam room (which happens often). Yes, even veterinarians aren’t above bashfulness when it comes to cultural inhibitions.
Nonetheless, this recent VIN thread had veterinarians quizzing themselves on this: How many ways can a veterinary rectal exam bear clinical fruit?
Here are some of the answers to how rectals (as they're colloquially known) can be highly relevant and eminently helpful:
1. Determining the size, shape and texture a dog’s prostate.
2. Assessing the size, fullness and texture of any pet’s anal gland.
3. Getting a sense as to the quality of a pet’s anal tone (a crucial point in neurological examinations).
4. Evaluating rectal hydration status (sometimes an indicator in cases of gastrointestinal obstruction).
5. Investigating the possibility and extent of a pelvic fracture, including the possibility of rectal perforation post-trauma.
6. Assessing stool quality, especially with respect to the presence of frank blood.
7. When examining the spine for pain, a rectal will often specifically reveal the presence of lumbosacral spinal pain.
8. Discovering rectal masses and evaluating the extent of other nearby masses, including normal lumps like the sublumbar lymph nodes, and abnormal lumps caused by things like perineal hernias.
9. Identifying the presence of stones that may be lodged in the nearby urethra.
10. Then there's always the issue of the rectum as a main pathway for copious quantities of blood flow, so that assessing pulse quality and tissue perfusion here can prove to be extra-useful.
And that's only ten from a list that easily went past fifteen on the thread.
Armed with all this crucial info, I just have to ask: Has your pet ever gotten the finger? What’s your honest take on it? And does this post make you feel better about it … or not?
Dr. Patty Khuly