Bob Asks:

Hi doc! I have an appointment with a urologist in a few days for an enlarged prostate.

I know the doc will probably need to do a digital rectal exam. Should I take a laxative or something else similar to what you’d take before a colonoscopy in order to make sure the rectal cavity is empty?

This is rather embarrassing and I don’t want to make this any more unpleasant for myself or the doctor than it has to be.

Also, if you think I should use a laxative, which one should I use, and how long before the appointment should I use it?

Bob –

It’s good for me to get questions like this because I often forget how much anxiety a physical exam can cause.  I only recently learned that many women shave their legs, and often wax their pubic areas, in preparation for their pelvic exams.

One woman, just as I was about to insert the speculum, said something along the lines of, “See doc?  No hair!  Isn’t that nice?”

The truth is that performing physical exams – the scientific evaluation of the of the human body – is the job of every doctor.  By the time we’re fully-trained, we’ve done thousands of them.  This makes non-medical things like smell, hair, feces, dirt, grime, growths, etc, decidedly uninteresting.

There really is a disconnect between the medical and non-medical parts of a physical exam.  This is part of the bigger question about how a male Ob/Gyn, for example, can see breasts and vaginas all day and then go home and be sexually attracted to his wife.  To most Ob/Gyns in that situation, it’s a strange question.  They’re two totally different worlds.

Plus, after you’ve done so many physical exams, you’ve seen some pretty crazy things.  Most ER’s have a “butt box”, for example.  This is a place where all the things people have inserted – in a state of sexual arousal, or out of just plain curiosity – into their rectums.  I had a patient once who came in with a full-size can of deodorant in his rectum.  “Fell on it in the shower, dude.  Can you get it out?”

So, it takes a lot for a PE to be memorable for a doctor.

That said, yes, a laxative might reduce the fecal matter in your rectum prior to the exam.  Over-the-counter laxatives won’t clean you out like the stuff they give you before a colonoscopy, but honestly dude, you don’t need that.  I’d do the laxative – any over the counter brand is fine – about 6 hours before your appointment, and make sure you’re near a bathroom!

Remember that a rectal exam takes all of 8 seconds.  The doc then quickly pulls the glove off and tosses it in the trash can.  Even if covered in something icky, you barely see it and rarely smell it.  I’d just recommend a good shower prior to your appointment.

If you’re really worried about this issue, you could do an enema.  There are over the counter versions you can do yourself, or you can have them done by a pro…which probably would not be helpful in your case!  An enema the day before your appointment will remove most of any material in your rectum.  So, you might feel less anxious prior to the appointment.

But again…all we ask is a good shower.