Digital rectal examination is a useful tool for identifying patients with dyssynergia

Kasaya Tantiphlachiva, Priyanka Rao, Ashok Attaluri, Satish S.C. Rao

Research output: Contribution to journalArticle

123 Scopus citations

Abstract

Background & Aims: Dyssynergic defecation is a common cause of chronic constipation; its diagnosis requires anorectal physiological tests that are not widely available. It is not known whether digital rectal examination (DRE) can be used to identify dyssynergia. We examined the diagnostic yield of DRE in patients with dyssynergic defecation. Methods: Consecutive patients with chronic constipation (Rome III criteria, n = 209) underwent DREs, anorectal manometry analyses, balloon expulsion tests, and colonic transit studies. In the DRE, dyssynergia was identified by 2 or more of the following features: impaired perineal descent, paradoxic anal contraction, or impaired push effort; diagnostic yields were compared with physiological test results. Results: Of the patients included in the study, 187 (87%) had dyssynergic defecation, based on standard criteria; 134 (73%) of these were identified to have features of dyssynergia, based on DREs. The sensitivity and specificity of DRE for identifying dyssynergia in patients with chronic constipation were 75% and 87%, respectively; the positive predictive value was 97%. DRE was able to identify normal resting and normal squeeze pressure in 86% and 82% of dyssynergic patients, respectively. Conclusions: DRE appears to be a reliable tool for identifying dyssynergia in patients with chronic constipation and detecting normal, but not abnormal, sphincter tone. DREs could facilitate the selection of appropriate patients for further physiologic testing and treatment.

Original languageEnglish (US)
Pages (from-to)955-960
Number of pages6
JournalClinical Gastroenterology and Hepatology
Volume8
Issue number11
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

Keywords

  • Anorectal Manometry
  • Balloon Expulsion Test
  • Constipation
  • DRE

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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