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Year : 2022  |  Volume : 2  |  Issue : 4  |  Page : 160-165

Digital rectal examination in defecatory disorders: Is it poor man's anorectal manometry?

1 Department of Gastroenterology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
2 Department of Radiology, LTMMC and LTMGH, Sion, Mumbai, Maharashtra, India
3 Department of Gastroenterology, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Akash Shukla
New Building, 9th Floor, Department of Gastroenterology, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ghep.ghep_21_22

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Background and Aims: Magnetic resonance defecography (MRD) and high-resolution anorectal manometry (HR-ARM) are considered gold standards for defining pelvic floor anatomy and diagnosis of dyssynergic defecation (DD) respectively. Digital rectal examination (DRE) is a bedside test which may be used to screen for DD. The objective of the study was to evaluate the usefulness of DRE as compared with HR-ARM and MRD for detection of DD. Materials and Methods: Sixty patients of functional constipation defined by ROME-IV criteria were enrolled. After ruling out structural causes of constipation using colonoscopy, all patients were subjected to undergo DRE and subsequently HR-ARM and BET, blinded to DRE findings. MRD was reported by a radiologist who was also blinded to the findings of DRE and HR-ARM. The diagnostic yield of DRE was compared with HR-ARM and MRD. Results: Dyssynergia was diagnosed in 48/60 (80%) patients on DRE and in 44/60 (73%) patients on ARM. The sensitivity, specificity, and positive predictive value (PPV) of DRE in diagnosing DD were 95.90%, 57.14%, and 83.83%, respectively (P = 0.01). Among clinical features, only digital maneuvering while defecation correlated with DD (P = 0.019). On DRE, paradoxical anal sphincter contraction correlated with DD (P = 0.010). The presence of excessive descent on DRE correlated with excessive anorectal descent on MRD. Structural abnormalities such as rectocele, cystocele, vaginal prolapse, and uterine prolapse were associated with DD in all. Conclusion: DRE is a useful bedside test in diagnosing DD with a high sensitivity and PPV. DRE is poor in identifying structural abnormalities contributing to DD.

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