Published in:
03-01-2024 | Constipation | Invited Commentary
Diagnosing Dyssynergic Defecation with the Digital Rectal Exam: The New Digital Revolution?
Published in: Digestive Diseases and Sciences | Issue 3/2024
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The digital rectal exam (DRE) is a component of the physical exam, with utility in the assessment of GI bleeding [1], the evaluation of sensory neurologic deficits [2], the early detection of prostate [3] or anal cancer [4], and the evaluation of anorectal motor disorders, including incontinence and dyssynergic defecation [5] (Table 1). Despite this, particularly in the era of focused physical exams, the rectal exam is often neglected due to patient or provider discomfort [5, 6].
Table 1
Performance characteristics of rectal exam findings for diagnosis of various conditions
|
Condition
|
Exam finding
|
Sensitivity
|
Specificity
|
Likelihood ratio
|
|---|---|---|---|---|
|
Upper GI bleeding [1]
|
Melena
|
25 (95% CI 4–174)*
|
||
|
Cauda Equina Syndrome [2]
|
Rectal tone
|
80%
|
86%
|
|
|
Perineal sensation
|
60%
|
68%
|
||
|
Prostate Cancer [3]
|
Prostate palpation
|
28.6%
|
90.7%
|
|
|
Anal Cancer [4]
|
Visible lesion/palpation
|
Insufficient data
|
||
|
Fecal Incontinence [17]
|
Sphincter resting and squeeze tone
|
90%
|
28%
|
|
|
Anal canal and puborectalis movement on simulated evacuation
|
75–83.2%
|
87%
|