Original article—alimentary tractDigital Rectal Examination Is a Useful Tool for Identifying Patients With Dyssynergia
Section snippets
Materials and Methods
Patients referred to a tertiary care center with symptoms of chronic constipation and difficult defecation, and who fulfilled the Rome III criteria for functional constipation,16, 17 were enrolled in this study. They were asked to complete a constipation symptom questionnaire that assessed the prevalence of common bowel symptoms. Their clinical assessment included a detailed DRE (as described later), performed by a single investigator (S.S.C.R.). Subsequently, all patients underwent anorectal
Demographics and Symptoms
A total of 209 patients (men/women, 191/18) with a mean age (± standard deviation) of 41 ± 15.3 years, and with a diagnosis of chronic constipation (ROME III), were enrolled. The mean duration (± standard deviation) of constipation symptoms was 17 ± 15.1 years. The symptom patterns reported by these patients are shown in Figure 1.
Anorectal Manometry
A total of 183 patients (87%) had a dyssynergic pattern of defecation based on established criteria.19 The anal resting sphincter pressure was normal in 101 patients
Discussion
Because the prevalence of dyssynergia in the community is not known and the diagnosis of dyssynergic defecation requires both symptomatic and objective physiologic criteria,6, 8, 9 we examined a consecutive group of patients presenting with chronic constipation and difficulty with defecation to a specialized defecation disorders clinic. Although previous studies have examined the correlation between DRE and anorectal manometry findings in subgroups of patients with anorectal disorders,14, 26, 27
Acknowledgments
The authors sincerely acknowledge the excellent statistical advice and help of M. Bridget Zimmerman, PhD.
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This article has an accompanying continuing medical education activity on page e116. Learning Objectives—At the end of this activity, the learner should be able to recognize the diagnostic criteria for dyssynergic defecation, appreciate the utility of rectal examination in suggesting the diagnosis, and recognize the prevalence of pelvic floor dysfunction as a cause of chronic constipation.
Conflicts of interest The authors disclose no conflicts.
Funding Dr Rao was supported by National Institutes of Health grant 2R01 KD57100-05A2; and Dr Tantiphlachiva was supported by a research fellowship grant from Chulalongkorn University, Bangkok, Thailand.
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