title: Digital rectal examination is a useful tool for identifying patients with dyssynergia.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
authors.forename: Kasaya
authors.initials: K
authors.lastname: Tantiphlachiva
authors.forename: Priyanka
authors.initials: P
authors.lastname: Rao
authors.forename: Ashok
authors.initials: A
authors.lastname: Attaluri
authors.forename: Satish S C
authors.initials: SS
authors.lastname: Rao
mesh_terms: D000328:Adult; D001259:Ataxia / Q000175:diagnosis* / Q000503:physiopathology; D003672:Defecation; D051517:Digital Rectal Examination / Q000379:methods*; D005242:Fecal Incontinence / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D012002:Rectal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D012384:Rome; D012680:Sensitivity and Specificity