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IS DIGITAL RECTAL EXAM RELIABLE IN GRADING ANAL SPHINCTER DEFECTS?
Marcelo de Melo Andrade Coura1, Silvana Marques Silva1, Romulo Medeiros de Almeida1
1Faculdade de Medicina, Universidade de Brasília, Brasília, Distrito Federal, Brasil.
Arquivos De Gastroenterologia
|October 6, 2016
Summary
Digital rectal examination shows good sensitivity but poor specificity for grading anal sphincter defects in fecal incontinence. However, anal tone assessment correlates with anal pressures, offering valuable clinical insights.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- Digital rectal examination (DRE) is standard for assessing anal sphincter tone in fecal incontinence.
- Its accuracy in identifying sphincter defects and muscle competence remains unproven.
Purpose of the Study:
- To evaluate DRE's accuracy in grading anal defects compared to 3D endoanal ultrasound.
- To correlate DRE findings of anal tone with measured anal pressures.
Main Methods:
- 76 women with fecal incontinence were grouped by defect size (small/extensive) using ultrasound.
- DRE sensitivity, specificity, and predictive values for grading defects were calculated.
- DRE anal tone was compared to resting and incremental anal pressures.
Main Results:
- DRE showed 90% sensitivity and 27.78% specificity for global defects.
- Abnormal DRE correctly identified 90% of patients with defects.
- Abnormal DRE anal tone correlated with lower resting and incremental pressures.
Conclusions:
- DRE has good sensitivity but poor specificity for grading global anal sphincter defects.
- DRE demonstrates fair sensitivity and poor specificity for external anal sphincter defects.
- DRE findings of anal tone correlate with objective anal pressure measurements.