Digital Rectal Exams Are Infrequently Performed Prior to Anorectal Manometry

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Pelvic Floor Disorders

Background:

• Digital rectal examination (DRE) is recommended before anorectal manometry (ARM).
• Real-world data on DRE performance and its diagnostic value is limited.
• Chronic constipation often involves dyssynergic defecation.

Purpose of the Study:

• To determine the frequency of DRE before ARM in a real-world setting.
• To assess the sensitivity of DRE in detecting dyssynergic defecation.
• To compare DRE's sensitivity with ARM and the balloon expulsion test (BET).

Main Methods:

• Retrospective single-center study of 142 patients undergoing ARM for chronic constipation (2021-2022).
• Primary outcome: Rate of DRE performed prior to ARM.
• Secondary outcome: Sensitivity of DRE for identifying dyssynergic defecation.

Main Results:

• Only 42.3% of patients had a DRE before ARM.
• Overall DRE sensitivity for dyssynergic defecation was 46.4%.
• Sensitivity was significantly higher for gastroenterology providers (p=.004), reaching 82.6% for attending gastroenterologists.

Conclusions:

• Digital rectal examination is underutilized in the workup of chronic constipation.
• The diagnostic accuracy of DRE for dyssynergic defecation is influenced by provider discipline and training level.
• Gastroenterology providers, particularly attendings, demonstrate higher sensitivity in detecting dyssynergic defecation via DRE.