Digital Rectal Examination and Balloon Expulsion Test in the Study of Defecatory Disorders: Are They Suitable as Screening or Excluding Tests?

Caetano, Ana Célia; Cruz, André Santa; Rolanda, Carla

doi:10.1155/2016/8654314

Cited by 22 publications

(32 citation statements)

References 48 publications

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“…The standard BET performance (evaluation of the ability to evacuate solid stool) is in accordance with the majority of the data presented in the literature. (9) Trying to discriminate the best performance of the BET, besides the standard BET, we evaluated the vvBET (evaluation of rectal sensory function, which can also disturb evacuation ability). The sequential BET, where vvBET is followed by standard BET, improved the BET performance regarding evaluation of DD.…”

Section: Discussionmentioning

confidence: 99%

“…Applying the creative concept of "low-cost" tools, we run an extensive review of the subject. (9) We found 3 potential "low-cost" tools -a DD clinical score, the BET and the digital rectal examination (DRE). Based on current evidence, it is not possible to know whether these "low-cost" strategies are useful in this setting.…”

Section: Introductionmentioning

confidence: 99%

“…Based on current evidence, it is not possible to know whether these "low-cost" strategies are useful in this setting. (9) Going into detail, no clinical score has emerged as a relevant diagnostic method in the diagram of DD and none was evaluated as a screening tool. Two speci c DD scores (Altomare score and Renzi score) were validated to grade severity and value of treatment's e cacy.…”

Section: Introductionmentioning

confidence: 99%

“…The BET is a convenient procedure but described with inconsistent methodology especially regarding the volume used to in ate the balloon. (9,(12)(13)(14) Considering the physiological aspects of defecation, there remains doubts if a xed low intrarectal volume is enough to trigger the desire to defecate or if higher variable volumes associated with the constant desire to evacuate can compensate for rectal hiposensitivity. (2,12) The DRE is another low-cost tool that may sometimes be under or inappropriately used (15,16) and its value in DD was assessed in very few studies.…”

Section: Introductionmentioning

confidence: 99%

“…(2,12) The DRE is another low-cost tool that may sometimes be under or inappropriately used (15,16) and its value in DD was assessed in very few studies. (9) Only Tantiphlachiva proposed a DRE score to diagnose DD. (17) Therefore, there is a need for prospective studies with descriptive and consistent methodology to evaluate BET and DRE utility.…”

Section: Introductionmentioning

confidence: 99%

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Does Sequential Balloon Expulsion Test improve the screening of Defecation Disorders?

Caetano

Costa

Gonçalves

et al. 2020

Preprint

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Purpose A Defecation Disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three “low-cost” tools to evaluate DD – a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET (standard and variable volume (vv)). Results From 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential vvBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Sequential Balloon Expulsion Test improve the screening of Defecation Disorders?

Caetano

Costa

Gonçalves

et al. 2020

Preprint

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Constipation: Prevalence in the Portuguese community using Rome IV—Associated factors, toilet behaviours and healthcare seeking

et al. 2022

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Background: Chronic constipation (CC) is a major public health condition and CC management remains challenging.Objective: We aimed to evaluate the CC (and subtypes) prevalence in a Southern Europe Mediterranean country using Rome IV criteria, and to assess related factors, toilet and healthcare seeking behaviours.Methods: Cross-sectional epidemiological survey, conducted in general community and representing the Portuguese population according to sex and age. The questionnaire covered bowel habits, factors potentially associated with CC (demographic, health/lifestyle, toilet behaviours) and data regarding healthcare seeking.Results: From the study data of 1950 individuals were analyzed. The answer rate was 68% and 1335 questionnaires were available for calculation. The CC prevalence was 17.8%, with respectively 9.3% of Functional Constipation (FC) and 8.5% of Irritable Bowel Syndrome -subtype constipation (IBS-C). The likelihood of constipation was significantly higher in younger (OR 1.01; 95% confidence interval [CI],1.007-1.031), solo (OR 2.48; 95% CI,) and low-income (OR 2.40; 95% CI, individuals. Constipated individuals spent more time at defecation, longer than 5 min (p = 0.001), and had particular toilet behaviours (absence of a morning pattern [p = 0.008], the use of triggers [p = 0.001] and reading/technological material [p = 0.006]) to facilitate the evacuation. Only 39% of affected individuals sought medical advice, mainly IBS-C patients (p = 0.018). Conclusion: Chronic constipation seems to impact 1 in each 5 Portuguese. Constipated patients are younger, solo, less active and with low income. They develop a clear toilet behaviour profile. FC and IBS-C patients assume particular behaviours.

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To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound

Dekker

Reijn-Baggen

Han-Geurts

et al. 2023

Int J Colorectal Dis

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Background Anorectal function tests are helpful for objective investigation of anorectal (dys)function. A variety of tests are available, but there is no recommendation when to perform which test. Furthermore, which test is the most accurate is controversial and the correlation between these tests is not very clear. The aim of our study was to examine the correlation of anal pressures and the possibility to diagnose pelvic floor dyssynergia between digital rectal examination (DRE) and several anorectal function tests. Methods Between January 2020 and April 2022, all men and women aged 18 to 80 years, treated at the Proctos Clinic, who were referred for pelvic floor physical therapy (PFPT) by the surgeon and underwent anorectal function tests, were included. DRE was performed to establish the anal pressure at rest and during squeeze and straining. Anorectal function tests included 3D high-resolution anal manometry (3D-HRAM), balloon expulsion test (BET), transperineal ultrasound (TPUS), and surface electromyography (s-EMG). Results A total of 50 patients, 37 (74%) females, were included. Median age was 51 years. Twenty-three (62%) females had a history of two or more vaginal deliveries. The most frequent reason for referral for PFPT was fecal incontinence in 27 (54%) patients. The assessed pressures and pelvic floor function measured with DRE by the surgeon and the pelvic floor physical therapist during rest, squeeze, and straining correlated in 78%, 78%, and 84%, respectively. Correlation between DRE and 3D-HRAM or s-EMG was better for squeeze pressures than resting pressures. The correlation between s-EMG and 3D-HRAM was better during squeeze than at rest with an agreement of 59% and 37%, respectively. Conclusion DRE by an experienced investigator is of sufficient value for daily clinical practice to detect dyssynergia and to measure sphincter tone. Commonly performed anorectal function tests correlate poorly with DRE and with other anorectal function tests. When conservative treatment fails, further investigation is warranted; however, these results should be interpreted with caution. What does this paper add to the literature? Anorectal function tests such as the 3D high-resolution anorectal manometry, balloon expulsion test, surface electromyography, and transperineal ultrasound are all frequently performed in the diagnostic workup in patients with defecation disorders. No previous study has compared these tests regarding their outcomes, nor has the interrater agreement been measured regarding the digital rectal examination by two experienced observers. Furthermore, transperineal ultrasound is in all probability not frequently used and therefore underexposed in the diagnostic workup of patients with dyssynergic defecation.

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Digital Rectal Examination and Balloon Expulsion Test in the Study of Defecatory Disorders: Are They Suitable as Screening or Excluding Tests?

Cited by 22 publications

References 48 publications

Does Sequential Balloon Expulsion Test improve the screening of Defecation Disorders?

Does Sequential Balloon Expulsion Test improve the screening of Defecation Disorders?

Constipation: Prevalence in the Portuguese community using Rome IV—Associated factors, toilet behaviours and healthcare seeking

To what extent are anorectal function tests comparable? A study comparing digital rectal examination, anal electromyography, 3-dimensional high-resolution anal manometry, and transperineal ultrasound

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