Dynamic Rectal Examination: Its Significant Clinical Value

Abstract

The aim of the present study was to carry out a proper correlation between patients' clinical symptoms and the radiological findings obtained by dynamic rectal examination (DRE). At DRE, the small bowel and in females the vagina are routinely opacified in addition to defecography. A prospective study of 248 consecutive patients (193 women and 55 men, ratio 3.5:1) and 14 control subjects was conducted. The parameters assessed included the anorectal angle, the position of the anorectal junction, and the total movement of the pelvic floor during squeezing and defecation. Anatomical changes as rectoceles, enteroceles and intussusceptions were also observed. Based on the findings, the following conclusions can be drawn. There is no indication for measurement of the central or posterior anorectal angle. There is no indication for measurement of the perineal ascent, perineal descent, and anorectal junction level. Anterior rectoceles occur very frequently in females, and are only of clinical relevance if the patients need digital vaginal support to facilitate defecation. DRE is a sensitive method for diagnosing enteroceles and intussusceptions.

Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography

“…Neither the extent of prolapse on the rectal side nor concomitant pelvic floor pathology is identified at the POP-Q examination. An important contribution of defecography when evaluating posterior vaginal wall prolapse is the detection of enteroceles [20,21], which frequently can be difficult to diagnose at clinical examination [6]. An enterocele and a widened rectovaginal space may be demonstrated at defecography.…”

Radiologic Evaluation of Pelvic Floor Disorders

“…9,10 Interobserver agreement was shown to be good for the diagnosis of rectocele and enterocele but inadequate for perineal descent. [2][3][4]11 Functional findings are also important. For example, an incomplete and prolonged contrast evacuation seems more specific of dyssynergia than an inappropriate puborectal contraction.…”

“…2,[13][14][15][16] In many instances, normal individuals show abnormal findings and hence the link between a clinical symptom and an abnormal defecography finding is difficult to establish. 3 …”

Defecographic Measurements of Rectal Intussusception and Prolapse in Patients and in Asymptomatic Subjects

“…Yet these radiologic signs appear to have lost their diagnostic value because healthy subjects and patients with outlet obstruction or anal incontinence may present variations in measurements of the anorectal angle, anal canal width, pelvic floor movements, and residual volume after defecation [2][3][4][5][6][7][8][9][10][11][12].…”

“…Moreover, any finding of changes in the morphology of the rectal wall is of little diagnostic value because rectocele, mucosal prolapse, rectal intussusception, and an absence of pelvic floor muscle relaxation are also observed in asymptomatic subjects [5,8,9,[13][14][15].…”