T1029 The Utility of the Digital Rectal Exam (DRE) Amongst Physicians and Students: A Multi-Center Study

Wong, Reuben K.; Drossman, Douglas A.; Bharucha, Adil E.; Rao, Satish S.; Wald, Arnold; Morris, Carolyn; Oxentenko, Amy S.; Handel, Daniel Van; Edwards, Hollie; Hu, Yuming; Bangdiwala, Shrikant I.

doi:10.1016/s0016-5085(10)62184-1

Cited by 2 publications

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“…A recent multicenter study involving medical students, primary care and internal medicine physicians and gastroenterologists showed that gastroenterologists performed the most DREs annually, followed by primary care, and internal medicine subspecialities [27]. Since symptoms alone are poor predictors of underlying pathology of chronic constipation [12], symptoms together with DRE findings may help identify patients who may require further specialized testing for evaluation and management.…”

Section: Clinical Evaluationmentioning

confidence: 99%

What is necessary to diagnose constipation?

Rao

Meduri

2011

Best Practice & Research Clinical Gastroenterology

115

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Constipation is a common ailment with multiple symptoms and diverse etiology. Understanding the pathophysiology is important to guide optimal management. During the past few years, there have been remarkable developments in the diagnosis of constipation and defecation disorders. Several innovative manometric, neurophysiologic, and radiologic techniques have been discovered, which have improved the accuracy of identifying the neuromuscular mechanisms of chronic constipation. These include use of digital rectal examination, Bristol stool scale, colonic scintigraphy, wireless motility capsule for assessment of colonic and whole gut transit, high resolution anorectal manometry, and colonic manometry. These tests provide a better definition of the underlying mechanism(s), which in turn can lead to improved management of this condition. In this review, we summarize the recent advances in diagnostic testing with a particular emphasis on when and why to test, and discuss the utility of diagnostic tests for chronic constipation.

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Section: Clinical Evaluationmentioning

confidence: 99%

What is necessary to diagnose constipation?

Rao

Meduri

2011

Best Practice & Research Clinical Gastroenterology

115

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“…An absence of these normal findings should raise the index of suspicion for an evacuation disorder such as dyssynergic defecation. DRE has a sensitivity of 77% and specificity of 87% for detecting dyssynergia 7 , but is infrequently performed, even by gastroenterologists, and there is lack of training 8 .Thus, a concerted effort is needed to improve the training of digital rectal examination.…”

Section: Digital Rectal Exam (Dre)mentioning

confidence: 99%

Medical and Surgical Management of Pelvic Floor Disorders Affecting Defecation

Schey

Cromwell

Rao

2012

American Journal of Gastroenterology

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Pelvic floor disorders that affect stool evacuation include structural (example: rectocele) and functional disorders (example: dyssynergic defecation). Meticulous history, digital rectal examination, and physiological tests such as anorectal manometry, colonic transit study, balloon expulsion and imaging studies such as anal ultrasound, defecography, and static and dynamic MRI can facilitate an objective diagnosis and optimal treatment. Management consists of education and counseling regarding bowel function, diet, laxatives, most importantly behavioral and biofeedback therapies, and lastly surgery. Randomized clinical trials have established that biofeedback therapy is effective in treating dyssynergic defecation. Because dyssynergic defecation may co-exist with conditions such as solitary rectal ulcer syndrome (SRUS), and rectocele, before considering surgery, biofeedback therapy should be tried and an accurate assessment of the entire pelvis and its function should be performed. Several surgical approaches have been advocated for the treatment of pelvic floor disorders including open, laparoscopic and trans-abdominal approach, stapled transanal rectal resection (STARR), and robotic colon and rectal resections. However, there is lack of well controlled randomized studies and efficacy of these surgical procedures remains to be established.

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T1029 The Utility of the Digital Rectal Exam (DRE) Amongst Physicians and Students: A Multi-Center Study

Cited by 2 publications

References 0 publications

What is necessary to diagnose constipation?

What is necessary to diagnose constipation?

Medical and Surgical Management of Pelvic Floor Disorders Affecting Defecation

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