| Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. | |
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MedLine Citation:
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PMID: 17096089 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Anal inspection and digital rectal examination are routinely performed in fecal incontinent patients but it is not clear to what extent they contribute to the diagnostic work-up. We examined if and how findings of anal inspection and rectal examination are associated with anorectal function tests and endoanal ultrasonography. METHODS: A cohort of fecal incontinent patients (n=312, 90% females; mean age 59) prospectively underwent anal inspection and rectal examination. Findings were compared with results of anorectal function tests and endoanal ultrasonography. RESULTS: Absent, decreased and normal resting and squeeze pressures at rectal examination correlated to some extent with mean (+/-SD) manometric findings: mean resting pressure 41.3 (+/-20), 43.8 (+/-20) and 61.6 (+/-23) Hg (p<0.001); incremental squeeze pressure 20.6 (+/-20), 38.4 (+/-31) and 62.4 (+/-34) Hg (p<0.001). External anal sphincter defects at rectal examination were confirmed with endoanal ultrasonography for defects <90 degrees in 36% (37/103); for defects between 90-150 degrees in 61% (20/33); for defects between 150-270 degrees in 100% (6/6). Patients with anal scar tissue at anal inspection had lower incremental squeeze pressures (p=0.04); patients with a gaping anus had lower resting pressures (p=0.013) at anorectal manometry. All other findings were not related to any anorectal function test or endoanal ultrasonography. CONCLUSIONS: Anal inspection and digital rectal examination can give accurate information about internal and external anal sphincter function but are inaccurate for determining external anal sphincter defects <90 degrees. Therefore, a sufficient diagnostic work-up should comprise at least rectal examination, anal inspection and endoanal ultrasonography. |
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Authors:
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Annette C Dobben; Maaike P Terra; Marije Deutekom; Michael F Gerhards; A Bart Bijnen; Richelle J F Felt-Bersma; Lucas W M Janssen; Patrick M M Bossuyt; Jaap Stoker |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2006-11-10 |
Journal Detail:
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Title: International journal of colorectal disease Volume: 22 ISSN: 0179-1958 ISO Abbreviation: Int J Colorectal Dis Publication Date: 2007 Jul |
Date Detail:
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Created Date: 2007-05-25 Completed Date: 2007-10-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8607899 Medline TA: Int J Colorectal Dis Country: Germany |
Other Details:
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Languages: eng Pagination: 783-90 Citation Subset: IM |
Affiliation:
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Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. a.c.dobben@amc.uva.nl |
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| MeSH Terms | |
Descriptor/Qualifier:
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Anal Canal
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physiology* Digital Rectal Examination* Endosonography* Fecal Incontinence* / pathology, physiopathology, ultrasonography Female Follow-Up Studies Humans Male Manometry Middle Aged Pressure Prognosis Prospective Studies Rectum / physiology* Reproducibility of Results Severity of Illness Index |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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