Accuracy of the digital anal examination in women with fecal incontinence

• Published in: International Urogynecology Journal Vol. 23; no. 6; pp. 765 - 768
• Main Authors: Jeppson, Peter C., Paraiso, Marie Fidela R., Jelovsek, J. Eric, Barber, Matthew D.
• Format: Journal Article
• Language: English
• Published: London Springer-Verlag 01.06.2012; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anal Canal - pathology; Anal Canal - physiopathology; Anal Canal - ultrastructure; Defecation; Diagnosis, Differential; Digital Rectal Examination - methods; Endosonography; Fecal Incontinence - diagnosis; Fecal Incontinence - physiopathology; Female; Follow-Up Studies; Gynecology; Humans; Medicine; Medicine & Public Health; Middle Aged; Original Article; Reproducibility of Results; Retrospective Studies; ROC Curve; Severity of Illness Index; Urology; Fecal incontinence; Anal sphincter defect; Digital rectal examination; Endoanal ultrasound; Anal sphincter
• ISSN: 0937-3462; 1433-3023; 1433-3023
• DOI: 10.1007/s00192-011-1590-1

Introduction and hypothesis This study aims to determine the accuracy of digital rectal examination (DRE) to detect anal sphincter defects when compared to endoanal ultrasound (US) in women with fecal incontinence (FI). Methods Seventy-four patients identified by retrospective chart review who presented with complaints of bothersome FI who underwent endoanal US are the subjects of this analysis. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for the ability of the DRE to detect anal sphincter defects. Results Anal sphincter defect was suspected on DRE in 75%. At endoanal US, external sphincter defects were noted in all three segments in 41% (complete defect) while partial defects were noted in 30%. DRE demonstrated a sensitivity of 82%, specificity of 32%, +likelihood ratio 1.2 (95% confidence interval (CI), 0.95–1.16) and −likelihood ratio of 0.6 (95% CI, 0.2–1.24) for detecting a complete EAS defect on endoanal US. Conclusion DRE has poor specificity for detecting anal sphincter defects seen on endoanal US.