An exploring study of defecography, digital rectal examination, and balloon expulsion test for screening and predicting of symptoms with defecation disorders

Background: Defecation disorder is widely common in constipa� tion, which diagnosed by Defecography (DF), Digital Rectal Examina� tion (DRE), Balloon Expulsion Test (BET), and others. It remains not clear that which one would be more accessible and effective due to no comparison of defecation disorders among diagnosis, classification and treatments, based on symptoms. The aim of this study is to evalu� ate which method should be used more easy operational and accu� rately in clinics with prediction based on symptoms. Methods: Consecutive patients with chronic constipation (Rome III criteria, n=141) underwent DF, DRE, and BET between 2014 and 2018. Those examination findings and symptoms with constipation were re� corded and analyzed. Results: Of the 141 patients included in our study, 67 (47.5%) had a sensation of incomplete defecation, 66 (46.8%) of these were identi� fied to have clinical symptoms with obstruction. The sensitivity and specificity of DF for identifying patients with obstruction were 42.4% and 78.7%, respectively; the positive predictive value was 63.6%, with [AUC: 0.62 (95% CI: 0.54-0.71)]. The sensitivity and specificity of DRE for identifying patients with a sensation of incomplete defecation were 76.1% and 44.6%, respectively; the positive predictive value was 55.4%, with [AUC: 0.60 (95% CI: 0.53-0.68)]. It is only useful dignosis for abdominal distention used BET. The sensitivity and specificity of BET for identifying patients with abdominal distention were 75.0% and 43.6%, respectively, with [AUC: 0.59 (95% CI: 0.51-0.68)]. The positive correlation between sacrum-rectal separate and obstruction was ob� served in the study, the similar correlation was observed in between Pelvic floor hernia and abdominal distention. Conclusions: It is a valuable tool for diagnosis and further treat� ment of these six symptoms used an index combining DF and DRE. In addition, DF and DRE would be a more accessible and effective clini� cal tool for screening and diagnosis of patients with obstruction and a sensation of incomplete defecation, respectively. However, it would be only valuable tool for abdominal distention used BET. Both methods could facilitate the selection of appropriate patients for further exami� nations and tailored therapy accordingly.