Enhancing clinical practice: The role of digital rectal examination in diagnosing functional defecation disorders

Abstract

Digital rectal examination (DRE) is essential for diagnosing anorectal diseases, yet its widespread adoption remains suboptimal among practitioners. While modalities such as anorectal manometry, rectal balloon expulsion tests, pelvic floor electromyography, and dynamic imaging (defecography/pelvic floor magnetic resonance imaging) enable comprehensive assessment of anorectal function, many healthcare facilities lack advanced diagnostic tools and specialized personnel. DRE has notable diagnostic value in the primary evaluation of functional defecation disorders (FDDs), particularly for detecting dyssynergic defecation and structural pelvic floor defects. Its cost efficiency and universal accessibility render it indispensable in resource-limited environments where high-resolution diagnostic technologies (e.g., high-resolution manometry) are unavailable. This review delineates standardized DRE protocols for assessing FDDs and highlights characteristic imaging features of FDDs with the aim of improving the understanding of DRE. This review will hopefully encourage clinicians to perform DREs in diverse clinical settings.

Keywords: Constipation; Digital rectal examination; Dyssynergic defecation; Functional defecation disorders; Review.

Figure 1

Steps of digital rectal examination.

Figure 2

Patient positioning for digital rectal examination.

Figure 3

Digital insertion and anorectal palpation.

Figure 4

Morphological changes demonstrated by defecography (indicated by the arrow). A: Sac-like protrusion of the anterior rectal wall; B: Internal rectal prolapse in a funnel-shaped configuration; C: Rectal luminal distension; D: The sigmoid colon descends below the pubococcygeal line; E: Evident pressure trace of the puborectalis muscle.