Correlation of Digital Rectal Examination and Anorectal Manometry with Patient-Reported Outcomes Among Women with Fecal Incontinence.
Anorectal manometry
Anorectal physiology
Clinical examination
Fecal incontinence
Patient-reported outcome measures
Women
Journal
International urogynecology journal
ISSN: 1433-3023
Titre abrégé: Int Urogynecol J
Pays: England
ID NLM: 101567041
Informations de publication
Date de publication:
20 Aug 2024
20 Aug 2024
Historique:
received:
07
03
2024
accepted:
10
05
2024
medline:
20
8
2024
pubmed:
20
8
2024
entrez:
20
8
2024
Statut:
aheadofprint
Résumé
Standardized digital rectal examination (DRE) correlates with anorectal manometry (ARM) measures. However, less is known about the relationship between DRE/ARM measures and patient-reported outcomes (PROs), especially among women with fecal incontinence (FI). Our aims were to evaluate associations between DRE and ARM measures and compare PROs with diagnostic evaluation measures for women with FI. We analyzed data from the parent clinical trial, Controlling Anal incontinence by Performing Anal exercises with Biofeedback or Loperamide (CAPABLe). We pooled data from randomized women who completed standardized ARM, DRE, and validated PROs at baseline and 12 and 24 weeks post-treatment initiation. PROs included FI severity, impact on quality of life, and bowel diary data. We analyzed ARM pressure and volume data and DRE using the Digital Rectal Examination Scoring System (DRESS) resting and squeeze mean scores. We used Spearman Rank Correlation to measure associations between the ARM measures and mean DRESS scores, and between PROs and ARM/DRESS scores. Among 291 randomized women with ARM and DRE data, the correlation between DRESS and ARM resting measures was 0.196 (p<0.001) and between squeeze measures was 0.247 (p<0.001). At most timepoints, PROs more consistently correlated with squeeze ARM pressures and squeeze DRESS scores than resting measures. We found weak correlations between ARM and DRE measures and between those measures and PROs. Although DRE and ARM are commonly used diagnostic measures among women with FI, the weak correlations with patient-reported symptoms raises questions about their utility in clinical care.
Identifiants
pubmed: 39162808
doi: 10.1007/s00192-024-05848-7
pii: 10.1007/s00192-024-05848-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NICHD NIH HHS
ID : U10 HD054215
Pays : United States
Informations de copyright
© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
Références
Ng KS, Sivakumaran Y, Nassar N, Gladman MA. Fecal incontinence: community prevalence and associated factors–a systematic review. Dis Colon Rectum. 2015;58(12):1194–209.
doi: 10.1097/DCR.0000000000000514
pubmed: 26544818
Grover M, Busby-Whitehead J, Palmer MH, et al. Survey of geriatricians on the effect of fecal incontinence on nursing home referral. J Am Geriatr Soc. 2010;58(6):1058–62.
doi: 10.1111/j.1532-5415.2010.02863.x
pubmed: 20487073
pmcid: 2924928
Carrington EV, Scott SM, Bharucha A, et al. Expert consensus document: advances in the evaluation of anorectal function. Nat Rev Gastroenterol Hepatol. 2018;15(5):309–23.
doi: 10.1038/nrgastro.2018.27
pubmed: 29636555
pmcid: 6028941
Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015;58(7):623–36.
doi: 10.1097/DCR.0000000000000397
pubmed: 26200676
Bordeianou LG, Carmichael JC, Paquette IM, et al. Consensus statement of definitions for anorectal physiology testing and pelvic floor terminology (Revised). Dis Colon Rectum. 2018;61(4):421–7.
doi: 10.1097/DCR.0000000000001070
pubmed: 29521821
Jelovsek JE, Markland AD, Whitehead WE, et al. Controlling faecal incontinence in women by performing anal exercises with biofeedback or loperamide: a randomised clinical trial. Lancet Gastroenterol Hepatol. 2019;4(9):698–710.
doi: 10.1016/S2468-1253(19)30193-1
pubmed: 31320277
pmcid: 6708078
Jelovsek JE, Markland AD, Whitehead WE, et al., Controlling anal incontinence in women by performing anal exercises with biofeedback or loperamide (CAPABLe) trial: design and methods. Contemp Clin Trials. 2015;44:164–74.
doi: 10.1016/j.cct.2015.08.009
pmcid: 4757512
Markland AD, Jelovsek JE, Whitehead WE, et al. Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol. Neurogastroenterol Motil. 2017;29(1):e12906.
doi: 10.1111/nmo.12906
Orkin BA, Sinykin SB, Lloyd PC. The digital rectal examination scoring system (DRESS). Dis Colon Rectum. 2010;53(12):1656–60.
doi: 10.1007/DCR.0b013e3181f23c85
pubmed: 21178861
Bharucha AE, Stroetz R, Feuerhak K, Szarka LA, Zinsmeister AR. A novel technique for bedside anorectal manometry in humans. Neurogastroenterol Motil. 2015;27(10):1504–8.
doi: 10.1111/nmo.12636
pubmed: 26227262
pmcid: 4584182
Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999;44(1):77–80.
doi: 10.1136/gut.44.1.77
pubmed: 9862829
pmcid: 1760067
Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193(1):103.
doi: 10.1016/j.ajog.2004.12.025
pubmed: 16021067
Kwon S, Visco AG, Fitzgerald MP, Ye W, Whitehead WE; Pelvic Floor Disorders Network (PFDN). Validity and reliability of the modified Manchester health questionnaire in assessing patients with fecal incontinence. Dis Colon Rectum. 2005;48(2):323.
doi: 10.1007/s10350-004-0899-y
pubmed: 15616750
Bordeianou L, Lee KY, Rockwood T, et al. Anal resting pressures at manometry correlate with the Fecal Incontinence Severity Index and with presence of sphincter defects on ultrasound. Dis Colon Rectum. 2008;51(7):1010–4.
doi: 10.1007/s10350-008-9230-7
pubmed: 18437494
Dobben AC, Terra MP, Deutekom M, et al. Anal inspection and digital rectal examination compared to anorectal physiology tests and endoanal ultrasonography in evaluating fecal incontinence. Int J Colorectal Dis. 2007;22(7):783–90.
doi: 10.1007/s00384-006-0217-3
pubmed: 17096089
Coura MM, Silva SM, de Almeida RM, Forrest MC, Sousa JB. Is digital rectal exam reliable in grading anal sphincter defects? Arq Gastroenterol. 2016;53(4):240–5.
doi: 10.1590/S0004-28032016000400006
pubmed: 27706453
Ramage L, Qiu S, Yeap Z, et al. Anorectal manometry versus patient-reported outcome measures as a predictor of maximal treatment for fecal incontinence. Ann Coloproctol. 2019;35(6):319–26.
doi: 10.3393/ac.2018.10.16
pubmed: 31937071
pmcid: 6968727
Bordeianou L, Rockwood T, Baxter N, Lowry A, Mellgren A, Parker S. Does incontinence severity correlate with quality of life? Prospective analysis of 502 consecutive patients. Colorectal Dis. 2008;10(3):273–9.
doi: 10.1111/j.1463-1318.2007.01288.x
pubmed: 17608751
Govaert B, Melenhorst J, Nieman FH, Bols EM, van Gemert WG, Baeten CG. Factors associated with percutaneous nerve evaluation and permanent sacral nerve modulation outcome in patients with fecal incontinence. Dis Colon Rectum. 2009;52(10):1688–94.
doi: 10.1007/DCR.0b013e3181b55595
pubmed: 19966599
Horrocks EJ, Chadi SA, Stevens NJ, Wexner SD, Knowles CH. Factors associated with efficacy of percutaneous tibial nerve stimulation for fecal incontinence, based on post-hoc analysis of data from a randomized trial. Clin Gastroenterol Hepatol. 2017;15(12):1915–21.e2.
doi: 10.1016/j.cgh.2017.06.032
pubmed: 28647458
Richter HE, Jelovsek JE, Iyer P, et al. Characteristics associated with clinically important treatment responses in women undergoing nonsurgical therapy for fecal incontinence. Am J Gastroenterol. 2020;115(1):115–27.
doi: 10.14309/ajg.0000000000000482
pubmed: 31895722
pmcid: 7197976
Bols E, Hendriks E, de Bie R, Baeten C, Berghmans B. Predictors of a favorable outcome of physiotherapy in fecal incontinence: secondary analysis of a randomized trial. Neurourol Urodyn. 2012;31(7):1156–60.
doi: 10.1002/nau.21236
pubmed: 22488751
Carrington EV, Heinrich H, Knowles CH, et al. The International Anorectal Physiology Working Group (IAPWG) recommendations: standardized testing protocol and the London classification for disorders of anorectal function. Neurogastroenterol Motil. 2020;32(1):e13679.
doi: 10.1111/nmo.13679
pubmed: 31407463