E. Buch et al., CAN DIGITAL EXAMINATION SUBSTITUTE ANORECTAL MANOMETRY FOR THE EVALUATION OF ANAL-CANAL PRESSURES, Revista espanola de enfermedades digestivas, 90(2), 1998, pp. 90-93
INTRODUCTION: anorectal manometry provides objective information on th
e sphincter function of the anal canal. However, in many centers sphin
cter function is evaluated by digital examination, due to the unavaila
bility of manometry. OBJECTIVE: a study is made to correlate the sensi
tivity and specificity of a quantitative digital examination in the an
alysis of sphincter tone with the pressures recorded by manometry, and
to examine the capacity of both techniques to discriminate continent
subjects and incontinent patients. PATIENTS AND METHODS: a total of 19
1 patients were divided into three groups: control (C), obstructive de
fecation (OD) and fecal incontinence (FI). Subjective quantitative dig
ital evaluation of anal tone was performed on a scale of 0 to 5 points
at rest, and 0 to 10 points at squeeze. A correlation analysis was pe
rformed, and the sensitivity and specificity of each fecal incontinenc
e diagnostic test was determined. RESULTS: digital examination found r
ectal tone to be diminished in elderly patients. A significant correla
tion was established between the digital and manometric tone readings,
both at rest and at squeeze. Both techniques showed a low anal sphinc
ter pressure in the Fl group versus the C and OD groups. Differences i
n tone were recorded between the C and OD groups with manometry, but n
ot with digital examination. The latter was in turn found to be more s
ensitive but less specific than manometry in differentiating between f
ecal continence and incontinence. CONCLUSIONS: although digital examin
ation does not substitute anorectal manometry, a good correlation exis
ts between the two techniques. In this sense, digital examination may
afford an approximate clinical evaluation of some fecal continence mec
hanisms in those centers where manometry is not available.