Zhu LJ, Zeng XL, Yang XD. Enhancing clinical practice: The role of digital rectal examination in diagnosing functional defecation disorders. World J Gastrointest Surg 2025; 17(7): 106471 [DOI: 10.4240/wjgs.v17.i7.106471]
Corresponding Author of This Article
Xiang-Dong Yang, PhD, Professor, Department of Colorectal and Anal Surgery, Chengdu Anorectal Hospital, No. 152 Daqiang East Street, Taisheng South Road, Chengdu 610015, Sichuan Province, China. y-xd@vip.163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2025; 17(7): 106471 Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.106471
Enhancing clinical practice: The role of digital rectal examination in diagnosing functional defecation disorders
Lian-Jun Zhu, Xing-Lin Zeng, Xiang-Dong Yang
Lian-Jun Zhu, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China
Xing-Lin Zeng, Department of General Surgery, Jiangbei Campus of The First Affiliated Hospital of Army Medical University, Chongqing 400020, China
Xiang-Dong Yang, Department of Colorectal and Anal Surgery, Chengdu Anorectal Hospital, Chengdu 610015, Sichuan Province, China
Author contributions: Zhu LJ and Yang XD contributed to the manuscript outline, composed the paper, and originated the concept for this manuscript; Zeng XL was responsible for sourcing and organizing relevant literature; Yang XD provided supervision, reviewed the paper, and finalized the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang-Dong Yang, PhD, Professor, Department of Colorectal and Anal Surgery, Chengdu Anorectal Hospital, No. 152 Daqiang East Street, Taisheng South Road, Chengdu 610015, Sichuan Province, China. y-xd@vip.163.com
Received: March 5, 2025 Revised: May 7, 2025 Accepted: June 4, 2025 Published online: July 27, 2025 Processing time: 140 Days and 4.3 Hours
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.
Core Tip: In this study, we delineate a standardized digital rectal examination protocol for diagnosing functional defecation disorders and explore clinical metrics validated by dynamic imaging. By incorporating high-resolution defecographic imaging from representative cases, we can establish anatomic-pathophysiological correlations to increase diagnostic precision. These visual didactic tools serve as pivotal clinical references for training and clinical decision-making. The protocol is based on pathognomonic physical signs and systematic characterization, enabling targeted differential diagnosis and evidence-based therapeutic stratification in routine clinical workflows.
