This study investigates dyssynergia defecation (DD), a significant contributor to persistent constipation caused by impaired pelvic floor relaxation, particularly in patients requiring pelvic floor surgery. Because diagnosing DD is crucial for determining treatment plans in such patients—and given the limited availability and high cost of manometry—this research compared simpler, more accessible tests (DRE and BET) against anorectal manometry.

A cross-sectional design was adopted, enrolling patients with chronic constipation (CC) or constipation-predominant irritable bowel syndrome (IBS-C) at a specialized pelvic floor disorders clinic. Data collection included digital rectal examination (DRE), balloon expulsion test (BET), and anorectal manometry, the latter serving as the reference test for assessing sphincter pressures and rectal compliance.

Of 250 participants, 140 were diagnosed with DD via manometry. DRE showed moderate agreement with manometry, demonstrating high specificity but moderate sensitivity. By contrast, BET exhibited higher sensitivity but lower specificity, leading to weaker overall agreement with manometric findings.

Despite DRE’s ease of use and cost-effectiveness, manometry remains vital for definitive diagnosis. Environmental factors, such as multiple examiners in an educational setting, may have influenced patient comfort and study outcomes. Ultimately, systematic DRE training and the judicious use of manometry can enhance diagnostic efficiency, especially in cases requiring surgical intervention—such as rectocele—where precise identification of dyssynergia is essential before surgery.

A carefully performed digital rectal examination (DRE) offers a straightforward and reliable initial screening tool for dyssynergia defecation (DD). When used alongside bedside examination, DRE can help clinicians identify patients who are most likely to benefit from confirmatory manometry, thus facilitating earlier initiation of targeted therapies. The divergence between DRE and manometric measurements may partly be explained by patient bias, particularly in an educational center where multiple examiners may be present. Furthermore, up to 15% of asymptomatic individuals can exhibit abnormal manometry findings. Only simple part of DRE criteria alone may not diagnose DD; rather, a comprehensive assessment considering all DRE findings is necessary. Finally, accurate identification of dyssynergia is crucial in cases such as rectocele surgery, where misdiagnosis can increase recurrence rates. Our findings support using DRE to rule in—or out—primary dyssynergia at the bedside, reserving manometry for confirmation and guiding surgical decisions when indicated.