1 General introduction 23 Digital rectal examination (Rao®) Next, the patient is asked to bear down (push). The examiner places his/her left hand on the patient’s abdomen and the patient is asked to push and bear down. Repeat this maneuver once or twice to make sure the patient understands the order and complied with the request, and that the responses are consistent.50 Push effort is scored as relaxation, indifferent or paradoxical contraction. To clinically diagnose dyssynergia, the presence of any two of the following findings can be used: the inability to contract the abdominal muscles, inability to relax the anal sphincter and puborectalis muscle, a paradoxal contraction of the anal sphincter and puborectalis muscle, or the absence of perineal descent.50 The sensitivity of digital rectal examination in diagnosing dyssynergia is 71% and the specificity is 76%.53 The current Rome criteria recommends the use of additional tests for diagnosing dyssynergia.54 Push effort (Rao®)
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