Table 1:
Diagnostic utility of symptoms in diagnosing RED and STC alone
| Symptoms | SN (%) | SP (%) | (+) LR | (−) LR | SN (%) | SP (%) | (+) LR | (−) LR | SN (%) | SP (%) | (+) LR | (−) LR |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Diagnosing RED with or without STC | Diagnosing STC alone | Diagnosing RED alone | ||||||||||
| Straining1–15 | 88.1 (76.1–93.3) | 35.0 (21.2–42.1) | 1.1 (1.0–1.5) | 0.7 (0.3–1.2) | 67.9 (55.9–78.6) | 40.7 (30.0–49.6) | 1.1 (0.8–1.9) | 0.9 (0.6–1.3) | 76.0 (69.2–82.7) | 40.7 (40.3–41.0) | 1.3 (1.2–1.4) | 0.6 (0.4–0.8) |
| Hard or lumpy stools1–3, 5–11, 13–15 | 73.7 (55.1–79.2) | 33.1 (26.9–45.6) | 1.0 (0.8–1.1) | 0.8 (0.7–1.0) | 52.2 (46.4–60.6) | 43.1 (36.7–49.2) | 1.0 (0.9–1.0) | 1.1 (1.0–1.1) | 72.0 (71.2–72.9) | 42.4 (35.4–49.5) | 1.3 (1.2–1.5) | 0.8 (0.6–0.9) |
| Sensation of incomplete evacuation1, 2, 4–16 | 80.6 (20.0–90.7) | 38.2 (27.9–57.0) | 1.1 (1.0–1.7) | 0.7 (0.2–0.9) | 68.9 (51.3–78.3) | 48.3 (31.0–61.5) | 1.1 (0.8–1.6) | 1.0 (0.6–2.2) | 80.5 (77.3–83.7) | 48.3 (44.1–52.4) | 1.6 (1.4–1.8) | 0.4 (0.3–0.5) |
| Anorectal blockage/obstruction sensation1, 3, 6–11, 13–15 | 69.7 (46.4–76.9) | 61.3 (37.2–77.6) | 1.4 (1.2–1.6) | 0.8 (0.6–0.8) | 28.6 (18.1–44.5) | 73.3 (51.8–76.9) | 0.9 (0.6–1.0) | 1.1 (1.1–1.2) | 49.9 (47.1–52.6) | 76.9 (75.1–78.7) | 2.2 (2.0–2.5) | 0.7 (0.6–0.7) |
| Digital or manual maneuvers1, 2, 4–15, 17 | 46.1 (37.3–52.3) | 58.3 (51.8–75.6) | 1.1 (0.9–1.3) | 0.9 (0.8–1.1) | 11.5 (7.1–34.2) | 72.4 (58.3–81.3) | 0.6 (0.1–1.2) | 1.1 (0.9–1.1) | 46.4 (45.6–47.3) | 74.8 (66.6–83.1) | 3.2 (2.2–4.1) | 0.7 (0.6–0.7) |
| Infrequent BM ≤3/wk1–3, 5–11, 13, 15 | 45.6 (31.6–59.5) | 60.0 (56.0–70.2) | 1.1 (1.1–1.2) | 0.9 (0.8–1.0) | 61.8 (53.2–72.5) | 51.1 (37.6–62.0) | 1.4 (1.1–1.5) | 0.6 (0.5–1.0) | 51.9 (39.1–59.8) | 61.7 (51.0–62.0) | 1.1 (0.9–1.2) | 0.8 (0.8–1.0) |
| Laxative and/or enema dependent1–3, 17 | 64.4 (54.9–73.1) | 61.7 (53.2–70.0) | 1.2 (1.2–2.5) | 0.8 (0.5–0.8) | 42.9 (39.2–58.7) | 48.2 (41.6–59.2) | 1.0 (0.9–1.4) | 1.0 (0.9–1.2) | 53.7 | 76.7 | 1.4 | 0.8 |
| Suppository use17 | 13.5 | 93.8 | 2.2 | 0.9 | ||||||||
| Awareness of sphincter contraction during BM18 | 93.9 | 66.0 | 2.8 | 0.1 | ||||||||
| Anal/rectal pain1–3, 13 | 33.7 (19.8–51.7) | 65.3 (54.9–72.5) | 1.1 (0.7–1.5) | 0.9 (0.7–1.5) | 31.6 | 49.5 | 0.6 | 1.4 | 51.9 | 66.7 | 1.6 | 0.7 |
| Abdominal discomfort/pain3, 4, 15 | 46.7 (46.3–62.6) | 50.0 (31.7–53.8) | 0.9 (0.9–1.0) | 1.1 (1.0–1.3) | ||||||||
| Abdominal distension/fullness/bloating2, 4, 5, 19 | 87.1 (85.1–90.6) | 48.3 (34.1–62.4) | 2.3 (1.7–2.9) | 0.4 (0.3–0.5) | 92.9 (77.0–96.4) | 76.6 | 4.0 | 0.1 | ||||
| Duration on toilet ≥10mins1, 20 | 36.6 (29.1–44.1) | 70.9 (65.5–76.4) | 1.2 (1.2–1.3) | 0.9 (0.8–0.9) | 54.3 | 60.0 | 1.4 | 0.8 | 61.1 | 60.0 | 1.5 | 0.6 |
| Position other than sitting to defecate1, 7 | 40.7 (29.0–52.5) | 91.7 | 2.0 | 0.9 | 25.7 | 91.7 | 3.1 | 0.8 | 20.4 | 91.7 | 2.4 | 0.9 |
| Lack of call to stool2, 21 | 44.6 (32.5–56.8) | 51.8 (30.1–73.4) | 7.0 (3.6–10.4) | 4.8 (2.6–7.1) | 10.7 | 8.5 | 0.1 | 10.5 | ||||
| Feeling of call to stool2, 21 | 55.4 (43.2–67.5) | 48.2 (26.6–69.9) | 4.8 (2.6–7.1) | 7.0 (3.6–10.4) | 89.3 | 91.5 | 10.5 | 0.1 | ||||
| Lack of response to fiber (30g/d x 6 weeks)22 | 62.3 | 77.5 | 2.8 | 0.5 | 71.7 | 77.5 | 3.2 | 0.4 | ||||
| UGI symptoms* 2 | 11.9 (10.2–24.6) | 25.5 (22.3–35.1) | 0.2 (0.1–0.4) | 3.5 (2.4–4.1) | 55.6 (33.7–61.9) | 25.5 (22.3–35.1) | 0.5 (0.3–0.8) | 2.8 (1.9–3.6) | ||||
| Urinary symptoms2, 7, 23 | 46.4 (32.1–51.8) | 96.7 (96.7–100) | >10 | 0.5 (0.5–0.7) | ||||||||
| Frequency increased (>7 times/d)7 | 35.7 | 83.3 | 2.1 | 0.8 | ||||||||
| Urgency7 | 60.7 | 93.3 | 9.1 | 0.4 | ||||||||
| Nocturia7 | 21.4 | 100 | >10 | 0.8 | ||||||||
| Hesitancy7 | 46.4 | 100 | >10 | 0.5 | ||||||||
| Strain to start stream7 | 21.4 | 100 | >10 | 0.8 | ||||||||
| Strain to empty7 | 50.0 | 96.6 | 15 | 0.5 | ||||||||
| Weak or prolonged urinary stream7 | 57.1 | 100 | >10 | 0.4 | ||||||||
| Incomplete urinary emptying sensation7 | 53.5 | 96.7 | 16.1 | 0.5 | ||||||||
| Interrupted urinary stream7 | 42.9 | 96.7 | 12.9 | 0.6 | ||||||||
Data presented as median (Q1,Q3). If no IQR present, this is due to only one reference with the pertinent information.
Reference numbers in brackets are found in the Supplemental reference list.
*
Nausea, vomiting, dyspepsia, heartburn, or borborygmi
Grey = SN/SP ≥85% with IQR <20%; (+)LR ≥2 with IQR <1.0, (−) LR ≤0.5 with IQR <0.5;
Black = SN/SP ≥95% with IQR <20%, (+) LR ≥5 with IQR <1.0, (−) LR ≤0.2 with IQR <0.