The use and impact of defaecating proctograms – could less be more?
E Decker, A Moore, M McFall
Worthing Hospital, Western Sussex NHS Trust, UK
Dynamic investigations of pelvic floor function are integral to the assessment of pelvic floor disorders, including obstructive defecation syndrome (ODS) and rectocele. Traditionally this includes a defaecating proctograms (DP), which some patients find embarrassing. Additionally pathology identified through DP may be apparent on history and examination alone.
We audited the impact of DP on the management of defaecatory disorders in a DGH without a subspecialist pelvic floor service.
DP performed between January 2014 to September 2017 were identified from the radiology database.
Hospital records were evaluated for presenting symptoms, examination findings, indications on request forms and subsequent
management. Details of the referrer including specialty and seniority were also recorded.
Aims of the study were:
Overall concordance with clinical query was 55%
40 inter-speciality referrals were made: largely from surgery to gynaecology.
17 patients underwent surgery, 3 declined an operation, 9 had physiotherapy referrals.
No documented change in management occurred in 50%.
DP requests were frequently made with inadequate clinical details, often by non-consultant staff and importantly did not result in change in management. DP might be rationalized by limiting requests to senior clinicians and by more stringent patient selection.