Development of a Simplified Clinical Score for Defecation Disorder

Background/Aims: : Defecation disorder (DD) is typically unresponsive to standard laxative therapy. Biofeedback is the treatment of choice, but diagnosis relies on physiological tests such as anorectal manometry (ARM), which are not widely accessible. This study aims to develop a clinical diagnostic score for DD using routinely assessed clinical features. Methods: : This retrospective study included 402 patients with refractory constipation in the derivation cohort and 100 patients in the validation cohort. All patients underwent ARM and balloon expulsion test. Predictive variables were identified by logistic regression and converted into an integer-based scoring system. Diagnostic performance was evaluated by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, predictive values and likelihood ratios. Results: : DD was diagnosed in 52.5% of the derivation cohort (mean age 52.4 years; 82.1% female). Six independent predictors were identified and incorporated into an 11-point score, termed the STRAIN score: straining (adjusted odds ratio [aOR] 7.76, 3 points), 3 or more bowel movements per week (aOR 4.67, 2 points), rectal blockage sensation (aOR 3.71, 2 points), assisted defecation/manual maneuvers (aOR 2.55, 2 points), incomplete evacuation (aOR 1.95, 1 point), and new-onset symptoms ≤2 years (aOR 1.88, 1 point). The score showed AUROC values of 0.91 in the derivation and 0.88 in the validation cohort. A cutoff score of ≥6 provided 87.2% sensitivity, 83.2% specificity, 85.2% positive predictive value, and 85.5% negative predictive value. Conclusions: : This simple and accurate clinical score provides a practical tool for recognizing DD and may support early diagnosis and intervention in patients with refractory constipation.