Digital rectal examination in the evaluation of rectovaginal septal defects

Suneetha Rachaneni, Ixora Kamisan @ Atan, Ka Lai Shek, Hans Peter Dietz

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction and hypothesis: The objective was to evaluate the diagnostic potential of digital rectal examination in the identification of a true rectocele. Methods: This is a retrospective observational study utilising 187 archived data sets of women presenting with lower urinary tract symptoms and/or pelvic organ prolapse between August 2012 and November 2013. Evaluation included a standardised interview, ICS-POPQ, rectal examination and 4D translabial ultrasound. The main outcome measure was the diagnosis of rectocele by digital rectal palpation on Valsalva manoeuvre. This diagnosis correlated with the sonographic diagnosis of rectocele to determine agreement between digital examination and ultrasound findings. Results: Complete data sets were available for 180 participants. On imaging, the mean position of the rectal ampulla was 11.07 (−36.3 to 44.3) mm below the symphysis pubis; 42.8% (77) had a rectocele of a depth of ≥10 mm. On palpation, a rectocele was detected in 60 women (33%). Agreement between palpation and imaging was observed in 77%; the kappa was 0.52 (CI 0.39–0.65). On receiver operator characteristic analysis, the area under the curve was 0.854 for the relationship between rectocele pocket depth and the detection of rectocele on palpation. Conclusion: Moderate agreement was found between digital rectal examination for rectocele and translabial ultrasound findings of a “true rectocele”. Digital rectal examination may be used to identify these defects in clinical practice. Extending the clinical examination of prolapse to include rectal examination to palpate defects in the rectovaginal septum may reduce the need for defecatory proctograms for the assessment of obstructive defecation and may help triage patients in the management of posterior compartment prolapse.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalInternational Urogynecology Journal
DOIs
Publication statusAccepted/In press - 17 Feb 2017

Fingerprint

Rectocele
Digital Rectal Examination
Palpation
Prolapse
Pubic Bone
Pelvic Organ Prolapse
Valsalva Maneuver
Lower Urinary Tract Symptoms
Defecation
Triage
Area Under Curve
Observational Studies
Retrospective Studies
Outcome Assessment (Health Care)
Interviews

Keywords

  • Digital rectal examination
  • Obstructed defecation
  • Pelvic organ prolapse
  • Rectocele
  • Rectovaginal septum
  • Translabial ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Urology

Cite this

Digital rectal examination in the evaluation of rectovaginal septal defects. / Rachaneni, Suneetha; Kamisan @ Atan, Ixora; Shek, Ka Lai; Dietz, Hans Peter.

In: International Urogynecology Journal, 17.02.2017, p. 1-5.

Research output: Contribution to journalArticle

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