title: Implementation of a standardized digital rectal exam to improve the accuracy of rectocele diagnosis.
abstract: OBJECTIVE
  The standardized evaluation of posterior compartment prolapse using the Pelvic Organ Prolapse Quantification (POP-Q) system is limited. The primary objective of this study is to develop and validate the interexaminer reliability of a new system for assessing the posterior vaginal wall for the presence of a rectocele.
  
  
  METHODS
  This was a cross-sectional study of women presenting to an academic urogynecology clinic. Subjects underwent a routine pelvic examination that included a standard POP-Q followed by two Standardized Digital Rectal Exams (SDRE) by two different providers, each blinded to the other's results. The SDRE measures the distance from the leading edge of a posterior bulge to the hymen with a finger in the distal rectum - first visually and then an actual measured distance using a marked cotton swab (Q-tip measurement). Correlations between examiners for the SDRE and the POP-Q were analyzed using Pearson's correlation coefficient (ρ).
  
  
  RESULTS
  Eight attending and fellow urogynecologists examined 50 subjects. Mean age was 57.3 years, mean BMI 30.9 kg/m(2), with an overall median POP-Q stage 2 (range 0-3), and median posterior POP-Q stage 1 (range 0-3). Overall, 54 % of women had a noteworthy rectocele by typical digital rectal exam. Interexaminer correlations with SDRE for both the visual assessment (ρ = 0.697, p < 0.0001) and the Q-tip measurement (ρ = 0.767, p = p < 0.001) were strong. The intraexaminer visual assessment and the Q-tip measurement were highly correlated (ρ = 0.934, p = <0.001).
  
  
  CONCLUSIONS
  This standardized rectal examination provides a consistent method for the reporting of distal rectoceles that can lend additional information to the POP-Q exam.
authors: Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina, Chapel Hill, NC, USA, andreakcrane@gmail.com.
authors: Andrea K
authors: AK
authors: Crane
authors: Elizabeth J
authors: EJ
authors: Geller
authors: Erinn M
authors: EM
authors: Myers
authors: Jacquia L
authors: JL
authors: Fenderson
authors: Ellen
authors: E
authors: Wells
authors: Mary
authors: M
authors: Jannelli
authors: AnnaMarie
authors: A
authors: Connolly
authors: Catherine A
authors: CA
authors: Matthews
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D051517:Digital Rectal Examination / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D056887:Pelvic Organ Prolapse / Q000175:diagnosis; D020047:Rectocele / Q000175:diagnosis*