Digitation associated with defecation: what does it mean in urogynaecological patients?
OBJECTIVE
Obstructed defecation is a common symptom complex in urogynaecological patients, and perineal, vaginal and/or anal digitation may required for defecation. Translabial ultrasound can be used to assess anorectal anatomy, similar to defecation proctography. The aim of the present study was to determine the association between different forms of digitation (vaginal, perineal and anal) and abnormal posterior compartment anatomy.


METHODS
A total of 271 patients were analysed in a retrospective study utilising archived ultrasound volume datasets. Symptoms of obstructed defecation (straining at stool, incomplete bowel emptying, perineal, vaginal and anal digitation) were ascertained on interview. Postprocessing of stored 3D/4D translabial ultrasound datasets obtained on maximal Valsalva was used to diagnose descent of the rectal ampulla, rectocoele, enterocoele and rectal intussusception at a later date, blinded to all clinical data.


RESULTS
Digitation was reported by 39 % of our population. The position of the rectal ampulla on Valsalva was associated with perineal (p = 0.02) and vaginal (p = 0.02) digitation. The presence of a true rectocoele was significantly associated with perineal (p = 0.04) and anal (p = 0.03) digitation. Rectocoele depth was associated with all three forms of digitation (P = 0.005-0.02). The bother of symptoms of obstructed defecation was strongly associated with digitation (all P < = 0.001), with no appreciable difference in bother among the three forms.


CONCLUSIONS
Digitation is common, and all forms of digitation are associated with abnormal posterior compartment anatomy. It may not be necessary to distinguish between different forms of digitation in clinical practice.
Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.|GE Healthcare, Beijing, China.
Cao
C
Hai-Ying
Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.|Departamento de Ginecología y Obstetricia, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile.|Departamento de Ginecología y Obstetricia, Hospital Clínico de la Universidad de Chile, Santiago, Chile.
Rodrigo
R
Guzmán Rojas
Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.
Jessica Caudwell
JC
Hall
Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.|Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
Ixora Kamisan
IK
Atan
Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia. hpdietz@bigpond.com.
Hans Peter
HP
Dietz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D003248:Constipation / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D003672:Defecation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007443:Intussusception / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000150:complications* / Q000000981:diagnostic imaging; D010502:Perineum; D012002:Rectal Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D020047:Rectocele / Q000150:complications* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014621:Vagina; D064232:Visual Analog Scale; D055815:Young Adult
Digitation; Obstructed defecation; Pelvic floor; Rectocoele; Translabial ultrasound