title: Digital rectal examination in the evaluation of rectovaginal septal defects.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Clinical and Experimental Medicine , University of Birmingham, Birmingham, UK. sunilalam@yahoo.com.
authors.forename: Suneetha
authors.initials: S
authors.lastname: Rachaneni
authors.affiliation: Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Ixora Kamisan
authors.initials: IK
authors.lastname: Atan
authors.affiliation: Department of Obstetrics and Gynecology, Liverpool Clinical School, University of Western Sydney, Parramatta, Australia.
authors.forename: Ka Lai
authors.initials: KL
authors.lastname: Shek
authors.affiliation: Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Dietz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D051517:Digital Rectal Examination / Q000379:methods*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis*; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging; D056887:Pelvic Organ Prolapse / Q000175:diagnosis*; D020047:Rectocele / Q000175:diagnosis*; D012007:Rectum / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Digital rectal examination; Obstructed defecation; Pelvic organ prolapse; Rectocele; Rectovaginal septum; Translabial ultrasound