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Digitation associated with defecation: what does it mean in urogynaecological patients?

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Abstract

Introduction and hypothesis

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.

Conclusion

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.

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References

  1. Andromanakos N, Skandalakis P, Troupis T, Filippou D (2006) Constipation of anorectal outlet obstruction: pathophysiology, evaluation and management. J Gastroenterol Hepatol 21:638–646

    Article  PubMed  Google Scholar 

  2. D'Hoore A, Penninckx F (2003) Obstructed defecation. Colorectal Dis 5:280–287

    Article  PubMed  Google Scholar 

  3. Karlbom U, Lundin E, Graf W, Påhlman L (2004) Anorectal physiology in relation to clinical subgroups of patients with severe constipation. Colorectal Dis 6(5):343–349

    Article  CAS  PubMed  Google Scholar 

  4. Rentsch M, Paetzel C, Lenhart M, Feuerbach S, Jauch KW, Fürst A (2001) Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology. Dis Colon Rectum 44(7):999–1007

    Article  CAS  PubMed  Google Scholar 

  5. Dietz H, Cartmill J (2013) Imaging in patients with obstructed defecation. Tech Coloproctol 17:473–474

    Article  CAS  PubMed  Google Scholar 

  6. Dietz HP, Steensma AB (2005) Posterior compartment prolapse on two- dimensional and three- dimensional pelvic floor ultrasound: the distinction between true rectocele, perineal hypermobility and enterocele. Ultrasound Obstet Gynecol 26:73–77

    Article  CAS  PubMed  Google Scholar 

  7. Dietz HP, Haylen BT, Broome J (2001) Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol 18(5):511–514

    Article  CAS  PubMed  Google Scholar 

  8. Bump RC, Mattiasson A, Bø K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  CAS  PubMed  Google Scholar 

  9. Dietz H (2004) Ultrasound Imaging of the Pelvic Floor. I. 2D aspects. Ultrasound Obstet Gynecol 23:80–92

    Article  CAS  PubMed  Google Scholar 

  10. Oerno A, Dietz H (2007) Levator co-activation is a significant confounder of pelvic organ descent on Valsalva maneuver. Ultrasound Obstet Gynecol 30:346–350

    Article  Google Scholar 

  11. Orejuela F, Shek K, Dietz H (2012) The time factor in the assessment of prolapse and levator ballooning. Int Urogynecol J 23:175–178

    Article  PubMed  Google Scholar 

  12. Dietz HP, Beer-Gabel M (2012) Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation. Ultrasound Obstet Gynecol 40:14–27

    Article  CAS  PubMed  Google Scholar 

  13. Rodrigo N, Shek K, Dietz H (2011) Rectal intussusception is associated with abnormal levator structure and morphometry. Tech Coloproctol 15:39–43

    Article  CAS  PubMed  Google Scholar 

  14. Dietz HP, Korda A (2005) Which bowel symptoms are most strongly associated with a true rectocele? Aust NZ J Obstet Gynaecol 45:505–508

    Article  Google Scholar 

  15. Alam P et al (2014) The 'bother' of obstructed defecation. Int Urogynecol J 25:S114–S115

  16. Beer-Gabel M, Teshler M, Barzilai N et al (2002) Dynamic transperineal ultrasound in the diagnosis of pelvic floor disorders: pilot study. Dis Colon Rectum 45(2):239–245

    Article  PubMed  Google Scholar 

  17. Perniola G, Shek C, Chong CC, Chew S, Cartmill J, Dietz HP (2008) Defecation proctography and translabial ultrasound in the investigation of defecatory disorders. Ultrasound Obstet Gynecol 31:567–571

    Article  CAS  PubMed  Google Scholar 

  18. Beer-Gabel M, Assoulin Y, Amitai M, Bardan E (2008) A comparison of dynamic transperineal ultrasound (DTP-US) with dynamic evacuation proctography (DEP) in the diagnosis of cul de sac hernia (enterocele) in patients with evacuatory dysfunction. Int J Colorectal Dis 23:513–519

    Article  CAS  PubMed  Google Scholar 

  19. Tan L, Guzman Rojas R, Dietz H (2014) The repeatability of sonographic measures of functional pelvic floor anatomy. Neurourol Urodyn 33:1058–1060

    Google Scholar 

  20. Steensma AB, Oom DM, Burger CW, Schouten WR (2010) Assessment of posterior compartment prolapse: a comparison of evacuation proctography and 3D transperineal ultrasound. Colorectal Dis 12(6):533–539

    Article  CAS  PubMed  Google Scholar 

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Conflicts of interest

H.P. Dietz has received unrestricted educational grants from GE Medical.

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Correspondence to Hans Peter Dietz.

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Hai-Ying, C., Rojas, R.G., Hall, J.C. et al. Digitation associated with defecation: what does it mean in urogynaecological patients?. Int Urogynecol J 27, 229–232 (2016). https://doi.org/10.1007/s00192-015-2813-7

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  • DOI: https://doi.org/10.1007/s00192-015-2813-7

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