Skip to main content
SpringerLink
Log in

Implementation of a standardized digital rectal exam to improve the accuracy of rectocele diagnosis

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

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/m2, 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).

Conclusion

This standardized rectal examination provides a consistent method for the reporting of distal rectoceles that can lend additional information to the POP-Q exam.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bump RC, Mattiasson, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  CAS  PubMed  Google Scholar 

  2. Hall AF, Theofrastous JP, Cundiff GW, Harris RL, Hamilton LF, Swift SE, Bump RC (1996) Interobserver and intraobserver reliability of the International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system. Am J Obstet Gynecol 1467–71.

  3. Kobak WH, Rosenberger K, Walters MD (1996) Interobserver variation in the assessment of pelvic organ prolapse. Int Urogynecol J 7:121–124

    Article  CAS  Google Scholar 

  4. Zoorob D, Sanan CC, Evans JM, Maxwell R, South M (2012) A retrospective comparison of defecatory symptoms in subjects with a posterior vaginal wall defect identified by POP-Q scores versus digital rectal exam. Female Pelvic Med Reconstr Surg 18:S116

    Google Scholar 

  5. Weber AM, Walters MD, Ballard LA, Booher DL, Piedmonte MR (1998) Posterior vaginal prolapse and bowel function. Am J Obstet Gynecol 179:1446–1449

    Article  CAS  PubMed  Google Scholar 

  6. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185:1332–1337

    Article  CAS  PubMed  Google Scholar 

  7. Bradley CS, Brown MB, Cundiff GW, Goode PS, Kenton KS, Nygaard IE, Whitehead WE, Wren PA, Weber AM (2006) Bowel symptoms in women planning surgery for pelvic organ prolapse. Am J Obstet Gynecol 195:1814–1819

    Article  PubMed  Google Scholar 

  8. Chmielewski L, Walters MD, Weber AM, Barber MD (2011) Reanalysis of a randomized trial of three techniques of anterior colporraphy using clinically relevant definitions of success. Am J Obstet Gynecol 205:69.e1–69.e8

    Article  Google Scholar 

  9. Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193:103–113

    Article  CAS  PubMed  Google Scholar 

  10. Lewis SJ, Heaton KW (1997) Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32:920–924

    Article  CAS  PubMed  Google Scholar 

  11. Spence-Jones C, Kamm MA, Henry MM, Hudson CN (1994) Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol 101:147–152

    Article  CAS  PubMed  Google Scholar 

  12. Cundiff GW, Fenner D (2004) Evaluation and treatment of women with rectocele: focus on associated defecatory and sexual dysfunction. Obstet Gynecol 104:1403–1421

    Article  PubMed  Google Scholar 

  13. Kahn MA, Breitkopf CR, Valley MT, Woodman PJ, O'Boyle AL, Bland DI, Schaffer JI, Grady JJ, Swift SE (2005) Pelvic organ support study (POSST) and bowel symptoms: staining at stool is associated with perineal and anterior vaginal descent in a general gynecologic population. Am J Obstet Gynecol 192:1516–1522

    Article  PubMed  Google Scholar 

  14. Mouritsen L, Larsen JP (2003) Symptoms, bother, and POP-Q in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 14:122–127

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Mr. Yilan Xu and Dr. J.S. Marron of the Department of Statistics and Operations Research at the University of North Carolina at Chapel Hill for their statistical support.

Conflicts of interest

Matthews CA and Geller EJ: Robotics fellowship grant from Intuitive Surgical.

Author information

Authors and Affiliations

  1. Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina, Chapel Hill, NC, USA

    Andrea K. Crane, Elizabeth J. Geller, Erinn M. Myers, Jacquia L. Fenderson, Ellen Wells, Mary Jannelli, AnnaMarie Connolly & Catherine A. Matthews

  2. WakeMed Physician Practices Women’s Center, Raleigh, NC, USA

    Andrea K. Crane

Authors
  1. Andrea K. Crane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth J. Geller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erinn M. Myers
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacquia L. Fenderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ellen Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mary Jannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. AnnaMarie Connolly
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Catherine A. Matthews
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea K. Crane.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crane, A.K., Geller, E.J., Myers, E.M. et al. Implementation of a standardized digital rectal exam to improve the accuracy of rectocele diagnosis. Int Urogynecol J 26, 107–111 (2015). https://doi.org/10.1007/s00192-014-2479-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-014-2479-6

Keywords

Search

Navigation