Is digitation associated with proctographic abnormality?

Constipated patients referred for evacuation proctography were questioned as to the need for digital manoeuvres to assist evacuation, to determine the frequency of digitation, and to investigate whether any proctographic feature was associated with this symptom. Seventy one percent of patients interviewed admitted to digitation. Proctographic findings in 20 constipated patients who digitated per vagina and 20 who digitated per anum were compared to 20 who did not. There was no significant difference between groups with respect to pelvic floor descent, anal canal width or any anrectal angle measurement. Rectocoele depth and area were significantly greater in patients who digitated per vagina, compared to the other two groups. Evacuation time was prolonged and a proctographic diagnosis of anismus more frequent, in patients who digitated per anum. Anal digitation is associated with prolonged evacuation, suggesting a proctographic diagnosis of anismus and vaginal digitation to assist rectal evacuation is significantly associated with large anterior rectocoele.