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Digitation to Void: What Is the Significance of This Symptom?

Ortega, Ismael, MD*; Subramaniam, Nishamini, MD; Friedman, Talia, MD; Turel, Friyan, MD; Dietz, Hans Peter, MD, PhD

Female Pelvic Medicine & Reconstructive Surgery: September/October 2018 - Volume 24 - Issue 5 - p 356–359
doi: 10.1097/SPV.0000000000000482
Original Articles

Objective Digitation to void is defined as the need to apply manual pressure on the perineum or the vagina to assist with voiding. It has been associated with prolapse; however, there is little objective data concerning this symptom. Our aim was to determine the correlation between digitation to void, symptoms and signs of pelvic organ prolapse (POP), and urodynamic data.

Methods This was a retrospective study that included a total of 1174 patients seen at a tertiary urogynecological unit. A standardized history was obtained from all patients followed by multichannel urodynamic testing, Pelvic Organ Prolapse Quantification scoring and 3-D/4-D translabial ultrasound. Stored 4-D translabial ultrasound volumes were obtained and analyzed at a later date.

Results Digitation to void was present in 7% (n = 83) of our population. It is associated with primary symptoms of POP (odds ratio [OR], 25.75; confidence interval [CI], 8.08–82.05), clinically significant POP (OR, 5.62; CI, 2.25–14.02), and POP on ultrasound (OR, 5.39; CI, 2.67–10.88). Cystocele presented the strongest association, clinically (OR, 3.45; CI, 1.98–6.03) and on ultrasound (OR, 4.04; CI, 2.46–6.64). Digitation to void was also associated with symptoms of voiding dysfunction (OR, 6.38 [3.83–10.64]) and slower maximum urine flow rate centile (18.4 vs 24.9, P = 0.017).

Conclusions Digitation to void is strongly associated with primary symptoms of prolapse and of voiding dysfunction, clinically significant POP, and pelvic organ descent on ultrasound. It is also associated with objective voiding dysfunction. The strongest associations were found with cystocele, both clinically and on imaging.

From the *Departamento de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular-Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain; and

Department of Obstetrics and Gynaecology, Sydney Medical School Nepean, University of Sydney, Sydney, Australia.

Correspondence: Hans Peter Dietz, MD, PhD, FRANZCOG, DDU, CU, Department of Obstetrics and Gynaecology, Sydney Medical School Nepean, Nepean Hospital, Penrith NSW 2750 Australia. E-mail:

HP Dietz has received unrestricted educational grants from GE Medical.

The authors have declared they have no conflicts of interest.

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