diagnosis

Last reviewed 01/2018

In women with symptoms suggestive of POP, offer pelvic examination.

• facilitate in defining the extent of prolapse and to establish the segments of the vagina affected (anterior, posterior, or apical)
• patients should be observed while resting and straining both standing and supine positions
• a procidentia should be obvious
• split-speculum examination with a Sims speculum or the posterior blade of a Graves speculum is used for the vaginal examination   
• for anterior vaginal prolapse - using a speculum to hold back the posterior vaginal wall ask the patient to strain. This should demonstrate descent of the anterior vaginal wall indicative of a cystocoele or urethral displacement
• for posterior vaginal prolapse - similarly, holding back the anterior vaginal wall while the patient strains, will demonstrate a rectocoele (1)

According to the presenting symptoms, additional testing would be required in majority of patients e.g. -            

• POP plus lower urinary tract symptoms - urine analysis and post-void residual volume evaluation to test for urinary tract infection, haematuria, and incomplete bladder emptying. 
• substantial urinary incontinence, irritative voiding symptoms, or voiding dysfunction – urodynamics
• outlet constipation or faecal incontinence - defecography, anal manometry and endoanal ultrasound (1).

Rectal examination - to confirm posterior wall prolapse and distinguish rectocoele from enterocoele.

In cases of difficulty, ask the patient to stand or walk for some time before examination.

Reference:

• (1) Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853