Pelvic Organ Prolapse

Diagnosis

Not every woman with pelvic organ prolapse experiences symptoms. However, symptoms can include:

• Pressure in the vagina or pelvis
• Pelvic discomfort
• A decrease in pain or pressure when lying down
• A lump at the opening of the vagina
• Recurrent urinary tract infections
• Urinary and bowel dysfunction
• Sexual dysfunction
• Painful intercourse
• Back pain

Doctors thoroughly examine the vagina to determine the type of prolapse and its severity. During an exam, patients may sit upright and strain, so that prolapsed tissues can be identified.

Imaging Tests

Imaging tests typically used for pelvic organ prolapse include:

Magnetic Resonance Imaging (MRI) Scan

This test is used to get a detailed, three-dimensional image of the pelvis.

Ultrasound

This test is used to visualize the kidneys or bladder in women with urinary incontinence, or the muscles around the anus in women with anal incontinence.

Cystourethroscopy

This test is used to view the urethra and bladder. This imaging test is valuable for evaluating patients with symptoms of urinary urgency, frequency, bladder pain or blood in the urine. A cytoscope is a small tube with a light and camera, lubricated with an anesthetic gel and inserted into the urethra. It produces images on a television screen.

Exam Tests

Exam tests for pelvic organ prolapse include:

Q-tip Test

A small, cotton-tipped applicator lubricated with an anesthetic gel is inserted into the urethra, and the patient is asked to strain. If the applicator rises, it indicates if there is a loss of support to the urethra and helps determine the best treatment for incontinence.

Bladder-Function Tests

This tests the ability of the bladder to store and empty urine. The first step measures the amount and force of the urine stream. During the second step, a catheter is inserted into the bladder and the bladder is filled with sterile water. Clinicians record the volume at which the patient experiences urgency and fullness and the pressures of the bladder and urethra. The patient is asked to cough or bear down to elicit leakage. This helps surgeons select the proper type of surgery for prolapse of the bladder or urethra.

Pelvic Floor Strength Tests

A gynecologist tests the strength of the woman's pelvic floor and her sphincter muscles. It is also used to assess the strength of muscles and ligaments that support the vaginal walls, uterus, rectum, urethra and bladder. Findings are helpful for all pelvic organ prolapses, to determine if a patient would benefit from pelvic floor exercises (Kegel exercises).