clinical features

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Patients with mild POP may be asymptomatic (1). Not uncommonly, prolapse is an incidental finding. Many patients cope by pushing the prolapse back into the vagina

Classically, genital prolapse occurs in a parous postmenopausal woman who complains of "something coming down"

  • patients may complain of a single symptom such as feeling a vaginal bulge or pelvic pressure or a combination of symptoms depending on the position of the uterus and pressure of the surrounding structures.
    • a cross sectional study of 237 patients evaluated for POP revealed
      • 73% with concurrent urinary incontinence
      • 86% with urinary urgency/frequency
      • 34-62% with voiding dysfunction
      • 31% with faecal incontinence.
  • typically, as the day progresses, bulging and discomfort may increase. Extensive standing, lifting, coughing, and physical exertion may worsen symptoms.
  • in severe prolapse, erosions of the vagina or cervix may  present with vaginal bleeding or spotting (1,2)

Patients may present with the following symptoms:

  • vaginal symptoms
    • sensation of vaginal bulging or protrusion
    • seeing or feeling a bulge
    • pelvic or vaginal pressure
    • heaviness in pelvis or vagina
  • urinary symptoms
    • incontinence
    • urgency and/or frequency
    • weak or prolonged urinary stream
    • feeling of incomplete emptying
    • manual reduction of prolapse to start or complete voiding
  • bowel symptoms
    • incontinence of flatus or stool
    • feeling of incomplete emptying
    • hard straining to defecate
    • urgency to defecate
    • digital evacuation to complete defication
  • sexual symptoms
    • dyspareunia
    • decreased sensation
    • decreased arousal or orgasm
    • decreased body image
  • pain
    • pain in vagina, bladder or rectum
    • pelvic or low back pain (2)

Neglected cases may be complicated by excessive purulent discharge, decubitus ulceration and bleeding.


Last reviewed 01/2018