diagnosis

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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:

Last reviewed 01/2018