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.