What are the key clinical features to assess when diagnosing pelvic organ prolapse in women?

Key clinical features to assess when diagnosing pelvic organ prolapse in women include:

• Symptoms of prolapse such as a sensation of vaginal bulging or pressure.
• Urinary symptoms that are bothersome, including incontinence or obstructed voiding.
• Symptoms of bowel dysfunction, including obstructed defaecation or faecal incontinence.
• Pelvic pain and any symptoms not explained by examination findings.
• A thorough history covering urinary, bowel, sexual function, and any previous pelvic floor or abdominal surgery.
• Physical examination to document the presence and degree of prolapse in the anterior, central, and posterior vaginal compartments using the POP-Q (Pelvic Organ Prolapse Quantification) system.
• Assessment of pelvic floor muscle activity and vaginal tissue condition (checking for thinning, drying, inflammation, loss of elasticity, and vaginal shortening).
• Inspection to rule out pelvic masses or other pathologies.
• Examination techniques may include asking the woman to bear down to check for visible vaginal or rectal prolapse and rectal examination if indicated.
• Consideration of the woman’s age, lifestyle factors, comorbidities, and preferences during assessment.

Imaging is not routinely required if prolapse is confirmed on physical examination. If symptoms are not explained by initial findings, repeat examination in different positions (standing or squatting) or at different times may be helpful.

Use of validated pelvic floor symptom questionnaires can aid assessment and decision making.

These assessments help differentiate prolapse from other causes and guide management decisions.

References: NICE NG123,NICE NG210