From the Guidelines
Vaginal or uterine prolapse is typically tested through a comprehensive pelvic examination and imaging studies such as MR defecography or fluoroscopy cystocolpoproctography (CCP), with MR defecography being one of the initial imaging tests of choice for evaluation of a vaginal protrusion or bulge or clinically suspected pelvic organ prolapse 1.
Testing for Vaginal or Uterine Prolapse
The diagnosis of vaginal or uterine prolapse involves a combination of physical examination and imaging studies.
- A comprehensive pelvic examination is performed by a healthcare provider to visually inspect the vaginal area and assess the position of the vagina, cervix, and uterus.
- The patient may be asked to bear down or cough to see if this causes the prolapse to become more visible.
- A classification system called the Pelvic Organ Prolapse Quantification (POP-Q) system is often used to grade the prolapse on a scale from 0 (no prolapse) to 4 (complete protrusion).
Imaging Studies
Imaging studies such as MR defecography or fluoroscopy CCP are used to evaluate the pelvic floor and detect any abnormalities.
- MR defecography is a specialized type of dynamic MRI of the pelvic floor that is typically performed with rectal contrast but without IV contrast and includes MRI acquisition during active defecation of rectal contrast 1.
- Fluoroscopy CCP involves fluoroscopic imaging during defecation with the patient sitting in physiologic upright position on a fluoroscopic commode 1.
Choosing the Appropriate Test
The choice of test depends on the severity and symptoms of the prolapse, as well as the presence of any associated pelvic floor abnormalities.
- MR defecography is beneficial in detecting or characterizing enteroceles as a cause of posterior vaginal bulge 1.
- Fluoroscopy CCP is useful in evaluating posterior compartment prolapse and detecting prolapse that is clinically occult 1.
Treatment Approach
The treatment approach for vaginal or uterine prolapse depends on the severity and symptoms of the prolapse, as well as the presence of any associated pelvic floor abnormalities.
- Treatment options may range from pelvic floor exercises to pessary insertion or surgical repair depending on severity and symptoms.
- The choice of treatment should be individualized based on the patient's specific needs and medical history.
From the Research
Testing for Vaginal or Uterine Prolapse
To test for vaginal or uterine prolapse, the following methods are used:
- Clinical evaluation, including an assessment of symptoms and their impact on daily life, as well as ruling out other pelvic pathologies 2
- Pelvic examination to identify anatomic landmarks and diagnose pelvic organ prolapse 3
- Description of the prolapse compartment by compartment, indicating the extent of externalization for each 2
- Additional exams, such as radiographic assessment, may be requested to explore symptoms associated with or not explained by the observed prolapse 2, 4
Diagnostic Techniques
Various diagnostic techniques can be used to evaluate pelvic organ prolapse, including:
- Dynamic magnetic resonance imaging (MRI) to quantify pelvic floor relaxation and prolapse 5
- Computed tomography (CT) to demonstrate organ prolapse and pelvic floor anatomy, particularly in patients who cannot tolerate MRI 6
- Physical examination, which is the primary method for diagnosing pelvic organ prolapse 4, 3
Evaluation and Staging
The evaluation and staging of pelvic organ prolapse can be done using various classification systems, such as: