Diagnosis

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The most common symptoms associated with pelvic organ prolapse (POP) are related to urination. You may have feelings of urgency, in which you suddenly have to urinate, find yourself urinating more often than normal, experience urinary incontinence or have difficulty urinating and completely emptying your bladder.

Some women experience painful intercourse, problems reaching orgasm and reduced sexual desire or libido. Some women avoid sex because they are embarrassed about the changes in their pelvic anatomy, and some worry that having sex will "hurt" something or cause more damage.

You may also experience problems in the rectal area. Some women with POP have pain and/or straining during bowel movements, and some experience anal incontinence, in which they inadvertently release stool. One study found a twofold increase in the risk of anal incontinence in women with serious POP.

Other symptoms include feeling as if a tampon is falling out. In fact, if the cervix has descended into the vagina, you may find you can't use a tampon at all.

However, a study evaluating 352 women with POP found that overall there are few strong associations between specific symptoms and the severity of the women's POP. This means that doctors may have trouble diagnosing the condition, particularly since many symptoms can be related to situations and medical conditions unrelated to POP. The following questions can help alert your doctor to the possibility that you may have POP:

• Do you ever have to push tissue back in the vagina to urinate?
• Do you have to use your fingers in the vagina, on the perineum (the area between the anus and vagina) or in the rectum to have a bowel movement?
• Do you ever feel a bulge or that something is "falling out" of your vagina?

Let your doctor know if you answered yes to any of these questions.

Diagnosing POP begins with a complete medical history and physical examination. The doctor will carefully examine your vulva and vagina for any lesions or ulcers and will perform an internal examination to identify any prolapsed organs. The doctor will also conduct a rectal examination to test for the resting tone and contraction of the anal muscle and to look for any abnormalities in that region. The doctor may also examine you while you're standing (to see if gravity brings the organs down) and may ask you to strain as if you were urinating or having a bowel movement.

The severity of your condition determines its treatment. After diagnosing you with POP, your doctor will "stage" your condition using the Pelvic Organ Prolapse Quantification system. It measures nine locations on the vagina and vulva relative to the hymen, or bottom of the vagina, to assign a stage from I to IV, from mild to severe.

The doctor will also determine what type of prolapse you have. They are:

Bladder prolapse (cystocele). In this form, the bladder falls toward the vagina, creating a bulge in the vaginal wall. Usually the urethra also prolapses with the bladder, called urethrocele. The two together are called cystourethrocele. Symptoms include stress incontinence (when you urinate a little when you sneeze, cough, jump, etc.) or problems urinating.

Rectal prolapse (rectocele). This occurs when the back wall of the vagina—the rectum—prolapses, pushing against the vaginal wall and creating a bulge. You notice this form most often during bowel movements.

Uterine prolapse (uterine descensus). This is a very common form of POP. It occurs when the ligaments that hold the uterus in place weaken, like a rubber band that's been stretched too often. This causes the uterus to fall, weakening the back walls of the vagina. This condition is also staged from first to fourth degree depending on the severity.

Vaginal vault prolapse. This form occurs when the vaginal supports weaken and the vagina drops into the vaginal canal. It may also occur when the front and back walls of the vagina separate, allowing the intestines to push against the vaginal wall in a form of prolapse called enterocele. This form is most common after a hysterectomy, when the uterus no longer supports the top of the vagina.

Tests

Your doctor may order several tests to confirm a diagnosis of POP. These include:

Urinary tract infection screening. You pee in a cup and your urine is evaluated for the presence of bacteria.

Postvoid residual urine volume test. This test determines if any urine remains in your bladder after voiding. After urinating, the doctor or nurse inserts a catheter, or thin tube, into the urethra to measure any remaining urine or uses an ultrasound to identify any urine remaining in the bladder.

Urodynamic testing. This test uses special sensors placed in the bladder and rectum to measure nerve and muscle response.

If you have problems with bowel movements, your doctor will likely refer you to a gastroenterologist for a thorough evaluation, including a colonoscopy to rule out colon cancer, which can cause constipation and straining.