Vaginal Prolapse (cont.)
When to Seek Medical Care for Prolapsed Vagina
Any woman who experiences symptoms that may indicate a vaginal prolapse should contact her doctor. A vaginal prolapse is rarely a life-threatening condition. However, most prolapses gradually worsen and can only be corrected with intravaginal pessaries or surgery. Thus, timely medical care is recommended to evaluate for and to prevent problematic symptoms and complications caused by weakening tissue and muscles surrounding the vagina.
Questions to Ask the Doctor about Prolapsed Vagina
- How will the vaginal prolapse affect sexual relations?
- Will the condition affect the ability to have children?
- Are any nonsurgical treatments options appropriate?
- When is surgical repair necessary?
Vaginal Prolapse Diagnosis
Generally, the most reliable way that a doctor can make a definite diagnosis of any type of vaginal prolapse involves a medical history and a thorough physical examination. This involves the doctor examining each section of the vagina separately to determine the type and extent of the prolapse in order to decide which type of treatment is most appropriate.
During the physical examination, a woman may need to sit in an upright position and strain so that any prolapsed tissues are more likely to become apparent.
Some types of vaginal prolapse such as cystocele or rectocele are more easily identifiable during the physical examination than are types such as vaginal vault prolapse or enterocele.
The following are tests that the doctor may use to evaluate women with advanced vaginal prolapse. Since many of these women also have urinary incontinence, these tests can further evaluate the anatomy and function of the pelvic floor.
- Q-tip test: In this diagnostic test, the doctor inserts a small cotton-tipped applicator lubricated with an anesthetic gel into the woman's urethra. The doctor then asks the woman to strain down. If the applicator raises 30 degrees or more as a result, this means that the urethra descends while straining and is a predictive factor of success of anti-incontinence surgery.
- Bladder function test: This involves a diagnostic procedure called urodynamics. This tests the ability of the bladder to store and evacuate urine (i.e. urinate) and to dispose of it. The first part of this test is called uroflowmetry, which involves measuring the amount and force of the urine stream. The second step is called a cystometrogram. In this step, a catheter is inserted into the bladder. The bladder is then filled with sterile water. The volume at which the patient experiences urgency and fullness are recorded. The pressures of the bladder and urethra are measured and the patient is asked to cough or bear down to elicit leakage with the prolapse pushed up (reduced). This is important clinical information that may assist the surgeon in selecting the correct type of surgery.
- Pelvic floor strength: During the pelvic examination, the doctor tests the strength of the woman's pelvic floor and of her sphincter muscles. The doctor also assesses the strength of the muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. These findings help the doctor determine if the woman would benefit from exercises to restore the strength of the muscles of the pelvic floor (for example, Kegel exercises [see Self-Care at Home]).
The following are imaging test that the doctor may use for further diagnostic purposes, if indicated:
- Magnetic resonance imaging (MRI) scan: This imaging tool uses a powerful magnet to stimulate tissues within the pelvis. These tissues produce a signal, which is analyzed by a computer. A 3-dimensional image of the pelvis is then produced on the computer screen using these signals.
- Ultrasound: This diagnostic tool uses sound waves. Sound waves are reflected back when they contact relatively dense structures, such as fibrous tissue or blood vessel walls. These reflected sound waves are then converted into pictures of the internal structures being studied. With an ultrasound, the doctor may visualize the kidneys or bladder in women with urinary incontinence or the muscles around the anus in women with anal incontinence.
- Cystourethroscopy: A cystoscope, which is a small, tubelike instrument, is lubricated with an anesthetic gel and inserted into the urethra. The cystoscope has a light and camera, which allow visualization of the interior of the bladder and urethra on a television screen. With this procedure, the doctor can view inside the urethra and bladder. Cystourethroscopy is especially valuable for women who have symptoms of urinary urgency, frequency, bladder pain, or blood in the urine. It can be performed in the office using local anesthesia.
Medically Reviewed by a Doctor on 1/11/2016
George Lazarou, MD, FACOG
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