Vaginal Prolapse (cont.)
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 physical examination of the woman. This involves the doctor examining each section of the vagina separately to determine the type and extent of the prolapse and what type of treatment is most appropriate.
During the physical
examination, the 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-bladder neck drops 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
urine and to dispose of it (urinate). The first step 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.
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
Cystourethroscopy: A cystoscope, which is a small,
tubelike instrument, is lubricated with an anesthetic gel and inserted into
the urethra. The end of the cystoscope has a light and camera, which produces
images on a television screen. With this procedure, the doctor can view inside
the urethra and bladder. This procedure 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.
George Lazarou, MD, FACOG
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