Vaginal prolapse

• Anterior Vaginal Wall Prolapse (Cystocele): Bulge in the anterior vaginal wall, urinary symptoms such as incontinence or urgency
• Posterior Vaginal Wall Prolapse (Rectocele): Bulge in the posterior vaginal wall, difficulty with bowel movements, feeling of incomplete evacuation
• Uterine Prolapse: Descent of the uterus into the vaginal canal, sensation of pelvic pressure or a protruding mass
• Vault Prolapse: Post-hysterectomy prolapse of the vaginal vault, vaginal or pelvic heaviness, protruding mass

• Pelvic Masses (e.g., fibroids, ovarian cysts): Sensation of pelvic pressure or fullness, may be palpable on examination, no associated vaginal bulge
• Urethral Diverticulum: Anterior vaginal wall mass, often associated with post-void dribbling, dysuria, or dyspareunia
• Chronic Pelvic Pain Syndrome: Pelvic pain without a noticeable mass or bulge, often associated with dysmenorrhea or dyspareunia

Assess the specific symptoms presented by the patient:

• Sensation of Vaginal Bulge: Ask about the presence of a protruding mass or sensation of fullness in the vagina, especially when standing or straining
• Urinary Symptoms: Incontinence, urgency, frequency, or difficulty emptying the bladder, suggestive of a cystocele
• Bowel Symptoms: Constipation, straining during bowel movements, or feeling of incomplete evacuation, suggestive of a rectocele
• Pelvic Pressure: General feeling of heaviness or discomfort in the pelvic area, which may worsen with prolonged standing
• Sexual Dysfunction: Dyspareunia or changes in sexual satisfaction, which may be linked to the physical changes caused by prolapse

Gather a detailed background including:

• Obstetric History: Number of vaginal deliveries, history of large babies, prolonged labour, or use of forceps
• Past Medical History: Previous pelvic surgeries, including hysterectomy, or any connective tissue disorders
• Menopausal Status: Lack of oestrogen post-menopause can weaken pelvic tissues and contribute to prolapse
• Family History: Any family history of pelvic organ prolapse or connective tissue disorders
• Lifestyle Factors: Chronic cough (e.g., due to COPD), heavy lifting, chronic constipation, and obesity, which increase intra-abdominal pressure

• Pelvic Examination: Assess for any visible or palpable prolapse, grade the prolapse using the POP-Q system, and check for associated conditions like cystocele or rectocele
• Speculum Examination: To assess the extent of prolapse and identify the specific compartments involved (anterior, posterior, or apical)
• Bimanual Examination: Assess for any pelvic masses or tenderness, which could indicate other pathologies like fibroids or ovarian cysts

• Ultrasound: To rule out other pelvic pathologies, such as ovarian cysts or fibroids, that might be contributing to the symptoms
• MRI of the Pelvis: Detailed imaging to assess the extent of prolapse and associated pelvic floor dysfunction, particularly if surgical intervention is considered
• Urodynamic Testing: If there are significant urinary symptoms, to assess bladder function and determine if there is associated stress incontinence