Evaluation and Counseling of Patients With Pelvic Organ Prolapse

Publication Date: September 1, 2017
Last Updated: March 14, 2022

RECOMMENDATIONS

For patients presenting with POP
Determine the duration and severity of pelvic symptoms and associated bother.
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Ask specifically about urinary, bowel, sexual symptoms, and previous treatments.
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Obtain a medical and surgical history including previous pelvic surgery.
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Perform a physical examination including a POP-Q examination and assessment of pelvic floor muscle function.
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Quantify the extent of the prolapse using the POP-Q examination and confirm that the examination findings reflect the patient's experience.
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Assess for abnormal vaginal bleeding

a. Document the patient's denial of vaginal bleeding.
b. Evaluate symptoms of vaginal bleeding to rule out premalignant or malignant conditions.
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Assess bladder function

a. Continence: Consider cough stress test with the prolapse in the native, neutral, and reduced position (at bladder volume of 300 mL or capacity, whichever is less). If considering surgery, assess risk of occult stress urinary incontinence using available risk prediction models.
b. Emptying: Evaluate PVR urine volume in patients with anterior vaginal wall prolapse beyond the hymen or abnormal voiding symptoms.
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Asymptomatic women without evidence of urinary retention can be offered expectant management.
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Asymptomatic women should be offered an appropriate range of interventions based upon their medical histories and treatment goals, including vaginal pessary and surgery.
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Recommendation Grading

Overview

Title

Evaluation and Counseling of Patients With Pelvic Organ Prolapse

Authoring Organization

Publication Month/Year

September 1, 2017

Last Updated Month/Year

January 17, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adult, Older adult

Health Care Settings

Emergency care, Operating and recovery room, Outpatient, Radiology services

Intended Users

Radiology technologist, nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Management, Treatment

Diseases/Conditions (MeSH)

D056887 - Pelvic Organ Prolapse

Keywords

Urinary Incontinence, pelvic organ prolapse, POP

Source Citation

This document was developed by the American Urogynecologic Society (AUGS) Guidelines and Statements Committee with assistance of Cassandra L. Carberry, MD, Paul K. Tulikangas, Beri M. Ridgeway, Sarah A. Collins, and Rony A. Adam. This peer-reviewed document reflects clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Its content is not intended to be a substitute for professional medical judgment, diagnosis or treatment. The ultimate judgment regarding any specific procedure or treatment is to be made by the physician and patient in light of all circumstances presented by the patient.. American Urogynecologic Society Best Practice Statement: Evaluation and Counseling of Patients With Pelvic Organ Prolapse. Female Pelvic Medicine & Reconstructive Surgery 23(5):p 281-287, 9/10 2017. | DOI: 10.1097/SPV.0000000000000424