Pelvic organ prolapse:
Main presenting features:
Your assessment before referral:
Perform a vaginal examination to identify presence of pelvic organ prolapse or pelvic mass. If no prolapse is detected it may be useful to repeat the examination with the woman in a standing position or to ask her to book another appointment to repeat the examination at a different time (the end of the day and/or when she knows her symptoms are likely to be worse).
All patients presenting with associated urinary incontinence/symptoms should undertake a urine dipstick screening to detect the presence of blood, glucose, protein, leucocytes and nitrites in the urine.
If you feel that your patient has mild to moderate pelvic organ prolapse refer her to physiotherapy. The physiotherapist will complete a detailed assessment, following which she will work with your patient, with the aim of resolving or reducing her symptoms. This may include:
Advice on an individualised pelvic floor muscle exercise programme.
Education on daily activities, general exercise, lifting, diet, weight loss and avoidance of constipation.
Advice on how to achieve optimal bladder and bowel emptying.
If urinary symptoms are present these will be treated accordingly
If conservative management fails the physiotherapist may discuss referral to the gynaecological consultant.
Referrals to consultant-led services:
If your patient describes any of the following symptoms she should be referred directly to the appropriate consultant-led service (following locally-agreed pathways):
Symptomatic prolapse at or below the introitus
Post-menopausal vaginal bleeding
Persistent intermenstrual bleeding
Unexplained abdominal, bowel or urinary symptoms
Vulval lump, bleeding and/or ulceration
Palpable abdominal/pelvic mass