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Diagnosis

The diagnosis of any type of pelvic prolapse is usually made when your doctor does a detailed physical exam, including a pelvic exam. You may be referred to a specialist for this exam.

What to Expect from the Pelvic Exam

The exam will likely take longer than a routine exam, so your doctor can carefully examine the vaginal wall for bulges and weaknesses. You will be asked to push as you would during a bowel movement, so that the doctor can see the effect that this stress has on the wall of the vagina. Your doctor may also need to reposition the speculum in your vagina to get a better view of different portions of the vaginal wall. You may be asked to stand during part of the exam.

The exam should be done when your bladder is partly full. When you push down, the doctor will want to see if any urine escapes from the urethra (the opening you urinate through). The doctor may also examine the urethra in other ways, for example, by inserting a narrow Q-tip® to see if the angle of this passage has been affected by changes in the muscles of the pelvic floor.

Deciding How to Treat Your Prolapse

Decisions about how and when to treat your prolapse will be based on your symptoms. Your doctor will ask you questions about how the prolapse is affecting your life. Expect questions about:

  • your regular bowel and bladder habits
  • any problems you have been having with urinary frequency or urgency, or urinary incontinence/leaking
  • any problems with constipation or diarrhea
  • your sex life and whether you are experiencing pain during intercourse

Because women’s pelvic muscles sometimes weaken as their estrogen levels decrease after menopause, you may also be asked questions about if and when your menopause occurred, and any menopausal symptoms you experienced.

Assessing Bladder Concerns

If the prolapse is causing you to urinate frequently, or making it difficult to hold your urine or empty your bladder, the doctor will likely recommend tests to assess the severity of these problems. Such tests are called urodynamic studies. For more details about these tests, visit the Diagnosis section of the Urinary Incontinence Health Centre.

If you have several different types of prolapse, it may be difficult for the doctor to distinguish one from another. In this case, the doctor may send you for imaging tests. Imaging tests are usually done in the radiology department of your local hospital. The doctor may use special x-rays and dyes to see the bladder and bowel more clearly.

 

The pelvic floor is a layer of muscles that stretches like a hammock from the pubic bone at the front of the pelvis to the base of the spine in the back. These muscles support the weight of the pelvic organs and enable everyday activities like walking and sitting. Ligaments within the pelvis hold the organs in place.

The pelvic floor muscles also play a crucial role in the functioning of pelvic organs. For example, bands of muscle encircle the urethra (the opening you urinate through) and bowel. These bands are called sphincters. Sphincters control the release of urine and feces. Other muscles surrounding these organs control the filling and emptying of the bowel and bladder.

Muscles throughout the pelvis also work when a woman gives birth. Some of these same muscles contribute to the enjoyable sensations of female orgasm.

Damage or weakness in these muscles can interfere with all of these functions. One of the most obvious signs of damage is a prolapse.

Think of the pelvic floor as a mesh of muscles, like a nylon stocking. When these muscles are weakened or damaged, runs or even holes appear in the mesh and it can no longer support the pelvic organs. A prolapsed organ is an organ that has shifted position and begun to protrude through this mesh. Most commonly, prolapsed organs press down against the vagina, since this is the largest opening to the pelvic floor. This causes a bulge in the wall of the vagina. In severe cases, a prolapse can push part of the vaginal wall out through the vaginal opening.

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Pelvic Prolapse

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Diagnosis

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