Symptoms of prolapse

A recent joint report from the International Urogynecological Association (IUGA) and International Continence Society (ICS) (15) on the symptoms of POP states that the most common symptom is that of vaginal bulge or ‘something coming down' towards or through the vaginal introitus.

• pelvic pressure, heaviness, or dragging in the suprapubic area and/ or pelvis

• bleeding, discharge, or infection due to dependent skin ulceration of the prolapse

• splinting/digitation—the need to digitally replace the prolapse or apply manual pressure to the vagina or perineum (splinting), or to the vagina or rectum (digitation) to assist voiding or defecation respectively

• low backache

• lower urinary tract symptoms/overactive bladder, sexual dysfunc­tion (both dyspareunia and psychological due to poor general and genital body image)

• vaginal pain is rarely a symptom of POP.

Symptoms of sexual dysfunction

POP may result in a departure from normal sensation and/or func­tion experienced by a woman during sexual activity:

• Dyspareunia (superficial and deep): persistent or recurrent pain or discomfort associated with attempted or complete vaginal penetration.

• Obstructed intercourse: complaint that vaginal penetration is not possible due to obstruction from the bulge/POP.

• Vaginal laxity: complaint of excessive vaginal laxity.

• Loss of libido due to poor genital body image.

Anorectal dysfunction

• Anal incontinence

• Incomplete emptying of the bowel with digitation

• Faecal urgency

• Rectal prolapse.