Generally, the most reliable way that a doctor can make a definite diagnosis of any type of prolapse involves a medical history and physical exam of the woman. This involves the doctor examining each section of the vagina separately to determine the type and extent of the prolapse and what type of treatment is most appropriate.
During the physical exam, the woman may need to sit in an upright position or stand and strain so that any prolapsed tissues are more likely to become apparent.
Some types of prolapse such as cystocele or rectocele are more easily identifiable during the physical exam than are types such as vaginal vault prolapse or enterocele.
The following are tests that the doctor may use to evaluate women with advanced pelvic organ prolapse. Since many of these women also have urinary incontinence, these tests can further evaluate the anatomy and function of the pelvic floor.
Q-tip test: In this diagnostic test, the doctor inserts a small cotton-tipped applicator lubricated with an anesthetic gel into the woman’s urethra. The doctor then asks the woman to strain down. If the applicator raises 30 degrees or more as a result, this means that the urethra-bladder neck drops while straining and is a predictive factor of success of anti-incontinence surgery.
Bladder function test: This involves a diagnostic procedure called urodynamics. This tests the ability of the bladder to store urine and to dispose of it (urinate). The first step of this test is called uroflowmetry, which involves measuring the amount and force of the urine stream. The second step is called a cystometrogram. In this step, a catheter is inserted into the bladder. The bladder is then filled with sterile water. The volume at which the patient experiences urgency and fullness are recorded. The pressures of the bladder and urethra are measured and the patient is asked to cough or bear down to elicit leakage with the prolapse pushed up (reduced). This is important information that may assist the surgeon in selecting the correct type of surgery.
Pelvic floor strength: During the pelvic exam, the doctor tests the strength of the woman’s pelvic floor and of her sphincter muscles. The doctor also assesses the strength of the muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. These findings help the doctor determine if the woman would benefit from exercises to restore the strength of the muscles of the pelvic floor (for example, Kegel exercises).
The following are imaging tests the doctor may use for further diagnostic purposes, if indicated:
Ultrasound: This diagnostic tool uses sound waves. Sound waves are reflected back when they contact relatively dense structures, such as fibrous tissue or blood vessel walls. These reflected sound waves are then converted into pictures of the internal structures being studied. With an ultrasound, the doctor may visualize the bladder in women with urinary incontinence or the muscles around the anus in women with anal incontinence.
Cystourethroscopy: A cystoscope, which is a small, tube-like instrument, is lubricated with an anesthetic gel and inserted into the urethra. The end of the cystoscope has a light and camera, which produces images on a television screen. With this procedure, the doctor can view inside the urethra and bladder. This procedure is especially valuable for women who have symptoms of urinary urgency, frequency, bladder pain, or blood in the urine. It can be performed in the office using local anesthesia.