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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Pelvic-organ prolapse assessment

Obstetrics and gynaecology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Irreducible prolapse with tissue or urinary compromise

An acutely painful irreducible prolapse, brisk bleeding, ulceration with systemic infection, urinary retention, obstructive renal injury or a suspicious pelvic or vaginal mass needs prompt specialist assessment rather than routine pessary review.

Action: Assess observations, pain, bleeding, exposed tissue, abdomen, urine output and bladder residual; protect prolapsed tissue with gentle moist care, avoid forceful reduction, treat sepsis or retention urgently and obtain same-day gynaecology or urology review when compromise is suspected.

Synopsis

Assess pelvic-organ descent with symptom-led, consented examination; describe compartments and severity reproducibly; and identify bladder, bowel, tissue and malignancy features that alter management.

  • Pelvic-organ prolapse is descent of one or more vaginal compartments: anterior wall, posterior wall, uterus or post-hysterectomy vaginal vault.
  • Treat symptoms and goals, not anatomy alone; mild prolapse is often asymptomatic and observation is a valid option.
  • Ask about bulge, dragging, urinary storage and emptying, bowel evacuation and splinting, sexual function, bleeding, pain and impact on activity.
  • Examine with consent and a chaperone, using a speculum to assess each compartment during maximal strain and recording a reproducible POP-Q description where possible.
  • If symptoms are not explained by a supine examination, repeat while standing or squatting, at another time or after appropriate bladder filling.
  • Assess vaginal tissue, cervix, pelvic-floor contraction and pelvic masses; perform rectal examination only when posterior-compartment or bowel findings warrant it.
  • Urinalysis is routine when incontinence coexists; residual volume is measured for voiding symptoms or recurrent UTI, and imaging or urodynamics is selective.
  • Discuss observation, lifestyle measures, vaginal oestrogen for menopausal genitourinary symptoms, supervised PFMT, pessary and surgery according to bother and preference.

Key red flags

Painful non-reducible prolapse, dusky or ulcerated tissue, heavy bleeding or fever requires urgent gynaecological assessment.

Inability to void, hydronephrosis, renal impairment or recurrent infection with significant prolapse indicates clinically important obstruction.

Postmenopausal bleeding, contact bleeding, an irregular mass, unexplained weight loss or abnormal cervix needs the appropriate suspected-cancer pathway.

Faecal incontinence, rectal bleeding, severe obstructed defecation or a suspected rectovaginal fistula requires bowel and colorectal assessment.

New neurological deficit, saddle sensory change or acute bladder and bowel dysfunction should not be attributed to prolapse.

Investigation priorities

01
Compartmental pelvic examinationFirst step

Confirm prolapse, identify the leading edge, assess tissue and exclude an obvious mass or cervical lesion.

Management branches

Symptom assessmentDefine bother across compartments

A person reports a vaginal bulge, pressure or related bladder or bowel symptoms.

  1. Ask about protrusion, reducibility, urinary storage and emptying, bowel evacuation and splinting, sex, bleeding, pain and daily impact.
  2. Review childbirth, menopause, pelvic surgery or mesh, cough, constipation, physical load, connective tissue and reproductive plans.
  3. Identify urgent tissue, urinary, bowel, neurological or suspected-cancer features before arranging routine examination.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG123 pelvic-organ prolapse assessment
  • RCOG pelvic-organ prolapse patient information
  • NHS pelvic-organ prolapse
  • NHS urinary incontinence diagnosis

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom