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Urinary incontinence and pelvic organ prolapse

ACOG/AUGS symptom-led evaluation, conservative care and referral boundaries for urinary leakage and pelvic organ prolapse.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adult patients with stress, urgency or mixed urinary incontinence and/or symptomatic pelvic organ prolapse. Recurrent infection, fistula, neurogenic bladder, urinary retention, pelvic malignancy and acute postoperative complications require separate diagnostic pathways.
sources for this section:ACOG PB 155ACOG/AUGS PB 214

The Bottom Line

  • Classify leakage as stress, urgency, mixed, overflow or another pattern from the history, bladder diary, examination and urinalysis before selecting treatment.
  • Correlate prolapse anatomy with bothersome bulge, pressure, voiding, defecatory and sexual symptoms; incidental support loss does not mandate intervention.
  • Offer pelvic-floor muscle training, bladder and bowel measures, weight and fluid interventions and a pessary when appropriate before assuming surgery is required.
  • Use medication for urgency incontinence through shared decisions about cognition, dry mouth, constipation, blood pressure, emptying and cost; medication does not treat stress leakage or prolapse anatomy.
  • Choose stress-incontinence or prolapse surgery only after goals, uterine preference, sexual function, recurrence, mesh or graft issues and future pregnancy are discussed.
sources for this section:ACOG PB 155ACOG/AUGS PB 214

Practical clinical workflow

1
Record leakage triggers, urgency, frequency, nocturia, pad use, bulge, splinting, bowel symptoms, pain, hematuria, obstetric and surgical history, medicines and functional impact.
2
Perform abdominal, neurologic and pelvic examination with consent, demonstrate stress leakage when possible, assess prolapse compartments and obtain urinalysis and postvoid residual when indicated.
3
Use a bladder diary and symptom questionnaire, treat infection or constipation and begin phenotype-specific conservative care with trained pelvic-floor therapy where available.
4
Fit and review a pessary with a removal, cleaning, vaginal-health and follow-up plan, or trial appropriate bladder medication with objective symptom review.
5
Refer complicated leakage, high residual, recurrent ulceration, failed conservative treatment or a preference for procedure to urogynecology for urodynamic and surgical decisions.
sources for this section:ACOG PB 155ACOG/AUGS PB 214

Safety boundaries and escalation

  • New retention, kidney dysfunction, gross hematuria, recurrent infection, fecal incontinence with neurologic deficits or suspected fistula or malignancy requires prompt diagnostic escalation.
  • A neglected pessary can cause bleeding, ulceration, infection or fistula; every device needs a feasible follow-up and removal plan.
  • Before anti-incontinence surgery, objectively demonstrate stress leakage and assess emptying; complicated presentations may need additional testing to avoid the wrong procedure.
  • Transvaginal mesh for prolapse has distinct FDA restrictions and is not interchangeable with a midurethral sling; discuss the exact material and route.
sources for this section:ACOG PB 155ACOG/AUGS PB 214

Localization

This summary uses reaffirmed joint ACOG/AUGS bulletins. US procedure availability, FDA device status and insurance access vary.
sources for this section:ACOG PB 155ACOG/AUGS PB 214

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. American College of Obstetricians and Gynecologists and American Urogynecologic SocietyUrinary Incontinence in WomenPractice Bulletin No. 155 路 Reaffirmed 2025 路 published 2015-11-01 路 accessed 2026-08-20
    view source
  2. American College of Obstetricians and Gynecologists and American Urogynecologic SocietyPelvic Organ ProlapsePractice Bulletin No. 214 路 Reaffirmed 2024 路 published 2019-11-01 路 accessed 2026-08-20
    view source
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