What investigations are necessary to evaluate the severity of pelvic organ prolapse in a primary care setting?

Investigations necessary to evaluate the severity of pelvic organ prolapse in primary care include:

• Taking a detailed history focusing on symptoms of prolapse, urinary, bowel, and sexual function to understand the impact and associated dysfunctions.
• Performing a clinical examination to document the presence of prolapse and to exclude other causes such as pelvic masses or malignancy.
• Asking the woman to bear down during examination to check for visible vaginal or rectal prolapse.
• Considering a rectal examination in women at risk of impaction or those unable to provide an accurate history (e.g., cognitive impairment).
• Using validated pelvic floor symptom questionnaires to aid assessment and decision making where appropriate.
• Not routinely performing imaging to document prolapse if physical examination confirms it.
• If symptoms are not explained by initial examination findings, repeating the examination with the woman standing or squatting or at a different time.

These steps allow assessment of the presence and degree of prolapse and help exclude other pathologies before referral or management decisions are made in primary care.

Note: Detailed quantification of prolapse severity (e.g., POP-Q system) and pelvic floor muscle assessment are typically performed in secondary care.

References: NICE NG210,NICE NG123