Management of Pelvic Organ Prolapse

Diagnosis and Initial Management

The American College of Radiology recommends that standard pelvic organ prolapse evaluation requires only clinical assessment with history and physical examination to identify the compartments involved and the degree of externalization 1
Laboratory tests are not routinely indicated for uncomplicated prolapse, according to Praxis Medical Insights 2
The American College of Radiology states that the vast majority of pelvic organ prolapse cases can be diagnosed and managed without any imaging studies 1

The American College of Radiology indicates that imaging is necessary in cases of severe or recurrent prolapse, suspected enteroceles, defecatory dysfunction, discordance between symptoms and clinical findings, pre-operative planning for complex or revision surgery, and patients unable to tolerate adequate physical examination 1
Dynamic cystocolpoproctography (fluoroscopic defecography) shows 88% sensitivity for internal rectal prolapse and provides good correlation with surgical findings, according to Praxis Medical Insights 2
The American College of Radiology recommends MR defecography with rectal contrast to improve detection of prolapse compared to dynamic pelvic floor MRI without contrast 1
Transperineal ultrasound provides real-time dynamic evaluation and is useful for assessing complications from previous mesh or sling procedures, according to the American College of Radiology 1

Patients with rectal prolapse have a 4.2-fold increased risk of colorectal cancer, and colonoscopy or flexible sigmoidoscopy is recommended to screen for colorectal malignancy, according to the World Journal of Emergency Surgery and Praxis Medical Insights 2, 3
CT scan is indicated only for complicated rectal prolapse (irreducible, strangulated, or with signs of ischemia) in hemodynamically stable patients, according to the World Journal of Emergency Surgery and Praxis Medical Insights 2, 4, 5