What does a prolapse assessment involve?

At FemaleGP clinic, I focus on providing holistic, patient-centered care for women experiencing pelvic floor issues. My approach begins with a thorough discussion of each patient's unique journey.

We review key factors that may contribute to the symptoms. This includes evaluating for constipation, bladder function, and any pelvic muscle activation or spasms.  It is incredible how many women think they empty their bowels have their prolapse symptoms improved when we help you poo better!   I also consider any history of back or limb injuries, as well as chronic cough, which can affect pelvic floor health.

A detailed obstetric history is essential. I ask about the number and types of deliveries, emphasizing that even cesarean sections do not guarantee protection against pelvic floor disorders. We also discuss any birth injuries, such as perineal tears or levator ani avulsion.

It’s crucial to address any history of trauma, particularly sexual assault. I approach this topic sensitively to ensure patients feel safe and supported in sharing their experiences.

During the assessment, we talk about specific symptoms that are often associated with a prolapse, including feelings of pressure or bulging, urinary or fecal incontinence, and discomfort during intercourse.   We also review other parts of your health like your menstrual cycle, obstetric history, fertility plans, hormonal therapy, bowel history and more.  

Your pelvis is the centre of your body.  It has a role in pretty much everything you do.  This is why understanding your job, hobbies, toilet access, fluid intake and more is really important.  

To help understand the cause of your symptoms, and the extent of your possible prolapse a physical examination is recommended.  This includes a palpation (feel) of your abdomen and also a pelvic examination.  A pelvic exam typically involves using a speculum to look into the vagina, and perhaps individual assessment of the front and back walls of the vagina, but also an examination and feel inside the vagina to assess what the organs feel like, is there any other cause for the symptoms eg fibroids, or an ovarian cyst and what the muscles feel like.  The muscles may be over active, or under active, and some people are able to locate them, and others can't.  All of these aspects help ensure the best management strategy is planned.  Most importantly I reiterate that my patients are in control all the time.  For many women pelvic examination are very private and personal.  Often improving prolapse and bladder symptoms can be started without an examination.  I believe it's really important for you to trust the practitioner and understand what they are evaluating. 

It is really important to highlight mental health because this is closely related to pelvic floor symptoms and function. I explore how these issues affect patients' daily lives, relationships, and overall well-being and look at what mental health challenges you may have experienced that could be contributing to your symptoms now.  Understanding the psychological impact helps me provide more comprehensive support.

When it comes to treatment options, I prioritize a collaborative approach. We discuss conservative management strategies such as pelvic floor exercises and lifestyle modifications. I work closely specialized physiotherapists, both locally in Hawkes Bay and I have gotten to know many around New Zealand to. For those who need additional support, we can explore options like pessaries or surgical interventions.

Throughout this process, I emphasize that this is a journey we are on together. My goal is to empower each woman with knowledge about her body and the available treatment options. I encourage regular follow-ups to monitor progress and adjust our approach as needed.

Ultimately, my aim is for every woman to feel heard, understood, and equipped to take control of her pelvic health. With the right support and guidance, we can work together to achieve positive outcomes.