The Impact of Bladder Filling and Time of Day on the Assessment of Genital Prolapse

Abstract

Objectives: The aim of this study was to investigate whether it is necessary to consider time of day and bladder filling when assessing genital prolapse. Women with prolapse often experience larger bulge and heaviness in the evening and are more bothered when the bladder is full, but it is unclear whether this has any impact on the evaluation of the prolapse. Traction on the cervix with a tenaculum is still used by some gynecologists in the examination of a prolapse. This may be painful for the patients and it is uncertain whether it yields more information than performing a maximal Valsalva maneuver. Methods: Fifteen patients scheduled for prolapse surgery were examined before 10 am and after 8 pm according to the Pelvic Organ Prolapse Quantification (POP-Q) system. In addition, traction on the cervix was compared with maximal Valsalva maneuver when assessing the cervical descent. For a clinical difference of 1 cm in prolapse size and a type I error of 5% and a power of 90%, a paired sample of 15 were necessary. Results: No clinically relevant differences could be demonstrated, neither between morning and evening examination nor between examination with a full and empty bladder. There was very good correlation in the cervical descent between maximal Valsalva maneuvers and tenaculum traction on the cervix (correlation coefficient = 0.96, P = 0.001). Conclusions: Traction on the cervix is not necessary if the patient is able to perform the Valsalva maneuver. It is unnecessary to take into account bladder filling and time of day when assessing a genital prolapse.