One of the challenges we see in pelvic rehabilitation is an issue that we can observe across many conditions: an individual who may not appear to have significant objective signs can have significant impairments, while someone who presents with major physical dysfunction has mild or no complaints. Within the gynecologic literature, the question of "what is a significant level of prolapse" has been a frequent question, and usually a question that lacks specific answers. Looking at some of the research helps to highlight the clinical query and to demonstrate some of the research conclusions.
- When the authors Swift et al. (2003) attempted to correlate patient symptoms with level of pelvic organ support in a general population of 477 women, they found that women who presented with Stage II and stage III prolapse have increased symptoms. They suggested that these findings may help define POP levels that are symptomatic. (None presented with stage IV prolapse in the study.)
-Broekhuis et al. (2009) make the point that while pelvic organ prolapse (POP) and pelvic organ dysfunction symptoms can occur at the same time, they can also occur independent of each other. The only symptom in their study (n = 69) that correlated positively with degree of pelvic organ prolapse was having a sensation of or being able to see a vaginal bulge.
-In a similar study correlating the level of perineal descent with pelvic symptoms, the authors found that prolapse symptoms were associated with degree of perineal descent, but urinary incontinence and anorectal symptoms were not associated with level of descent. The study states that " …the clinical …impact of perineal descent in urogynecology is still unclear at this time point." (Broekhuis et al., 2010)