Step-by-step approach to managing pelvic organ prolapse: information for physicians.

Step 1: Presentation and history Prevalence: The prevalence of pelvic organ prolapse among parous women is 50%. Most women are asymptomatic. History: Physicians should ask about urinary frequency and urgency, bulges or lumps in the vagina, pelvic pressure or heaviness, incontinence of urine or stool, difficulty with defecation or constipation, dyspareunia, and whether patients insert their fingers in the vagina to void or defecate. Risk factors: Childbirth, constipation, age, pelvic surgery, chronic cough, raised intra-abdominal pressure, and obesity.