Importance of Urologic Assessment for Pelvic Organ Prolapse With Occult Incontinence

A Case Study

William E. Somerall, Jr., MD, MAEd; Lisa S. Pair, DNP, RN, WHNP-BC

Disclosures

Urol Nurs. 2020;40(5):245-247, 257. 

In This Article

Abstract and Introduction

Abstract

Case Study

Occult urinary incontinence is often masked by pelvic organ prolapse until the prolapse is reduced mechanically or surgically. This case study describes the urologic assessment needed to identify occult urinary incontinence, particularly if surgical repair is anticipated.

Introduction

Pelvic organ prolapse (POP) is a common health care condition of the female genital tract. Estimates indicate that approximately 50% of women experience some form of POP in their lifetime, but only 10% to 20% seek evaluation (Barber & Maher, 2013; Bohlin et al., 2018). There are various types of POP depending on the weakened support structure. A cystocele occurs when the supporting endopelvic fascia between the bladder and vagina weaken and stretch, resulting in a bulge into the vagina. A rectocele occurs when the muscles between the rectum and vagina weaken, creating a bulge into the vagina. An enterocele and uterine prolapse result from a weakness of apical vaginal support that allows descent of the uterus and/or bowel into the vaginal vault (Abrams et al., 2018).

Pelvic organ prolapse often masks the presence of urinary incontinence and voiding dysfunction in females. While many women with POP are unaware of incontinence issues, urodynamic studies demonstrate that 31% of women who are asymptomatic for urinary incontinence (UI) had detrusor overactivity (DO) and that 17% of women who are asymptomatic for UI have urodynamic evidence of occult stress urinary incontinence (SUI) (Asfour et al., 2018). The purpose of this article is to describe the importance of preoperative urodynamic studies in women who are asymptomatic for occult stress urinary incontinence (SUI) who seek treatment for symptomatic POP.

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