Consider Cough Test to Diagnose Asymptomatic Pelvic Organ Prolapse


MONTREAL — A cough is worth a thousand contractions of the pelvic floor muscles, since it can often reveal the otherwise hidden beginnings of pelvic organ prolapse, according to MarŸke Slieker-ten Hove of Erasmus Medical Center in Rotterdam, The Netherlands.

Symptoms of pelvic organ prolapse (POP) are present in more than 90% of parous women, but in the remaining asymptomatic group, early and sometimes advanced POP can be detected simply by asking patients to cough, she discovered during her research.

“It's often at a very early stage, there's no leakage, and they are not aware of it—but you can feel that they lose control of their muscles when they cough,” she said in an interview.

“Physicians will tell women who have a firm contraction that they don't have a pelvic floor muscle problem. But they don't ask them to cough. Although many women have a very strong muscle, they don't have control when they cough,” she said.

In her study, which she presented at the annual meeting of the International Continence Society, Ms. Slieker-ten Hove, who is head of pelvic physiotherapy education at the medical center, randomly selected 653 women from one small town who had agreed to answer questionnaires on urinary and fecal incontinence and quality of life. The women also underwent a physical examination to assess their pelvic floor muscles.

All women who were nulliparous and all those who answered positively on any questions concerning previous or current pelvic floor dysfunction were excluded. This left 51 asymptomatic parous women (about 8% of the original population) for analysis.

The research team then assessed the women for signs of POP, including conscious and unconscious contractions and relaxations of the pelvic floor muscles, as well as counteraction of the muscles during coughing.

Despite being completely asymptomatic, 18 women (35%) had signs of POP that were stage 2 or higher, 23 had signs of stage 1 POP, and only 9 women had no signs of POP.

By detecting these early, asymptomatic signs of POP, physicians might have more success at preventing the development of incontinence, rather than treating it once it becomes evident. “We only do something about incontinence at the end when patients already have complaints. We should be preventive [by] giving them information about protecting their pelvic floor,” she said.

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