Nausea, vomiting, malaise, frequent urination—Dx?

POP often is viewed as a minor problem, but it can cause obstructive uropathy with unilateral or bilateral hydronephrosis or renal dysfunction and/or failure. The delay often seen with reporting genital prolapse may be due to the mild symptoms or feelings of shame or fear. Combining screening for cervical pathology in general practice with a screening for genital prolapse could identify these problems.

Monitoring renal function is advised in patients with a Stage III or IV POP and any patients with POP who also have hypertension or diabetes mellitus. Because only minor changes in laboratory findings may be observed in patients with unilateral hydronephrosis, consider renal ultrasonography.

Treatment options for POP includes pelvic floor exercises, pessary insertion, and reconstructive surgery. Early treatment can resolve hydronephrosis and possibly prevent irreversible renal damage.

ACKNOWLEDGEMENTS
The authors thank Wilhelm Van Dorp, MD, Rob A. van de Beek, MD, and Alan Brind for their help with this manuscript.