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Is a “dragging sensation” a symptom of female pelvic organ prolapse?

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Abstract

Introduction and hypothesis

Pelvic organ prolapse (POP) commonly presents with a “vaginal lump or bulge” and/or a “dragging sensation.” The first symptom correlates strongly with clinical and imaging data. However, a “dragging sensation” may be less specific. Hence, we investigated the predictive value of both symptoms for POP.

Methods

This was a retrospective study involving archived data sets of women seen between November 2013 and May 2014. All underwent a clinical interview, POPQ examination, and 4D translabial ultrasound (TLUS). The main outcome measure was organ descent on clinical examination and TLUS. Offline analysis for organ descent was undertaken blinded against all other data.

Results

A total of 224 women were assessed. Mean age was 57 (23–84) years. Median parity was 3 (0–7). Ninety-three percent (n=208) were vaginally parous. Fifty-eight percent (n=129) complained of symptoms of prolapse: 49% (n=110) of a vaginal lump, 27% (n=61) of a dragging sensation. Clinically, mean point B anterior (Ba) was −0.86 (−3 to +7.5) cm, mean cervical station (C) was −4.1 (−9 to +8) cm, mean point B posterior (Bp) was −1.1 (−3 to +5) cm. On imaging, mean bladder, uterine, and rectal descent were −8.3 (−68.0 to 34) mm, +18.6 (−56.4 to 46.3) mm, and −5.3 (−39.8 to 36) mm respectively. On univariate analysis, both symptoms were strongly associated with objective prolapse clinically and on TLUS, with “vaginal lump” consistently the stronger predictor.

Conclusions

The symptom of a “vaginal lump or bulge” was consistently a stronger predictor of objective POP than “dragging sensation.” This finding was insensitive to adjustments for potential confounders. However, a “dragging sensation” is clearly a symptom of prolapse.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Neonatology, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Penrith, NSW, 2750, Australia

    Hans Peter Dietz, Candice Chatel & Ixora Kamisan Atan

  2. Department of Obstetrics and Gynaecology, University of Poitiers, Poitiers, France

    Candice Chatel

  3. Department of Obstetrics and Gynecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

    Ixora Kamisan Atan

Authors
  1. Hans Peter Dietz
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  2. Candice Chatel
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  3. Ixora Kamisan Atan
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Correspondence to Hans Peter Dietz.

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Conflicts of interest

H.P. Dietz has received unrestricted educational grants and honoraria from GE Medical. The other authors have no conflicts of interest to declare.

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Dietz, H.P., Chatel, C. & Atan, I.K. Is a “dragging sensation” a symptom of female pelvic organ prolapse?. Int Urogynecol J 29, 703–707 (2018). https://doi.org/10.1007/s00192-017-3410-8

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  • DOI: https://doi.org/10.1007/s00192-017-3410-8

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