Pelvic organ and rectal prolapse: Developing common terminology and physical exam pearls

Rectal prolapse is often accompanied by pelvic organ prolapse. The surgeon needs to be astute in order to elicit the symptoms and perform the appropriate exam in order to fully evaluate the pelvic floor. This is often a daunting task, and the immediate response is to refer to our urogynecology colleagues. However, with the knowledge of the individual tests, the purpose of each test, and a systematic approach to performing the comprehensive assessment every provider can and should be able to complete a full pelvic floor exam. In this chapter, we present a stepwise approach to performing a comprehensive multicompartment pelvic floor examination, as well as understanding the common terminology across the treatment team and critical components for the consultation. There is a full consort of physical examinations every patient with pelvic organ or rectal prolapse should undergo, and collaboration across specialties is needed to ensure this comprehensive and complete evaluation is performed. Every surgeon is not expected to perform every test, but significant multicompartment pelvic floor prolapse benefits from a multidisciplinary team to ensure a thorough evaluation is done. But with the information in this chapter, colorectal surgeons should feel comfortable completing the initial examinations, treatment regimens, and eliciting proper referrals for best care of prolapse.