Pelvic Organ Prolapse Questionnaire
Do You Suspect You Might Have Pelvic Organ Prolapse?
With 5 types of pelvic organ prolapse, several common causes, and a wide range of symptoms, it can be hard to identify what you’re experiencing as POP until it worsens. Sometimes, POP first manifests with chronic constipation, incontinence, or pain with intimacy (rather than the “obvious” visible symptoms).
If you believe you may be experiencing POP, we encourage you to self-screen using our pelvic organ prolapse risk factor questionnaire below. Vetted by medical practitioners around the world, the questionnaire contains 18 questions that are focused on POP risk factors, causes, and symptoms.
How Do You Know if You Have Pelvic Organ Prolapse?
Pelvic organ prolapse can be caused by childbirth, menopause, and other common life events, activities, and co-existing conditions. Symptoms can progress over time if left untreated. If you think you might have pelvic organ prolapse, answer these questions to evaluate your risk and seek treatment as soon as possible.
1. Have you had at least one vaginal birth? If yes, how many?
2. Did you experience a long labor, forceps, or suction delivery?
3. Do you feel or see tissues bulging from your vagina?
4. Are you in menopause?
5. Do you leak urine when you sneeze, cough, or laugh?
6. Do you have difficulty starting your urine stream?
7. Have you experienced stool leakage?
8. Have you had chronic constipation for over a year?
9. Do you lift heavy weight at home or work (including children over 30 lbs)?
10. Do you marathon run, jog, or engage in heavy lifting athletic activities?
11. Have you had a hysterectomy?
12. Do you experience chronic coughing from allergies or emphysema?
13. Do your tampons push out of place?
14. Do you feel pelvic, back, rectal, or vaginal pain?
15. Do you feel vaginal or rectal pressure?
16. Is intercourse painful?
17. Do you have reduced sexual sensation?
18. Are you double jointed?
Download the Questionnaire in Your Language
To download and print out the pelvic organ prolapse risk factor questionnaire, select the best language for you below.
Are you a medical practitioner who would like to help us translate the risk factor questionnaire into another language? Please reach out via info.apops@gmail.com.
How to Use the Questionnaire
The pelvic organ prolapse risk factor questionnaire is not meant to replace treatment or diagnosis by a healthcare professional. It is meant to clarify the need for pelvic organ prolapse screening by a practitioner. Use this questionnaire as a springboard to request POP screening from your doctor.
1. Fill out the questionnaire
Answer the questions to screen yourself for pelvic organ prolapse. Note that several “yeses” does not necessarily indicate POP.
2. Show it to your physician
Bring the questionnaire to your next appointment with your physician to start the conversation around pelvic organ prolapse.
3. Request a POP evaluation
If you suspect POP, ask to be screened during your pelvic exam. POP screening is not standard protocol — you may need to request it.
Thank you to the practitioners who helped us translate the Risk Factor Questionnaire.
Afrikaans: Joh-Ann Gouws, PT
Arabic: Dr. Hichem Bensmail
Danish: Sarah Groot, PT
Dutch: Odilia Egbers, PT
Estonian: Maris Perendi, PT
French: Dr. Hichem Bensmail
Hebrew: Professor Menahem Neuman
Hindi: Meenakshi Mohite, MPT and Dr. Rupinder Kaur Ruprai
Italian: Dr. Claudio Catalisano
Japanese: Dr. Sergio Zetina and Dr. Jimmy Nomura
Lithuanian: Dr. Greta Peciulyte
Nepalese: Dr. Manisha Yadav
Polish: Natalia Wencławek, PT
Portuguese (Brazil): Quelen Farias, PT
Russian: Dr. Lyudmila Tverdikova
Spanish: Dr. Jorge De Leon Soto
Wondering, “Now What?”
Did filling out the questionnaire lead to more questions about pelvic organ prolapse? Start your POP journey with APOPS. We’re here to support you through every step.