Underestimation of pelvic organ prolapse in the supine straining position, based on magnetic resonance imaging findings

Anique T.M. Grob* (Corresponding Author), Judith olde Heuvel, Jurgen J. Futterer, Diana Massop, Angelique L. Veenstra van Nieuwenhoven, Frank F.J. Simonis, Carl H. van der Vaart

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: Pelvic organ prolapse (POP) is clinically diagnosed in the supine position, where the effect of gravity is simulated by having the patients put strain on their pelvic floor. The objective of this study was to determine the degree of POP underestimation in the supine position based on magnetic resonance imaging (MRI) findings.

Methods: This prospective study was conducted with symptomatic POP grade ≥ 2 patients. Fifteen female patients were examined with an MRI system that allows supine and upright imaging. The differences between supine and upright in distances of the bladder neck, cervix, and pouch of Douglas from the pubococcygeal line (PCL) were estimated, together with changes in the genital hiatal area. Patients were scanned at rest and during straining. All distances were compared using the Wilcoxon ranking test.

Results: All mean distances from the PCL increased from the supine–strain to the upright–rest and from the supine–strain to the upright–strain position. These distances were found in the supine and upright positions: the bladder descended 1.3 cm to 1.4 cm, the cervix 1.1 cm to 2.2 cm, and the pouch of Douglas 0.8 cm to 1.5 cm respectively (all p values <0.05). The hiatal area was larger in the upright–strain position (mean 42.0 cm2; SD ±14.8) than during the supine–strain position (mean 33.5 cm2; SD ±14.5), with a p value of 0.02.

Conclusion: Upright MRI scanning of patients with POP grade ≥ 2 both at rest and during straining shows a significantly larger extent of the prolapse than that observed during supine straining.

Original languageEnglish
Pages (from-to)1939-1944
Number of pages6
JournalInternational Urogynecology Journal
Issue number11
Early online date17 Jan 2019
Publication statusPublished - 1 Nov 2019


  • Extent
  • Prolapse
  • Pubococcygeal line
  • Strain
  • Upright MRI

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