The Pelvic Organ Prolapse Symptom Score (POP-SS)

Assessment tool to measure symptoms of pelvic organ prolapse


Pelvic organ prolapse (POP), a common female condition, is the symptomatic descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina from the normal anatomical position [1]. Prolapse is strongly associated with childbirth, ageing and the menopause.  Women with prolapse present with a variety of symptoms (vaginal, bladder, bowel, back, abdominal and sexual). Some of these symptoms are specifically associated with the descending pelvic organs protruding into the vaginal canal, for example feeling of a bulge or something coming down. Others, such as urinary and bowel problems, can co-exist and may be related to or be independent of the prolapse. It is important in research and clinical practice that we quantify such symptoms using standardised instruments with known psychometric properties.

Developing a symptom score

In 2000, at the outset of a programme of research on the conservative management of prolapse, we identified the lack of a simple prolapse symptom score which could be used as a continuous primary outcome measure in randomised controlled trials.  To that end, we developed the Pelvic Organ Prolapse Symptom Score (POP-SS), and have published on its internal consistency, construct validity and sensitivity to change [2]. We concluded that the POP-SS has good internal consistency and construct validity and is sensitive to change. Additional work has been undertaken on its test-retest reliability and minimal clinically important difference [3]. The POP-SS has now been widely used, both in the research and clinical contexts.  We have a large volume of data which we plan to interrogate to further develop this important tool [4-11].

Using the POP-SS

The POP-SS is a brief 7-item questionnaire that is acceptable to women and lends itself to use in both research and the clinical environment. 

If you wish to obtain a copy of the POP-SS, email -(

Suzanne Hagen, Professor of Health Services Research, NMAHP Research Unit, Glasgow Caledonian University


  1. Haylen BT, Maher CF, Barber MD, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Neurourol Urodyn 2016; 35: 137–68.
  2. Hagen, S; Glazener, C; Sinclair, L; Stark, D; Bugge, C. Psychometric properties of the pelvic organ prolapse symptom score. BJOG: an international journal of obstetrics and gynaecology, 2009 Jan, 116(1):25-31.
  3. Hagen S, Glazener C, Cook J, Herbison P, Toozs-Hobson P. Further properties of the pelvic organ prolapse symptom score: minimally important change and test-retest reliability. Neurourol Urodyn 2010;29(6):1055-1056.
  4. Hagen S, Stark D, Glazener C, Dickson S, Barry S, Elders A, Frawley H, Galea MP, Logan J, McDonald A, McPherson G. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet. 2014 Mar 7;383(9919):796-806.
  5. Glazener CM, Breeman S, Elders A, Hemming C, Cooper KG, Freeman RM, Smith AR, Reid F, Hagen S, Montgomery I, Kilonzo M. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). The Lancet. 2016 Dec 21.
  6. Glazener C, Constable L, Hemming C, Breeman S, Elders A, Cooper K, Freeman R, Smith AR, Hagen S, McDonald A, McPherson G. Two parallel, pragmatic, UK multicentre, randomised controlled trials comparing surgical options for upper compartment (vault or uterine) pelvic organ prolapse (the VUE Study): study protocol for a randomised controlled trial. Trials. 2016 Sep 8;17(1):441.
  7. Glazener C, Elders A, Macarthur C, Lancashire RJ, Herbison P, Hagen S, Dean N, Bain C, Toozs‐Hobson P, Richardson K, McDonald A. Childbirth and prolapse: long‐term associations with the symptoms and objective measurement of pelvic organ prolapse. BJOG: An International Journal of Obstetrics & Gynaecology. 2013 Jan 1;120(2):161-8.
  8. Hagen S, Glazener C, McClurg D, Macarthur C, Elders A, Herbison P, Wilson D, Toozs-Hobson P, Hemming C, Hay-Smith J, Collins M. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. The Lancet. 2016 Dec 21.
  9. McClurg D, Hilton P, Dolan L, Monga A, Hagen S, Frawley H, Dickinson L. Pelvic floor muscle training as an adjunct to prolapse surgery: a randomised feasibility study. International urogynecology journal. 2014 Jul 1;25(7):883-91.
  10. Kashyap R, Jain V, Singh A. Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I–III pelvic organ prolapse. International Journal of Gynecology & Obstetrics. 2013 Apr 1;121(1):69-73.
  11. Özengin N, Kaya S, Orhan C, Bakar Y, Duran B, Ankaralı H, Akbayrak T. Turkish adaptation of the Pelvic Organ Prolapse Symptom Score and its validity and reliability. International Urogynecology Journal. 2017 Jan 6:1-6.