Pelvic & Sexual Health
Pelvic Organ Prolapse: Symptoms, Types and Treatment Options
Pelvic organ prolapse happens when the muscles and tissues holding up your pelvic organs weaken, so the bladder, uterus, rectum or top of the vagina drops into or out of the vaginal opening. The most common symptom is pressure or a bulge in the vagina. It's common, rarely dangerous and treatable with exercises, a pessary or surgery.
A lot of women find it in the shower: they feel something soft at the opening that wasn't there before, and they panic. That reaction makes sense. But if this is you, know that prolapse is something gynecologists see every day, and you have more options than you might think, including doing nothing if it doesn't bother you.
What it feels like
- Heaviness, fullness or a feeling that "something is falling out"
- A soft bulge you can feel or see at the vaginal opening
- Symptoms that are worse after standing all day, lifting a toddler or a long walk, and better when you lie down
- Trouble starting to pee, a weak stream, or needing to lean forward or shift to finish emptying
- Leaking urine, which can also be stress or urge incontinence
- Constipation, or needing to press on the vagina or the skin between vagina and anus (called "splinting") to have a bowel movement
- Discomfort or changed sensation during sex
- Spotting or irritation where tissue rubs on underwear
Many women with mild prolapse have no symptoms at all and need no treatment.
The types
Prolapse is named for whichever part is dropping:
| Type | What drops | Common symptoms |
|---|---|---|
| Cystocele (anterior prolapse) | Bladder bulges into the front wall of the vagina | Bulge, slow urine stream, not feeling empty, UTIs |
| Rectocele (posterior prolapse) | Rectum bulges into the back wall of the vagina | Trouble emptying bowels, needing to press on the vagina to have a bowel movement |
| Uterine prolapse | Uterus and cervix move down the vaginal canal | Heaviness, bulge, sometimes tissue outside the opening |
| Vaginal vault prolapse | Top of the vagina drops after hysterectomy | Bulge and pressure |
| Enterocele | Small bowel pushes against the top or back of the vagina | Pressure, pulling or ache |
Having more than one type at once is common.
Why it happens
Usually several things add up over years:
- Vaginal childbirth, which can stretch or injure pelvic floor muscles and connective tissue
- Aging and menopause, as lower estrogen and age weaken tissues
- Ongoing pressure on the pelvic floor from constipation and straining, a long-term cough, heavy lifting or higher body weight
- Genetics: some women just have less sturdy support tissue
- Prior pelvic surgery, including hysterectomy
The questions people are embarrassed to ask
"Did I do something to cause this?" Almost never in a way you could have controlled. Childbirth and genetics are the big drivers.
"Can I still have sex?" Usually yes. Prolapse isn't harmed by sex. If it's uncomfortable, tell your clinician; a pessary or treatment often helps.
"Will it fall all the way out?" Severe prolapse does happen but is less common, and most mild prolapse changes slowly, if at all.
"Can I keep running, lifting or doing CrossFit?" Often yes, with adjustments. A pelvic floor physical therapist can help you work out what's comfortable.
How it's diagnosed
A pelvic exam. Your clinician will ask you to bear down or cough, sometimes while standing, to see how far the tissue moves. It's not glamorous, and everyone feels a bit self-conscious; the exam takes only a few minutes. They may also check how well you empty your bladder and look for hidden stress incontinence. Imaging usually isn't needed.
Treatment options, compared
ACOG and AUGS advise treating prolapse only when it causes symptoms. If you're not bothered, watching and waiting is a safe choice.
| Option | Best for | What to expect |
|---|---|---|
| Pelvic floor physical therapy | Mild to moderate prolapse | Weekly or every-other-week sessions for a couple of months, plus daily exercises at home |
| Pessary | Any age or severity; avoiding or delaying surgery | Fitted in the office; may take a few tries to get the size right |
| Surgery | Bothersome symptoms when other options haven't worked or aren't preferred | Varies by procedure; ask about recovery time and lifting limits |
Pelvic floor physical therapy
Pelvic floor muscle training with a physical therapist can reduce symptoms, especially for mild to moderate prolapse. A therapist also teaches better habits for lifting, bowel movements and breathing. More in pelvic floor physical therapy. At home, regular Kegel exercises help, but many women do them wrong without coaching.
Pessary
A pessary is a removable silicone device placed in the vagina to hold things up. It comes in many shapes and sizes, and it's fitted in the office.
What daily life with one is like:
- You shouldn't feel it. If it's uncomfortable, falls out, or makes it hard to pee or have a bowel movement, it likely needs a different size or shape.
- Fitting can take a few tries. That's normal, not a failure.
- Cleaning: some women remove and clean it themselves; others have it done at regular office visits.
- Side effects: discharge, odor and irritation can happen. Vaginal estrogen sometimes helps.
- Sex: some types can stay in; others are easy to take out first. Ask which applies to yours.
- Exercise: many women find walking, running or lifting more comfortable with a pessary in.
It can be a long-term solution or a bridge while you decide about surgery, recover from childbirth, or wait for a better time.
Surgery
The main types:
- Native tissue repair: done through the vagina, using your own tissue to rebuild support
- Sacrocolpopexy: done through the abdomen, usually laparoscopic or robotic, attaching the top of the vagina to the tailbone area with mesh. It's often considered very durable for apical (top) prolapse.
- Hysterectomy, sometimes combined with a repair when the uterus has prolapsed, though uterus-sparing options exist
- Colpocleisis: closes the vagina. It works well and recovery is quick, but vaginal intercourse is no longer possible afterward, so it's only for women who are sure they don't want that.
About vaginal mesh. In 2019 the FDA ordered manufacturers to stop selling surgical mesh intended for transvaginal repair of prolapse. That doesn't apply to mesh used in sacrocolpopexy through the abdomen or to midurethral slings for stress incontinence. Ask your surgeon exactly which technique and materials they recommend, and why.
Keeping it from getting worse
- Treat constipation and avoid straining (a small footstool under your feet on the toilet helps many people)
- Do regular pelvic floor exercises
- Keep a healthy weight
- Exhale and tighten your pelvic floor as you lift, including grocery bags and kids
- Stop smoking to cut down on coughing
When to see a doctor
Make an appointment if you feel a vaginal bulge or pressure, have trouble emptying your bladder or bowels, or notice leaking or pain with sex. Get care promptly if:
- You can't pee at all
- Tissue outside the vagina is bleeding, has a sore, or can't be pushed back in
- You have fever, pelvic pain or signs of a bladder infection
- You have a pessary and notice bleeding, foul-smelling discharge or pain
A general OB/GYN can diagnose prolapse and fit many pessaries. Urogynecologists specialize in prolapse and its surgery. Search urogynecologists in New York across the five boroughs, Long Island and the Hudson Valley.
Frequently asked questions
What does pelvic organ prolapse feel like?
Many women describe heaviness or pressure in the vagina, or a bulge they can feel or see, often worse at the end of the day or after standing a long time. Some women have no symptoms at all.
Can prolapse go away on its own?
Mild prolapse may stay the same for years or even improve slightly, but it usually doesn't fully go away. Pelvic floor exercises, a pessary or surgery can relieve symptoms.
Is pelvic organ prolapse dangerous?
Prolapse is usually not dangerous, and treatment depends on how much it bothers you. See a doctor promptly if you can't urinate, have bleeding from exposed tissue, or have severe pain.
Sources
- ACOG/AUGS — Pelvic Organ Prolapse (Practice Bulletin 214)
- ACOG — Pelvic Support Problems (patient FAQ)
- AUGS — Pelvic Organ Prolapse patient fact sheet
- FDA — Urogynecologic Surgical Mesh Implants
- MedlinePlus — Pelvic Support Problems
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.