Pelvic organ prolapse

A prolapse is a descent of one of the pelvic organs into the vaginal wall. It is common, it is not dangerous in itself, and the degree of descent matters far less than how much it bothers the person who has it.

What is happening

The pelvic organs are held in place by a combination of muscle from below and connective tissue attachments at the sides and top. When those supports weaken or detach, the organ presses into the vaginal wall and the wall bulges. Nothing falls out of the body in the way the word suggests, although in advanced cases tissue can protrude beyond the vaginal opening.

Prolapse is described by which wall is affected. A bulge in the front wall usually involves the bladder. A bulge in the back wall usually involves the rectum. Descent of the cervix and uterus is described as uterine prolapse, and after a hysterectomy the top of the vagina itself can descend. More than one can be present at once, and often is.

How common it is

Some degree of descent is found in a large share of women who have given birth, most of whom have no symptoms whatsoever. This is the single most important thing to understand about prolapse: an examination finding on its own is not a diagnosis of a problem. Treatment is decided by symptoms.

Risk rises with vaginal birth, particularly instrumental delivery and larger babies, with age and the fall in oestrogen after menopause, with anything that raises abdominal pressure repeatedly such as chronic constipation, chronic cough or very heavy lifting, with a higher body weight, and with connective tissue that is naturally more elastic, which runs in families.

Symptoms

• A dragging, heavy or aching sensation low in the pelvis or vagina, typically absent in the morning and clearer by evening.
• A feeling of something being there, or a visible or palpable bulge.
• For front wall prolapse: slow urinary stream, needing to pass urine again shortly afterwards, or a sense of incomplete emptying.
• For back wall prolapse: difficulty emptying the bowel, or needing to press on the vaginal wall or perineum to complete a bowel movement.
• Discomfort or reduced sensation during sex, and sometimes an awareness of the bulge during it.
• Low back ache, though this has many other causes and is a weak sign on its own.

Pain is not a typical feature. Significant pain suggests something else is going on and should be assessed.

Assessment

Diagnosis is clinical. A vaginal examination is performed lying down and often standing, and the person may be asked to bear down so that the descent can be seen at its greatest. Grading systems describe how far the leading edge of the prolapse reaches relative to the hymenal ring, on a scale from mild descent to complete protrusion. The grade guides the discussion; it does not dictate the treatment.

Conservative treatment

Pelvic floor muscle training is the recommended first treatment for mild to moderate prolapse. It does not reverse the anatomy, but it improves symptoms for a substantial proportion of women by improving support and control. A supervised programme with a pelvic health physiotherapist outperforms a leaflet, and the eight week programme gives the structure.

Alongside that, the things that reduce downward pressure help: treating constipation properly, avoiding straining, managing a chronic cough, using a footstool for bowel movements, exhaling on effort when lifting, and reaching a weight that reduces load where that applies.

Pessaries

A pessary is a soft silicone device placed in the vagina to support the prolapse mechanically. Several shapes exist, and fitting is a matter of trial. It is a genuine treatment rather than a stopgap: many women use one for years, some as an alternative to surgery, and some to see whether symptom relief follows before committing to an operation. Pessaries are usually reviewed periodically and can be self managed by many people once they are confident. Vaginal oestrogen is often prescribed alongside a pessary in postmenopausal women to keep the tissue healthy.

Surgery

Surgery repairs or resuspends the supporting tissue and is normally considered when symptoms are significant and conservative treatment has not been enough, or when a woman prefers it after a full discussion. Approaches differ according to the compartment involved and whether the uterus is retained. Any surgical conversation should cover the chance of recurrence, the effect on sexual function, recovery time and alternatives, and it is entirely reasonable to ask how many of a particular operation the surgeon performs.

Living with a prolapse

A prolapse does not damage the body by being present, and it does not require the person to stop exercising. Higher impact activity may increase symptoms, in which case load can be adjusted rather than abandoned. Sex is not harmful, though positions may need adjusting and vaginal dryness, which is common in the same age group, makes everything feel worse and is easily treated. See the pages on vaginal dryness and genitourinary syndrome of menopause.

Last reviewed: September 2026