Summary
Read the full fact sheet- A pelvic organ prolapse happens when the ligaments and muscles that support pelvic organs stretch, causing the organs to drop down.
- Risk factors include pregnancy, childbirth, menopause and heavy lifting.
- There are things you can do to prevent or manage a pelvic organ prolapse.
On this page
What is pelvic organ prolapse?
The pelvic organs include the vagina, uterus, bladder and bowel.
A pelvic organ prolapse happens when the ligaments and muscles that support pelvic organs stretch, causing the organs to drop down.
There are different types of pelvic organ prolapse, including uterine prolapse, and bladder and bowel prolapse (vaginal prolapse).
Uterine prolapse
A uterine prolapse is when the uterus (womb) and cervix (the opening to the uterus) drop down towards the vaginal entrance and may even protrude outside the vagina.
Bladder and bowel prolapse (vaginal prolapse)
Bladder prolapse (cystocele) is when the bladder bulges into the front wall of the vagina.
Bowel prolapse (rectocele) is when the rectum bulges into the back of the vaginal wall.
Bladder and bowel prolapses usually happen together, but they can happen separately.
This type of prolapse is also known as 'vaginal prolapse' because the walls of the vagina become overstretched and bulge down towards the vaginal entrance.
Symptoms of a prolapse
The symptoms of a prolapse depend on the severity of the prolapse and your general health.
Symptoms can include:
- inability to completely empty your bladder or bowel when going to the toilet
- straining to wee or poo
- a slow flow of wee that may stop and start
- a feeling of fullness or pressure inside the vagina
- a sensation of vaginal 'dragging' or 'heaviness'.
There may also be:
- a feeling of swelling or a lump at the vaginal opening
- needing to go to the toilet quickly
- inability to control your wee or poo (incontinence)
- lower back ache.
In severe cases, the vaginal wall or cervix may protrude outside the vaginal entrance.
What causes a prolapse?
Anything that puts pressure on your pelvic floor muscles can cause a prolapse.
For example:
- pregnancy and childbirth
- constipation or regularly straining when trying to go to the toilet
- being overweight or obese
- coughing due to smoking or chronic lung disease
- repetitive lifting of heavy weights at work, home or the gym
- squatting for long periods of time.
The risk of prolapse increases:
- with previous pelvic or gynaecological surgery
- after menopause when oestrogen levels drop, causing pelvic floor muscles to lose elasticity.
Note that being sexually active does not cause or worsen prolapse.
Diagnosing prolapse
Prolapse is usually diagnosed by your doctor after discussing your symptoms and medical history. They will also do a physical pelvic examination to check:
- the degree of prolapse
- how well the pelvic floor muscles are working
- which organs are involved in the prolapse.
Other tests
You may also need other tests, including:
- a pelvic ultrasound
- a bladder function test (urodynamics)
- a bladder scan
- a midstream urine test.
Stages of prolapse
The severity of prolapse is measured using the POP-Q system to understand the stages of prolapse. Stages one to 4 are defined by how far the prolapse comes down into the vagina.
Treatment and management
Without intervention, symptoms of prolapse will usually get worse over time. Treatment and management will depend on the severity of the prolapse and how much it interferes with your daily life.
Mild and moderate prolapse
If you have a mild or moderate prolapse (stages one and 2), regular sessions with a pelvic floor physiotherapist will help.
If the prolapse is more severe you may need to try different approaches, including devices that support the pelvic organs (pessaries) or surgery.
What you can do
There are practical things you can do to reduce the risk of prolapse. These may also help you to recover well after a prolapse or surgery. For example you can:
- manage constipation by eating a balanced diet and drinking enough water
- do regular physical activity
- avoid heavy lifting
- make lifestyle changes, like quitting smoking.
You can also do pelvic floor exercises every day. For example, squeeze up pelvic floor muscles before lifting, coughing, laughing or sneezing. A pelvic floor physiotherapist can show you how to do this.
More information
For more detailed information, related resources, articles and podcasts, visit Jean Hailes Women's Health.
Where to get help
- Cystocele (prolapsed bladder), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, USA.
- Dietz HP. Pelvic organ prolapse - a review. Aust Fam Physician. 2015 Jul;44(7):446-52. PMID: 26590487.
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