A prolapse happens when one or more pelvic organs slip downward from their normal position because the muscles and tissues holding them in place have weakened. The bladder, uterus, rectum, or top of the vagina can drop into or, in severe cases, beyond the vaginal canal. It’s common: estimates based on physical exams find prolapse in 10 to 50 percent of women, though many have no symptoms at all.
What Happens Inside the Body
Your pelvic organs are held in place by a hammock-like system of muscles, ligaments, and connective tissue. The most important muscle group in this system is the levator ani, a broad sheet of muscle that forms the floor of the pelvis. When these structures stretch, tear, or thin out over time, the organs they support can shift downward under the pull of gravity and the pressure of everyday activities like standing, coughing, or lifting.
The descent can be slight, with organs dropping just a small amount inside the vaginal canal, or extensive enough that tissue bulges visibly outside the body. Doctors grade severity on a scale from stage 0 (no prolapse) to stage 4, where the vaginal walls have essentially turned inside out. Most people who seek treatment fall somewhere in the middle stages.
Types of Prolapse
The type depends on which organ has moved:
- Bladder prolapse (cystocele): The bladder drops into the front wall of the vagina. This is the most common type and often causes urinary symptoms.
- Uterine prolapse: The uterus descends into or through the vaginal canal.
- Rectal prolapse (rectocele): The rectum pushes into the back wall of the vagina, which can make bowel movements difficult.
- Vaginal vault prolapse: After a hysterectomy, the top of the vagina can collapse inward.
- Small bowel prolapse (enterocele): Part of the small intestine pushes against the upper vaginal wall, most often after hysterectomy.
It’s possible to have more than one type at the same time, since the same weakened support structures affect multiple organs.
What Prolapse Feels Like
Many people with mild prolapse notice nothing at all. When symptoms do appear, the hallmark sensation is feeling a bulge in the vagina, as if something is falling out. Beyond that, symptoms tend to cluster around three areas: pelvic pressure, urinary changes, and bowel difficulties.
Pelvic pressure or heaviness is often the first thing people notice. It typically worsens after standing for long periods or by the end of the day, and eases when lying down. Some people also feel an ache in the lower back. A practical early sign: not being able to keep a tampon in place.
Urinary symptoms can include needing to urinate more often, feeling urgency, having a weak stream, or not being able to fully empty the bladder. If urine backs up because the prolapse is blocking the flow, it can lead to urinary tract infections or, less commonly, kidney infections.
Bowel changes are especially common with rectoceles. You might feel like you can’t fully empty your bowels, or you may need to press a finger against the vaginal wall to support the bulge in order to pass stool. Doctors call this “splinting,” and while it sounds alarming, it’s a common and practical way that many people manage day to day. Pain during sex is another frequent symptom that can affect quality of life significantly.
Causes and Risk Factors
Vaginal childbirth is the single biggest risk factor. The process of labor and delivery can directly injure the pelvic muscles, the connective tissue (fascia) surrounding the organs, and the levator ani muscle complex. The more vaginal deliveries a person has had, the higher the risk. Prolonged labor, large babies, and assisted deliveries with forceps all increase the chance of damage.
Aging plays a major role too. As estrogen levels drop during and after menopause, the tissues that support the pelvic organs become thinner and less elastic. Carrying extra body weight increases pressure on the pelvic floor over time. Chronic coughing from smoking or lung disease, repeated heavy lifting, and chronic constipation all push downward on the pelvic floor and can contribute to or worsen a prolapse. There’s also a genetic component: some people are born with naturally weaker connective tissue, which makes them more susceptible regardless of other factors.
How It’s Diagnosed
Diagnosis is usually straightforward. A doctor performs a pelvic exam, using a speculum to look at the vaginal walls both at rest and while you bear down (similar to the effort of a bowel movement). Bearing down pushes the prolapse to its fullest extent, making it easier to see and measure. If the prolapse isn’t obvious while lying on an exam table, you may be asked to stand with one foot on a chair and strain again, since gravity makes the descent more apparent in an upright position.
The doctor assigns a stage from 0 to 4 based on how far the tissue has descended relative to the vaginal opening. Imaging like ultrasound or MRI is rarely needed for a standard diagnosis but may be used when planning surgery or evaluating complex cases.
Non-Surgical Treatment
For mild to moderate prolapse, or when someone prefers to avoid surgery, there are two main approaches: pelvic floor exercises and pessaries.
Pelvic floor muscle training (often called Kegel exercises) involves systematically contracting and relaxing the levator ani muscles to rebuild strength. Research shows this training significantly improves prolapse symptoms at 6, 12, and even 24 months. Programs vary widely, from doing exercises twice a week to daily sessions, and may run anywhere from 6 weeks to 2 years. Working with a pelvic floor physical therapist helps ensure you’re targeting the right muscles and progressing appropriately, since many people unknowingly do Kegels incorrectly.
A pessary is a removable device, usually made of silicone, that’s inserted into the vagina to physically support the organs that have dropped. Pessaries come in many shapes and sizes, and a doctor fits one during an office visit. Some people wear them continuously, while others insert them only during activities that make symptoms worse. For many, a pessary effectively manages symptoms without any need for surgery.
When Surgery Is Considered
Surgery is typically reserved for people whose symptoms significantly interfere with daily life and who haven’t found adequate relief from conservative approaches. There are two broad categories.
Reconstructive surgery is the more common approach. It aims to restore organs to their original position using your own tissue or sometimes surgical mesh. Some procedures are done through the vagina with no external incision, while others require an abdominal incision or laparoscopy (small incisions with a camera). Vaginal approaches generally mean shorter operating times and faster recovery.
Obliterative surgery narrows or closes the vaginal canal to provide support from below. It has a high success rate and is a simpler procedure, but it’s only appropriate for people who don’t plan to have vaginal intercourse in the future. This option is most often chosen by older adults who want effective relief with a less intensive operation.
Recovery from vaginal surgery is generally quicker than recovery from abdominal procedures, though both typically involve several weeks of activity restrictions, including avoiding heavy lifting. Prolapse can recur after surgery, particularly if the underlying risk factors (chronic cough, excess weight, heavy lifting habits) remain.
Living With Prolapse
Prolapse is not dangerous in most cases, but it can be deeply frustrating. The sensation of something falling out, difficulties with urination or bowel movements, and pain during sex all take a real toll on quality of life. Many people feel embarrassed or assume nothing can be done, which delays them from getting help.
Practical steps that can slow progression include maintaining a healthy weight, treating chronic constipation to avoid straining, learning proper breathing and bracing techniques for lifting, and sticking with a pelvic floor exercise routine. While formal evidence linking these habits to prolapse prevention specifically is limited, they reduce the chronic downward pressure on the pelvic floor that contributes to worsening over time. Starting pelvic floor exercises during pregnancy and resuming them after delivery is one of the most commonly recommended strategies for reducing long-term risk.