A prolapse happens when an organ slips out of its normal position because the tissues holding it in place have weakened. The term most commonly refers to pelvic organ prolapse, where the bladder, uterus, or rectum drops down into or through the vaginal canal. It can also describe a heart valve that doesn’t close properly. Prolapse is remarkably common: prevalence in the general female population ranges from 3 to 6%, but climbs to roughly 50% in women who have given birth vaginally.
How Pelvic Organ Prolapse Happens
Your pelvic organs, including the bladder, uterus, and rectum, are held in place by a hammock of muscles, ligaments, and connective tissue called the pelvic floor. When those structures stretch, tear, or weaken, one or more organs can sag downward. In mild cases the organ shifts only slightly. In severe cases it can bulge visibly outside the body.
The condition is staged from 0 to IV. Stage I means the organ has dropped but remains well inside the vaginal canal. Stage II means it has descended closer to the vaginal opening. Stage III means tissue extends beyond the opening, and Stage IV is a complete protrusion. Many people with Stage I or II prolapse have no symptoms at all and discover it only during a routine exam.
What Causes It
Vaginal childbirth is the single most common cause. Multiple deliveries, delivering twins or triplets, a large baby, or a delivery involving forceps or vacuum assistance all raise the risk because of the strain placed on pelvic floor muscles and connective tissue during labor.
Aging plays a major role too. As estrogen levels decline during menopause, the connective tissues supporting the pelvic floor lose elasticity and strength. This is why the highest rates of symptomatic prolapse appear in women in their 60s and 70s, with a reported rate of about 18.6 per 1,000 women aged 70 to 79.
Anything that puts chronic pressure on the abdomen can also contribute. Persistent constipation, a long-term cough (from smoking or lung disease), and frequent heavy lifting all push down on the pelvic floor repeatedly over time, gradually weakening it.
Types of Pelvic Organ Prolapse
The name depends on which organ has dropped:
- Anterior prolapse (cystocele): The bladder pushes into the front wall of the vagina. This is the most common type and often causes urinary problems like leaking or difficulty fully emptying the bladder.
- Uterine prolapse: The uterus descends into the vaginal canal. In advanced cases it can protrude outside the body.
- Posterior prolapse (rectocele): The rectum bulges into the back wall of the vagina, which can make bowel movements feel incomplete or difficult.
- Vaginal vault prolapse: After a hysterectomy, the top of the vagina can lose support and collapse inward.
It’s possible to have more than one type at the same time, since the same weakened pelvic floor supports all of these organs.
What It Feels Like
Mild prolapse often produces no noticeable symptoms. When symptoms do appear, the most recognizable one is a feeling of heaviness, fullness, or pressure in the vagina, sometimes described as the sensation of something “falling out.” You might feel or see a bulge of tissue at the vaginal opening, especially after standing for a long time or at the end of the day.
Other common signs include difficulty urinating or a weak urine stream, leaking urine when you cough or laugh, trouble having a complete bowel movement, lower back pain that eases when you lie down, and discomfort during sex. Symptoms tend to worsen with prolonged standing, lifting, or straining and improve with rest.
Non-Surgical Treatment Options
Pelvic floor muscle training (often called Kegel exercises) is the first-line treatment for mild to moderate prolapse. A Cochrane review pooling data from multiple trials found that women who completed a structured pelvic floor exercise program were significantly more likely to report improvement compared to women who received no treatment. The exercises work by strengthening the muscles that support the pelvic organs, effectively rebuilding the hammock from underneath. Subgroup analysis suggests the exercises are most effective for Stage I and Stage II prolapse.
Working with a pelvic floor physical therapist can help you learn to isolate and strengthen the correct muscles. Many women unknowingly contract the wrong muscle groups when doing pelvic floor exercises on their own, so guided instruction makes a real difference.
A pessary is another common option. This is a removable device inserted into the vagina to physically support the organs that have dropped. The most widely used type is a ring pessary, which is O-shaped and works well for mild to moderate prolapse. For more advanced prolapse or specific organ involvement, other shapes are available, including Gellhorn, donut, and cube designs. A healthcare provider fits the pessary in the office, and once in place, most women can’t feel it. Some pessaries for stress incontinence are even available over the counter.
When Surgery Is Needed
If symptoms are severe or haven’t improved with exercises and a pessary, surgery can reposition the organs. One of the most common procedures uses a small piece of surgical mesh to lift the organs and anchor them to a stable structure in the pelvis. This is typically done through small incisions using a camera, sometimes with robotic assistance. The procedure takes two to four hours, and most people go home the same day.
Recovery generally takes six to eight weeks, during which you’ll need to avoid heavy lifting and strenuous activity. The success rate for this type of repair is around 90%, making it one of the more reliable surgical options.
Mitral Valve Prolapse: A Different Condition
The word “prolapse” also applies to the heart. Mitral valve prolapse occurs when the two flaps of the mitral valve (the valve between the upper and lower left chambers of the heart) become floppy and don’t seal tightly when the valve closes. In some cases, blood leaks backward through the gap.
Most people with mitral valve prolapse have no symptoms and never need treatment. When symptoms do occur, they can include heart palpitations (a fluttering or skipping sensation), shortness of breath, fatigue, dizziness, chest pain, and migraines. It is generally considered a benign condition, though a small percentage of people develop significant valve leakage that requires monitoring or repair.