A prolapse happens when an organ slips out of its normal position, usually because the tissues that hold it in place have weakened. The term comes up most often in two contexts: pelvic organ prolapse, where the bladder, uterus, or rectum drops downward into or beyond the vaginal canal, and rectal prolapse, where part of the rectum slides out through the anus. Less commonly, it refers to mitral valve prolapse, a heart condition where a valve flap bulges backward during each heartbeat. Pelvic organ prolapse is by far the most common type, affecting an estimated 3 to 6% of women overall and up to 50% of women who have given birth.
Pelvic Organ Prolapse: The Most Common Type
Your pelvic floor is a hammock of muscles, ligaments, and connective tissue that holds the bladder, uterus, and rectum in place. When that support system weakens or stretches, one or more of those organs can sag downward. In mild cases, the shift is slight and you may not notice anything. In severe cases, tissue can bulge visibly outside the vaginal opening.
There are several subtypes depending on which organ has dropped:
- Cystocele (anterior prolapse): The bladder drops into the front wall of the vagina. This is the most common form and often causes urinary symptoms like leaking or difficulty emptying your bladder fully.
- Uterine prolapse: The uterus descends into the vaginal canal. In advanced cases it can protrude beyond the vaginal opening.
- Rectocele (posterior prolapse): The rectum pushes into the back wall of the vagina, sometimes making bowel movements difficult.
- Vaginal vault prolapse: After a hysterectomy, the top of the vagina can lose support and collapse inward.
More than one type can occur at the same time, since the same weakened pelvic floor supports all of these organs.
What It Feels Like
People with pelvic organ prolapse typically describe a sensation of fullness or pressure in the vagina, as if something were falling out. You might feel a heaviness that worsens after standing for a long time or by the end of the day. Some people can see or feel a soft bulge at the vaginal opening, especially during a bowel movement or while straining.
Other common symptoms include difficulty urinating or feeling like your bladder doesn’t empty completely, lower back pain, discomfort during sex, and a sense that you need to press on the vaginal wall to complete a bowel movement. Mild prolapse often causes no symptoms at all and is only discovered during a routine pelvic exam.
Stages of Severity
Doctors grade pelvic organ prolapse on a scale from 0 to 4, based on how far the organ has shifted relative to the vaginal opening:
- Stage 0: No prolapse. Everything is in its normal position.
- Stage I: The organ has dropped slightly but remains well above the vaginal opening.
- Stage II: The organ has descended to roughly the level of the vaginal opening.
- Stage III: The organ protrudes beyond the vaginal opening but the vaginal walls haven’t fully turned inside out.
- Stage IV: Complete eversion, meaning the vaginal walls have turned fully inside out.
Many people live comfortably with Stage I or II prolapse and never need treatment beyond lifestyle adjustments.
What Causes It
Pregnancy and vaginal childbirth are the biggest risk factors. The strain of carrying a baby and pushing during delivery stretches and sometimes tears the pelvic floor muscles and connective tissue. The more vaginal deliveries you’ve had, the higher the risk.
Age plays a major role as well. Estrogen helps keep pelvic tissues strong and elastic, so the drop in estrogen after menopause accelerates weakening. Incidence rises noticeably after age 40 and peaks between 65 and 74. Chronic straining from constipation, a persistent cough, or heavy lifting adds repeated downward pressure on the pelvic floor over time. Obesity, a prior hysterectomy, and a family history of connective tissue weakness also increase risk.
Rectal Prolapse
Rectal prolapse is a separate condition where part of the rectum slides through the anal opening. It can look and feel like hemorrhoids, with reddish tissue protruding during or after a bowel movement. The key difference is that hemorrhoids are swollen blood vessels and typically resolve on their own within a week or so, while rectal prolapse is chronic and progressive. It won’t go away without treatment.
Symptoms include a visible bulge from the anus, mucus or blood discharge, difficulty controlling bowel movements, and a feeling of incomplete evacuation. A doctor can usually diagnose it with a physical exam, sometimes asking you to bear down as if having a bowel movement to see the tissue protrude.
Mitral Valve Prolapse
In the heart, the mitral valve has two flaps that open and close to control blood flow between the left upper and lower chambers. In mitral valve prolapse, one or both of those flaps are slightly too large or too stretchy, so they bulge backward into the upper chamber each time the heart contracts. Most people with this condition have no symptoms and need no treatment. It affects roughly 2 to 3% of the population and is often found incidentally during a routine exam when a doctor hears a clicking sound through a stethoscope.
Treatment Without Surgery
For pelvic organ prolapse, the first line of treatment is almost always pelvic floor physical therapy. A trained therapist teaches you targeted exercises to strengthen the muscles supporting your organs. A 2016 analysis of 13 clinical trials found that women who did structured pelvic floor therapy were 1.7 times more likely to see an improvement in their prolapse stage, and were more than five times as likely to report that their symptoms had improved compared to those who received no therapy.
A pessary is another common nonsurgical option. It’s a small device, usually silicone, that you or your doctor inserts into the vagina to physically support the organs that have dropped. Ring pessaries are the most widely used and work well for mild to moderate prolapse. For more advanced prolapse, space-filling designs like the Gellhorn pessary sit in the upper vagina and create a barrier that prevents organs from slipping further. Pessaries can be worn long-term, and many people find they resolve symptoms well enough that surgery is never needed.
When Surgery Is an Option
Surgery is typically reserved for moderate to severe prolapse that significantly affects quality of life and hasn’t responded to conservative measures. The most common approach is a repair procedure that reinforces the weakened vaginal walls with stitches, tightening the tissue back into place. For vaginal vault prolapse after a hysterectomy, a procedure called sacrocolpopexy uses a small piece of surgical mesh to suspend the top of the vagina from a ligament near the tailbone. This procedure has a success rate of about 90%, with a recovery period of six to eight weeks.
The choice between surgical techniques depends on which organs are involved, the severity of the prolapse, your overall health, and whether you plan future pregnancies. Prolapse can recur after surgery, particularly if the underlying risk factors (chronic straining, heavy lifting, weak connective tissue) remain.
Reducing Your Risk
Pelvic floor exercises done during and after pregnancy lower the chance of developing prolapse. Pooled data from multiple trials shows that women who did structured pelvic floor training were about half as likely to report bothersome prolapse symptoms in the first year after giving birth. The same exercises reduced the risk of urinary incontinence by roughly 60% during late pregnancy.
Beyond pregnancy, maintaining a healthy weight, treating chronic constipation to avoid straining, managing a chronic cough, and using proper lifting techniques all reduce the cumulative stress on your pelvic floor. These steps won’t guarantee prevention, especially if you have a genetic tendency toward weaker connective tissue, but they meaningfully lower risk over a lifetime.