Pelvic floor prolapse, more precisely called pelvic organ prolapse, happens when one or more pelvic organs slip downward and press into or through the vaginal wall. Up to 50% of women will develop some degree of prolapse over their lifetime, though only about 3 to 6% experience noticeable symptoms. It occurs when the muscles and connective tissues that hold the bladder, uterus, and rectum in place become weakened or damaged.
How the Pelvic Floor Normally Works
Your pelvic floor is a group of muscles, ligaments, and connective tissue that sits like a hammock at the base of your pelvis. These structures hold your bladder, uterus, and rectum in position and keep them from shifting downward. The most important muscle group involved is the levator ani, a broad sheet of muscle that wraps around the vagina, urethra, and rectum. Ligaments called the cardinal and uterosacral ligaments anchor the cervix and upper vagina to the pelvic sidewall, while a second layer of connective tissue supports the middle portion of the vagina.
Prolapse happens when one or more of these support systems fails. That can mean direct muscle damage (particularly to the front portion of the levator ani), tearing or stretching of the ligaments that connect organs to the pelvic wall, or both. When the support gives way in one area, the organ behind that wall descends under gravity and pressure.
Types of Pelvic Organ Prolapse
The type of prolapse depends on where the weakness is and which organ drops:
- Anterior wall prolapse (cystocele): The bladder drops into the front wall of the vagina. This is the most common type.
- Uterine prolapse: The uterus descends into the vaginal canal, sometimes far enough to be visible outside the body.
- Posterior wall prolapse (rectocele): The rectum pushes forward into the back wall of the vagina.
- Vaginal vault prolapse: In women who have had a hysterectomy, the top of the vagina loses support and sinks downward.
- Enterocele: Part of the small intestine pushes into the upper vaginal wall. This is less common and often occurs alongside other types.
Many women have more than one type at the same time, since damage to the pelvic floor rarely affects just one area.
What It Feels Like
Mild prolapse often causes no symptoms at all, which is why it’s frequently discovered during a routine exam. When symptoms do appear, the most recognizable one is feeling or seeing a bulge of tissue at or beyond the vaginal opening. Many women describe a sensation of heaviness, pressure, or dragging in the pelvis that worsens throughout the day or after standing for long periods.
Prolapse also affects nearby functions. You might notice urinary changes: a weak stream, difficulty emptying your bladder completely, frequent urination, or sudden urgency. Bowel symptoms are common too, particularly feeling like you can’t fully empty your bowels. Some women find they need to press a finger against the vaginal wall to support the bulge in order to pass stool, a technique called splinting. Lower back pain, difficulty keeping a tampon in place, and pain during sex are also reported.
Symptoms tend to be worse at the end of the day, after physical activity, or after long periods on your feet, and they often improve when you lie down.
Causes and Risk Factors
Pregnancy and vaginal delivery are the primary causes. Childbirth can stretch and tear the connective tissue, muscles, and ligaments of the pelvic floor, and that damage sometimes never fully heals. The risk climbs with each pregnancy. Women who have had multiple pregnancies are roughly three times more likely to develop prolapse compared to women who have had one. Prolonged labor, vaginal tearing during delivery, and assisted delivery with forceps or vacuum also increase the risk.
Age is the other major factor. After 50, the odds of prolapse roughly double, partly because declining estrogen levels after menopause weaken pelvic tissues. Anything that chronically increases pressure inside your abdomen adds to the strain: obesity, a persistent cough (from smoking or lung disease), chronic constipation, and repeated heavy lifting all contribute. There is also a genetic component. A family history of prolapse, along with conditions that affect connective tissue strength, can make some women more vulnerable regardless of other factors. Diabetes and previous pelvic surgery have been identified as independent risk factors as well.
How Prolapse Is Graded
Doctors use a standardized system called POP-Q to measure how far organs have descended, grading it from Stage 0 to Stage 4. Stage 0 means no prolapse at all. In Stage 1, the organ has shifted slightly but remains well above the vaginal opening. Stage 2 means the lowest point of the prolapse sits near the vaginal opening. In Stage 3, tissue extends beyond the opening but the vagina hasn’t fully turned inside out. Stage 4 is complete eversion, where the vaginal walls have essentially turned inside out.
The stage doesn’t always match how you feel. Some women with Stage 2 prolapse have significant symptoms, while others with Stage 3 have very few. Treatment decisions are based more on how prolapse affects your daily life than on the stage number alone.
Pelvic Floor Muscle Training
Pelvic floor exercises, often called Kegels, are recommended as the first-line treatment for prolapse. A structured training program supervised by a pelvic floor physical therapist has been shown to improve prolapse symptoms, strengthen pelvic floor function, and improve quality of life. The exercises work by building strength in the levator ani and surrounding muscles so they provide better support to the organs above them.
What the exercises won’t reliably do is reverse the anatomical stage of prolapse. Research shows improvements in symptoms, urinary control, and bowel function, but changes in the actual grade of prolapse are inconsistent. Sexual function also doesn’t appear to improve significantly with exercises alone. Still, because pelvic floor training is safe and effective at reducing day-to-day symptoms, it’s the recommended starting point before considering other interventions.
Pessaries: A Nonsurgical Option
A pessary is a removable silicone device inserted into the vagina to physically support the organs that have dropped. It works like an internal brace, holding the bladder, uterus, or rectum back in position. Pessaries come in several shapes designed for different situations. The two most commonly tried first are the ring pessary, which looks like a flexible ring and is easy to insert and remove yourself, and the Gellhorn pessary, which has a wider base and provides stronger support for more advanced prolapse.
If those don’t work, your provider may try a space-filling pessary (like a donut or cube shape) that occupies more room in the vaginal canal to hold organs in place. There are also pessaries designed specifically for women who have both prolapse and urinary incontinence. Pessaries require periodic cleaning and checkups, but many women use them successfully for years and prefer them over surgery.
When Surgery Is Considered
Surgery becomes an option when symptoms significantly affect your quality of life and conservative treatments haven’t helped enough. The two main surgical approaches are native tissue repair, which uses your own tissues to rebuild support, and mesh-based repair, which uses a synthetic material to reinforce the vaginal wall.
Native tissue repair carries a lower risk of complications but a higher chance that prolapse will return. Mesh repair was developed to reduce that recurrence, and it does offer strong structural support, but it comes with a risk of mesh-related complications like erosion or pain. A large study tracking women for three years found that recurrence rates were nearly identical between the two approaches at the 36-month mark: about 27% in both groups. Long-term rates of pain during sex were also similar regardless of which method was used. About 7% of women who received mesh and about 4% who had native tissue repair needed a second procedure within that period.
The choice between approaches depends on the location and severity of your prolapse, your overall health, whether you’ve had previous repairs, and your own priorities around risk and recovery. This is a decision typically made collaboratively with your surgeon.
Reducing Your Risk
Because the causes of prolapse are so varied, there’s no guaranteed way to prevent it. But several strategies lower the cumulative strain on your pelvic floor. Maintaining a healthy weight reduces chronic downward pressure on the pelvic organs. Treating constipation with adequate fiber and hydration prevents repeated straining during bowel movements. If you have a chronic cough, addressing the underlying cause (and quitting smoking if relevant) removes another source of pressure. Learning to lift heavy objects by engaging your core and exhaling on effort, rather than bearing down, also helps protect the pelvic floor over time. Starting pelvic floor exercises during pregnancy and continuing after delivery can help the muscles recover from the strain of childbirth.