Pelvic organ prolapse is a condition where one or more pelvic organs slip downward from their normal position because the muscles and tissues holding them in place have weakened. It affects an estimated 3 to 6% of women overall, but that number jumps to roughly 50% among women who have given birth vaginally. Many cases are mild and cause no symptoms at all, while others create a noticeable bulge, pressure, or problems with bladder and bowel function.
What Happens Inside the Pelvis
Your pelvic organs, including the bladder, uterus, and rectum, sit in a bowl-shaped space at the bottom of your abdomen. They’re held in place by a hammock of muscles (collectively called the pelvic floor) and layers of connective tissue known as the endopelvic fascia. This fascia lines the pelvic cavity, wraps around the organs, and anchors them to the pelvic bones through reinforced bands that function like ligaments, including the cardinal and uterosacral ligaments.
When these support structures stretch, thin out, or tear, they can no longer hold the organs in position. The organs gradually descend toward or through the vaginal opening. Structural changes in the fascia itself, such as thickening and loss of elasticity, also play a role. Damage to the tissue between the vagina and the rectum, for example, can disrupt the way forces are transmitted across the pelvic floor, further compromising support.
Types of Prolapse
The condition is named based on which organ has shifted:
- Cystocele: The bladder drops into the front wall of the vagina. This is the most common type.
- Rectocele: The rectum bulges into the back wall of the vagina.
- Uterine prolapse: The uterus descends into the vaginal canal.
- Enterocele: The small intestine pushes into the upper part of the vagina.
- Vaginal vault prolapse: After a hysterectomy, the top of the vagina loses support and drops inward.
It’s common to have more than one type at the same time, because the weakened support structures often affect multiple organs at once.
Who Gets It and Why
Vaginal childbirth is the single biggest risk factor. Multiple deliveries, delivering twins or triplets, having a large baby, and deliveries requiring forceps or vacuum assistance all increase the strain on pelvic floor muscles and connective tissue. The damage can happen during delivery but may not become noticeable for years or even decades.
Aging compounds the problem. During menopause, the body produces less estrogen, and this hormonal decline weakens the connective tissues that support the pelvic floor. Carrying extra body weight adds constant downward pressure on those same structures. Studies consistently show that women with obesity are more likely to develop prolapse than those at a healthy weight.
Anything that creates repeated pressure in the abdomen can also contribute: chronic constipation, a persistent cough (from conditions like COPD or chronic bronchitis), and regular heavy lifting. Even underuse of the pelvic floor muscles, where they simply don’t contract and work enough over time, can lead to weakening.
What It Feels Like
Mild prolapse often causes no symptoms, and many women only learn about it during a routine pelvic exam. When symptoms do appear, the hallmark sensation is pressure or heaviness in the pelvis, sometimes described as something “falling out.” Some women can see or feel a bulge of tissue at or near the vaginal opening, especially after standing for long periods or at the end of the day.
Depending on which organ is involved, you might also experience difficulty emptying your bladder fully, urine leakage when you cough or laugh, a need to press on the vaginal wall to have a bowel movement, or discomfort during sex. Symptoms tend to worsen with gravity and physical activity and improve when lying down.
How It’s Diagnosed and Staged
Diagnosis is usually straightforward. A healthcare provider performs a pelvic exam, often asking you to bear down or cough so they can see how far the organs have shifted. The severity is measured using a standardized system called the Pelvic Organ Prolapse Quantification (POP-Q) scale, which has five stages:
- Stage 0: No prolapse.
- Stage I: The lowest point of descent is still more than 1 cm above the vaginal opening.
- Stage II: The descent reaches within 1 cm above or below the vaginal opening.
- Stage III: The tissue extends more than 1 cm past the vaginal opening but isn’t fully everted.
- Stage IV: Complete eversion, where the vaginal walls or uterus have fully turned outward.
Prevalence numbers shift dramatically depending on how prolapse is measured. Based on symptoms alone, roughly 15% of women are affected. When clinicians perform physical exams, that figure can reach as high as 64.6%, because many women have anatomical descent without ever noticing it.
Nonsurgical Treatment Options
For mild to moderate prolapse, or when surgery isn’t desired, a vaginal pessary is often the first-line approach. A pessary is a removable device inserted into the vagina to physically support the organs from below. The two most commonly used types are the ring pessary, an O-shaped device suited for mild to moderate prolapse and stress incontinence, and the Gellhorn pessary, a disk with a central knob that fills the upper vaginal space and works better for advanced prolapse.
Other shapes exist for specific situations: U-shaped devices for bladder or uterine prolapse, donut-shaped pessaries as thicker alternatives to rings, and cube-shaped devices with concave sides that suction to the vaginal walls. Over-the-counter options are also available for stress incontinence, though they’re less suited for significant prolapse. A provider fits the pessary to your anatomy, and most women try one or two sizes before finding a comfortable fit.
Pelvic floor muscle training (often called Kegel exercises) can strengthen the muscles that support the organs. This works best for earlier-stage prolapse and is sometimes combined with pessary use. Working with a pelvic floor physical therapist helps ensure you’re targeting the right muscles with the right technique, since many women unknowingly do Kegels incorrectly.
When Surgery Is Considered
Surgery becomes an option when symptoms significantly affect quality of life and conservative measures haven’t helped. About 11% of American women undergo surgery for prolapse or urinary incontinence before age 79, and nearly 30% of those may eventually need a repeat procedure, since prolapse can recur after repair.
Surgical approaches fall into a few categories. Native tissue repair uses your own tissue to rebuild support, stitching weakened structures back into place through the vagina. Sacrocolpopexy is an abdominal procedure (done through open surgery, conventional laparoscopy, or robotic-assisted laparoscopy) that uses surgical mesh to suspend the top of the vagina from the sacrum, the triangular bone at the base of the spine. For women who are not sexually active and want a definitive solution, colpocleisis narrows or closes the vaginal canal to provide support.
The Status of Surgical Mesh
In 2019, the FDA ordered manufacturers to stop selling mesh devices designed for transvaginal prolapse repair in the United States, concluding that the risks outweighed the benefits. Complications included mesh eroding through the vaginal wall, chronic pain, infection, and pain during intercourse.
Mesh is still used in abdominal sacrocolpopexy, where complication rates are considerably lower. The median rate of vaginal mesh erosion after abdominal placement is about 4% within the first two years. If you’re discussing surgical options with a provider, it’s worth understanding which approach they recommend and whether mesh is involved.
Reducing Your Risk
Not all risk factors are controllable (you can’t reverse aging or undo a past delivery), but several modifiable habits make a difference. Maintaining a healthy weight reduces the constant downward pressure on pelvic structures. Treating chronic constipation with adequate fiber and hydration prevents the repeated straining that weakens the pelvic floor over time. If you have a chronic cough, getting it managed helps for the same reason. When lifting heavy objects, using proper form and engaging your core reduces the force transmitted to your pelvic floor. And building regular pelvic floor exercises into your routine, particularly after childbirth, helps keep those muscles active and resilient before problems start.