A prolapse happens when an organ or tissue slips out of its normal position, usually because the structures holding it in place have weakened or stretched. The term covers several different conditions depending on which body part is involved. The most common types are pelvic organ prolapse, disc prolapse in the spine, and mitral valve prolapse in the heart. Each has different causes and treatment paths, but they all share that basic mechanism: something that should stay put has shifted.
Pelvic Organ Prolapse
Pelvic organ prolapse is the most frequently searched type and affects a large number of women, particularly after childbirth or menopause. It occurs when the muscles, ligaments, and connective tissue supporting the pelvic organs weaken enough that one or more organs drop down into or beyond the vaginal canal. The specific type depends on which organ has shifted:
- Cystocele (dropped bladder): The bladder slips downward and bulges into the front wall of the vagina. This is the most common type.
- Rectocele: The rectum pushes forward into the back wall of the vagina.
- Uterine prolapse: The uterus itself descends into the vaginal canal.
- Enterocele: The small intestine bulges into the upper or back wall of the vagina.
- Urethrocele: The urethra drops out of position, often alongside a cystocele.
These types can occur alone or in combination. Many women have more than one organ affected at the same time.
What Causes Pelvic Organ Prolapse
Vaginal childbirth is the strongest risk factor. Women who have had one vaginal delivery are roughly three times more likely to develop prolapse than women who have never given birth, and those with five or more deliveries face nearly six times the risk. Cesarean delivery appears to be protective: women who delivered only by cesarean have dramatically lower odds compared to those who delivered vaginally.
Higher body weight also plays a role. Women with a BMI between 25 and 30 have about 2.5 times the odds of prolapse compared to those under 25, and a BMI over 30 raises the risk to a similar degree. Age, menopause, chronic coughing, heavy lifting over many years, and connective tissue disorders all contribute to the gradual weakening of pelvic support structures.
How Prolapse Severity Is Measured
Doctors grade pelvic organ prolapse on a scale from Stage 0 to Stage 4 using a standardized system. Stage 0 means no prolapse at all. In Stage 1, the organ has shifted but remains well above the vaginal opening. Stage 2 means the organ has descended to roughly the level of the vaginal opening. Stage 3 involves tissue protruding beyond the opening, and Stage 4 represents a near-complete eversion, where the vaginal walls have essentially turned inside out.
Many women with Stage 1 or even Stage 2 prolapse have no symptoms and only discover it during a routine exam. Symptoms typically become noticeable at Stage 2 or 3 and can include a feeling of heaviness or pressure in the pelvis, a visible or palpable bulge at the vaginal opening, difficulty emptying the bladder or bowels completely, and discomfort during physical activity or sex.
Treatment Without Surgery
For mild to moderate prolapse, the first approach is usually conservative. Pelvic floor muscle training (often called Kegel exercises, sometimes guided by a specialized physiotherapist) can improve muscle strength and endurance around the pelvic organs. Research shows these exercises consistently build pelvic floor strength and reduce symptoms like heaviness and pressure. However, the evidence on whether they can actually reverse the stage of prolapse is mixed. Some studies found improvement in how far organs had dropped, while others found no measurable change in stage despite symptom relief.
A pessary is the other major non-surgical option. This is a removable silicone device inserted into the vagina to physically support the organs that have dropped. Ring pessaries are typically tried first because they’re easy to insert and remove. They work well for earlier-stage prolapse and can be left in during sex. For more advanced prolapse (Stage 3 or 4), space-occupying pessaries like the Gellhorn or donut shape provide more support, though intercourse isn’t possible while they’re in place. Most women can learn to insert and remove their pessary on their own, and with regular cleaning and follow-up, they can be used comfortably for years.
Surgical Repair Options
When symptoms are significant and conservative treatment isn’t enough, surgery aims to restore the organs to their normal position. The two broad categories are native tissue repair (using the body’s own tissues to rebuild support) and mesh-augmented repair (using a synthetic material to reinforce the repair).
Mesh repairs consistently produce better anatomical results on examination, meaning the organs are more likely to stay in the corrected position. But the subjective outcomes, how women actually feel, tend to be similar between mesh and traditional repair. And mesh carries its own risks. In one major trial comparing mesh to traditional repair for the front vaginal wall, the mesh erosion rate was 19%, meaning nearly one in five women developed complications from the mesh material. Subsequent surgery to address mesh-related problems occurred in about 3% of cases.
For prolapse at the top of the vagina, abdominal sacrocolpopexy (a procedure that anchors the vaginal vault using mesh placed through the abdomen, often laparoscopically) has success rates between 78% and 100% and is generally considered the most durable option. Vaginal mesh kits for the same problem have lower success rates, around 43%, and higher reoperation rates. Traditional vaginal repair without mesh has the lowest complication rate but a somewhat higher chance of the prolapse returning over time.
Disc Prolapse in the Spine
A prolapsed disc, also called a herniated disc, is a completely different condition that involves the spine rather than the pelvic organs. The discs between your vertebrae act as cushions, and a prolapse occurs when the soft inner material pushes through a weakened spot in the outer ring. This most commonly happens in the lower back (lumbar spine) and can press on nearby nerves.
The hallmark symptom is sciatica: pain that radiates from the lower back down through the buttock and into one leg. In severe cases, the compressed nerve can cause numbness, tingling, or weakness in the leg or foot. About 5% of men and 2.5% of women experience sciatica at some point in their lives.
The good news is that disc prolapse is usually self-limiting. Most people with acute sciatica notice marked improvement within 10 days, and 75% feel substantially better within a month. Over 6 to 12 weeks, symptoms resolve in 60% to 80% of cases without surgery. Long-term, 80% to 90% of people improve significantly. That said, about 30% of those who don’t have surgery still report intermittent pain a year later. Surgery is typically reserved for cases involving severe or progressive nerve damage, or a rare emergency called cauda equina syndrome where the bundle of nerves at the base of the spine is compressed enough to affect bladder or bowel control.
Mitral Valve Prolapse
Mitral valve prolapse is a heart condition where one or both flaps of the mitral valve (the valve between the left upper and lower chambers of the heart) are slightly too stretchy or have extra tissue. Instead of closing tightly when the heart squeezes, the flaps bulge backward into the upper chamber, somewhat like a parachute inflating.
Most people with mitral valve prolapse never have symptoms and live completely normal lives. When symptoms do occur, they’re caused by blood leaking backward through the valve that isn’t closing properly. This can produce a racing or irregular heartbeat, dizziness, shortness of breath (especially during exercise or when lying flat), and fatigue. In mild cases, no treatment is needed beyond periodic monitoring. More significant leakage may eventually require valve repair.