What Is Pelvic Organ Prolapse?

Medically Reviewed by Jabeen Begum, MD on March 13, 2024
7 min read

Sometimes, the muscles and other kinds of tissue that hold everything in place inside your pelvis get stretched out, weak, or torn. When this happens, some of your body parts can drop below their normal position, a condition known as prolapse. Sometimes, the dropped organs stay within the pelvic floor, or they may bulge outside your vagina.

Your pelvis is the lower part of your belly, located below your navel and between your hips. There are a lot of organs in this tight space -- your bladder, cervix, intestines, rectum, urethra, uterus, and vagina.

Nearly half of all women between ages 50 and 79 have at least a little bit of pelvic organ prolapse (POP). It doesn’t always cause symptoms, so you could have it and not know. However, a person of any gender can get POP.

The type of pelvic organ prolapse depends on the affected organ.

Anterior vaginal wall prolapse (cystocele) involves your bladder. Muscles that hold the bladder in place above the vagina weaken, causing it to protrude into the vagina. It's the most common kind of pelvic organ prolapse.

Posterior vaginal wall prolapse (rectocele) occurs when weak muscles cause your rectum to protrude into the back wall of the vagina.

Urethrocele, which often accompanies anterior vaginal wall prolapse, is caused when the urethra, the tube that carries urine outside your body, drops.

Enterocele is when the small intestine protrudes into the vagina's back wall.

Uterine prolapse occurs when the uterus drops into your vaginal canal.

Vaginal vault prolapse happens when the top of your vagina, the vault, slumps into the vaginal canal.

Pelvic organ prolapse in the male anatomy usually takes the form of rectal prolapse, in which when the end of the large intestine -- the rectum -- drops into the anus.

Pregnancy puts you at risk of pelvic organ prolapse, but vaginal delivery raises your risk (as opposed to a C-section). Repeated deliveries raise your risk.

Other things that make you more likely to have POP include:

  • Having surgery or radiation on your pelvic area
  • Breaking your back or the bones in your pelvis
  • Chronic constipation, because of the pushing and straining
  • Chronic cough (it puts pressure on your pelvic organs)
  • Obesity
  • Doing a lot of heavy lifting over and over
  • Getting older
  • Having family members who have it
  • Being white
  • Having a hysterectomy
  • Giving birth for the first time at a young age
  • Smoking

Symptoms depend on where in the pelvis your prolapse is. Most often, for women and those assigned female at birth (AFAB), it can feel like a swelling in your vagina and include:

  • A feeling of vaginal or pelvic pressure or fullness
  • Aching in your lower back
  • Aching, pressure, and fullness in your pelvic area
  • Pain, pressure, or the sense of a blockage during sex
  • Pelvic pressure when you're standing for long periods
  • Pressure or bulging that intensifies throughout the day
  • Spotting

You may also have symptoms of incontinence -- urge, stress, or fecal -- because loss of control of your bladder or bowel can also result from pelvic floor weakness.

There is a staging process for pelvic organ prolapse called POP-Q that grades prolapse by severity.

  • Stage 0 -- no prolapse in any organs
  • Stage 1 -- the prolapse reaches halfway to your hymen, the thin tissue at the opening of your vagina
  • Stage 2 -- the prolapse stretches to the hymen
  • Stage 3 -- the prolapse bulges about a centimeter past the hymen
  • Stage 4 -- the prolapsed organ has stretched as far as it can go

Your doctor will determine treatment based on the severity of your prolapse.

Your doctor will ask about your symptoms and give you a pelvic exam. You might be asked to cough so that your doctor can see the severity of the prolapse when you're relaxed or tense. Your doctor will also want to see the extent of the prolapse when you're sitting or standing.

In addition to a pelvic exam, your doctor may order additional tests to check the function of your bladder or to examine the inside of your urethra and bladder. Imaging tests, usually used in complex cases only, show the inside of your pelvis and may include an ultrasound or MRI.

Although there are surgical treatments for pelvic organ prolapse, your doctor will likely begin with nonsurgical treatments. Your doctor may insert a device called a vaginal pessary, which is made of silicon and works by propping up the dropped organ. Or your doctor may refer you to a physical therapist to teach you Kegel exercises that strengthen the muscles in your pelvic floor.

Pelvic organ prolapse surgery

Surgeries that repair pelvic organ prolapse fall into two types: obliterative and reconstructive. Obliterative surgery provides support for the affected organs by narrowing or closing the vagina. Although obliterative surgery has a high success rate, you should not have this surgery if you are sexually active or plan to be in the future.

Reconstructive surgery works to put your organs back in place. This type of surgery may be done by vaginal or abdominal incision or laparoscope. A laparoscope is a kind of lighted telescope inserted through a tiny incision that allows your surgeon to see and repair the prolapsed organ.

Forms of reconstructive surgery include:

Colporrhaphy. A type of surgery for anterior and posterior vaginal wall prolapse that secures the walls of your vagina and supports the rectum and bladder.

Sacrohysteropexy. Used for uterine prolapse, it secures your uterus back in place with surgical mesh attached to the cervix, vagina, and tailbone.

Sacrocolpopexy. It may be done by laparoscopy or incision and uses surgical mesh to treat vaginal vault prolapse and enterocele to raise your vagina back into its original place.

Surgeons can also repair uterine or vaginal prolapse with a procedure sometimes called "native tissue repair," by using your own tissue to attach the dropped organ to ligaments or muscles in your abdomen.

Pelvic organ prolapse is rarely life-threatening. But it can cause a few problems, such as:

  • Bladder control problems (urinary incontinence)
  • A kink in the urethra (the tube that carries your urine outside your body) that can make it hard to pee
  • Bowel control problems (fecal incontinence), with liquid or solid stools coming out
  • Problems with bowel movements when stools get trapped
  • Pain during sex
  • Urinary tract infections
  • Kidney damage if it blocks your pee

There are things you can do to tighten your pelvic muscles and reduce your risk. For instance, Kegel exercises can help strengthen the nerves and muscles in your pelvis. Making certain lifestyle changes might help, too.

If you’re overweight, for example, try to shed some pounds. Overweight people are more likely to get POP than those who maintain a healthy weight. Drink lots of fluids and eat high-fiber foods. This will help you to avoid constipation. Remember, constantly pushing and straining will only make the prolapse worse.

Try not to lift anything heavy. If you must, learn to lift the right way -- with your legs, not your back or abs.

If you smoke, stop. Smoking increases your risk of POP. And see a doctor about any health issues you might have, such as a cough that won’t go away. Coughing puts pressure on your pelvic muscles and can make your prolapse worse.

Pelvic organ prolapse exercises

Doctors recommend exercising your pelvic floor every day. Here's how to do it:

Long hold

  • Lie on your back, get on your hands and knees, or stand.
  • Clench the muscles you'd use to hold your pee or keep from passing gas.
  • Hold for 3-5 seconds, then release.
  • Repeat up to 10 times.
  • Do three sets daily, alternating on your back, hands and knees, and standing.

Quick squeeze

  • Squeeze your pelvic muscles and quickly let go.
  • Rest a couple of seconds between squeezes.
  • Do these 10 to 20 times three times a day.

For both exercises, you should feel a lift in your pelvis. Breathe as you would normally, and stop when your pelvic muscles tire.

People of any gender can get pelvic organ prolapse, but vaginal births are a big risk factor. Nonsurgical remedies are a first-line treatment for POP but your doctor may recommend surgery if those aren't effective. Daily Kegel exercises can help strengthen your pelvic floor muscles and prevent your pelvic organs from dropping.

What are the symptoms of pelvic organ prolapse?

You may leak urine and have difficulty emptying your bladder or having a bowel movement. You might feel pressure or fullness in your pelvis or pain in your lower back. More severely, you may see organs protruding from your vagina.

How do you fix a pelvic floor prolapse?

Treatment depends on how severe your prolapse is but may include Kegel exercises, hormonal therapy, lifestyle changes, a vaginal pessary, or surgery.

Is it OK to leave a prolapse untreated?

Talk with your doctor. Pelvic organ prolapse is not typically life-threatening, but it can impact your quality of life. It is usually okay to leave it untreated unless the prolapse is too large or interferes with peeing or bowel movements.

Can a prolapse heal itself?

It won't heal itself, but in milder cases, you can do Kegel exercises to strengthen the muscles in your pelvis and prevent the organ from dropping further.