Pelvic Organ Prolapse: What It Is, Why It Happens, and What Actually Helps
- Dr Natalie Hutchins
- 3 days ago
- 3 min read
By Dr Natalie Hutchins
Pelvic organ prolapse is common, under-discussed, and often misunderstood. Many women first encounter the term after noticing a feeling of heaviness, pressure, or a bulge in the vagina and are left fearful about what this means for their bodies and their futures.
Understanding what prolapse is, how it develops, and what evidence-based treatment looks like can reduce anxiety and help women access appropriate care earlier.
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when one or more pelvic organs - the bladder, uterus, or bowel - descend lower than usual due to reduced support from the pelvic floor muscles and connective tissues.
Prolapse exists on a spectrum, ranging from mild anatomical changes visible only on examination to more advanced descent associated with symptoms. Importantly, the degree of prolapse does not reliably predict how severe your symptoms will be.
Types of pelvic organ prolapse
Doctors use specific terms depending on which organ is coming down or prolapsing:
Cystocele – when the bladder bulges into the vagina
Rectocele – when the rectum bulges into the vagina
Uterine prolapse – when the uterus descends into the vagina
Vaginal vault prolapse – when the top of the vagina bulges downward, usually after a hysterectomy
More than one type of prolapse can be present at the same time.
What does prolapse feel like?
Symptoms vary between individuals and may include:
a sensation of heaviness or dragging in the vagina
a feeling of a bulge or something “coming down”
symptoms that worsen after standing or at the end of the day
difficulty emptying the bladder or bowels
discomfort or altered sensation during sex
Some women with significant prolapse have few symptoms, while others with mild prolapse are highly symptomatic.
Why does prolapse occur?
Pelvic organ prolapse is multifactorial. Contributing factors include:
pregnancy and vaginal childbirth, particularly with levator ani injury
genetic differences in connective tissue strength
chronic constipation and straining
repetitive heavy lifting or high-impact loading
ageing and menopause-related tissue changes
Prolapse is rarely caused by just one single event.
The role of childbirth and levator injury
Vaginal birth is the strongest modifiable risk factor for prolapse. Injury to the levator ani muscle, particularly levator avulsion, which significantly increases the lifetime risk of prolapse.¹
These injuries may be clinically silent for years and become symptomatic later, especially during the menopausal transition when tissue support declines.
How is prolapse managed?
For most women, conservative management (i.e. non-surgical measures like physiotherapy and pessaries) is first-line and effective.
- Pelvic health physiotherapy
Pelvic floor muscle training, when appropriately prescribed after assessment, can reduce prolapse symptoms and improve quality of life.²
- Lifestyle and pressure management
Managing constipation, modifying high-strain activities, and learning effective breathing and load strategies reduce symptom exacerbation.
- Vaginal pessaries
Pessaries provide mechanical support and can significantly improve symptoms and daily function. They are safe, reversible, and underutilised.³
- Surgery
Surgery is considered when conservative measures fail or symptoms are severe. It addresses anatomy but does not correct underlying tissue vulnerability, which is why recurrence is possible.
A realistic outlook
Pelvic organ prolapse is common, particularly after childbirth and around menopause but it is not inevitable, and not something women should feel embarrassed about.
With appropriate assessment and conservative care, many women experience meaningful symptom improvement and maintain full, active lives.
Further resources
NHS – Pelvic organ prolapse
Royal College of Obstetricians and Gynaecologists – Pelvic organ prolapse
Pelvic Obstetric and Gynaecological Physiotherapy (POGP)
International Urogynecological Association
References
DeLancey JOL et al. Am J Obstet Gynecol. 2007.
Hagen S et al. Cochrane Database Syst Rev. 2011.
Bugge C et al. Int Urogynecol J. 2013.
