Pelvic organ prolapse
Short answer
Pelvic organ prolapse is when the bladder, uterus or bowel drops and presses into the vaginal walls, because the supporting muscles and tissues have weakened. It often feels like a bulge or heaviness that worsens by evening. It is common, not dangerous in itself, and treatment ranges from pelvic floor training and a pessary to surgery, depending on how much it bothers you.
- Feels like a bulge, heaviness or something coming down.
- Often worse after standing, lifting or at the end of the day.
- Mild prolapse may need no treatment if it does not bother you.
- Pessaries and pelvic floor training are first options before surgery.
What is happening in the body
The pelvic floor muscles and ligaments hold the bladder, uterus and rectum in place. When that support weakens, one or more organs drop and push into the vaginal wall. The type of prolapse depends on which organ is involved.
| Type | What drops | Common symptoms |
|---|---|---|
| Front wall (cystocele) | Bladder | Bulge at the front, slow stream, frequent urination, leaking |
| Back wall (rectocele) | Rectum | Bulge at the back, trouble emptying the bowel, needing to press to go |
| Uterine prolapse | Uterus | Heaviness, dragging, cervix felt low in the vagina |
| Vault prolapse | Top of vagina after hysterectomy | Bulge or heaviness high up |
Many people have more than one type at once. Doctors grade prolapse by how far it descends, but the grade matters less than how much it affects you.
What causes it
- Pregnancy and vaginal birth, especially several births, large babies or assisted deliveries. Prolapse can show up years later.
- Menopause, when lower estrogen weakens the supporting tissue. See menopause and sex.
- Long-term straining from constipation, chronic cough or repeated heavy lifting.
- Higher body weight.
- Previous pelvic surgery, including hysterectomy.
- Inherited differences in connective tissue.
What you can try at home
Pelvic floor muscle training. NICE recommends at least four months of supervised training for symptomatic prolapse. It can reduce heaviness and stop mild prolapse from worsening. The pelvic floor timer helps with a routine.
Reduce pressure on the pelvic floor:
- Avoid straining on the toilet. Raise your feet on a small stool, lean forward and take your time.
- Treat constipation with fiber, fluids and movement.
- Breathe out as you lift, and lift close to your body. Squeeze the pelvic floor before lifting.
- Get a long-lasting cough checked.
- If you carry extra weight, losing some can ease symptoms.
- Lie down for a while if heaviness builds by evening.
What a clinician will check
Expect a pelvic exam, sometimes lying down and standing, often while you cough or bear down so the prolapse shows. They will ask about bladder, bowel and sexual symptoms. They may check how well your bladder empties and look for stress incontinence, which often comes along.
Prolapse and sex
Many people with prolapse worry about sex, either that it will cause damage or that a partner will notice. Sex does not make a prolapse worse. Some practical points:
- Positions where you lie on your back with a pillow under your hips, or lie on your side, often feel more comfortable than upright ones.
- Lubricant helps, especially after menopause.
- Emptying your bladder first can reduce pressure and leaking.
- Pelvic floor training often improves sensation and confidence as well as support.
If prolapse is affecting your sex life, say so at your appointment. It is a valid reason to choose one treatment over another.
Will it get worse
Prolapse does not always progress. Many mild prolapses stay stable for years, and some improve, particularly after pregnancy. Things that tend to make symptoms worse over time are repeated straining, heavy lifting without good technique, chronic coughing and the drop in estrogen after menopause. Keeping up pelvic floor training and managing constipation are the two most useful habits for keeping symptoms in check. If a bulge becomes noticeably larger or new symptoms appear, such as trouble emptying the bladder, go back for a review. A worse day after lifting or standing for hours is common and does not mean the prolapse has changed.
Treatment options
Watchful waiting. If the prolapse is mild and does not bother you, there is no medical need to treat it.
Pelvic floor physical therapy. The first step for most symptomatic prolapse. A therapist confirms you are using the right muscles and builds a program. See finding a pelvic floor therapist.
Vaginal pessary. A soft silicone device placed in the vagina to hold organs up. It is fitted by a clinician, comes in different shapes and sizes, and often relieves symptoms well. Some people learn to remove and clean it themselves; others have it changed at regular appointments. Local estrogen is often recommended alongside it after menopause to protect the vaginal skin.
Surgery. For prolapse that still bothers you after other options, or if you prefer a longer-term fix. Operations repair the vaginal walls, support the uterus or vaginal vault, or remove the uterus. A specialist will explain the success rates, recovery time and risks, including the chance of prolapse returning. Surgical mesh for vaginal prolapse repair is now restricted in several countries, so ask exactly what will be used and why.
If prolapse started after childbirth, the page on postpartum recovery covers what to expect in the first year.
Quick questions
Is it safe to have sex with a prolapse?
Yes. Sex will not make a prolapse worse or cause damage. Some people feel self-conscious or notice the bulge during sex, and positions that keep you more horizontal can feel better. Many pessaries can stay in during sex, while others are removed first. Ask which applies to yours.
Can a prolapse go back up on its own?
Mild prolapse can improve, especially in the months after childbirth and with pelvic floor training. Larger prolapses rarely reverse fully without treatment, but symptoms can often be kept manageable for years with training, a pessary and avoiding constant straining.
Can I still exercise?
Usually yes. Walking, swimming, cycling and strength training with good technique are generally fine. High-impact exercise and very heavy lifting can increase symptoms, so a pelvic floor therapist can help you adapt your routine rather than stopping altogether.