Pelvic Organ Prolapse in Women: Symptoms, Causes & Treatment
Many women live with a strange feeling of heaviness in the pelvis or a soft bulge at the vaginal opening and assume it is normal after childbirth, or feel too embarrassed to ask. In fact, this is a recognised, common and very treatable condition called pelvic organ prolapse. This guide explains what is happening, the different types, and the options from simple exercises to surgery.
What Is Pelvic Organ Prolapse?
The bladder, uterus (womb) and rectum are held in place by the muscles of the pelvic floor and by ligaments and connective tissue — like a hammock. When this support weakens or stretches, one or more of these organs can drop downwards and press into the vaginal wall. This is prolapse. Women can have one organ affected or several at once.
Types of Pelvic Organ Prolapse
| Type | Which organ drops | Typical symptoms |
|---|---|---|
| Cystocele (anterior wall prolapse) | The bladder bulges into the front wall of the vagina | Leakage, urgency, feeling of incomplete emptying, recurrent UTIs; see Cystocele Repair |
| Rectocele (posterior wall prolapse) | The rectum bulges into the back wall of the vagina | Constipation, needing to press on the vagina to open the bowels; see Rectocele Repair |
| Uterine prolapse | The uterus descends into or out of the vagina | Heaviness, dragging, a bulge, backache |
| Vaginal vault prolapse | The top of the vagina drops after a hysterectomy | Bulge, pressure, urinary and bowel symptoms |
| Enterocele | Part of the small bowel pushes down behind the vagina | Pelvic pressure, dragging sensation, often together with other prolapse |
Grades of Prolapse
Doctors grade prolapse on a scale of stages, based on how far the organ descends during examination. The grade describes anatomy — it does not always match how much the prolapse bothers you.
| Stage | What it means |
|---|---|
| Stage 0–1 | Little or no descent; the organ stays well inside the vagina |
| Stage 2 | The organ reaches close to the vaginal opening |
| Stage 3 | The organ descends through the opening of the vagina |
| Stage 4 | Complete prolapse — the organ (or the entire vagina) is outside the body |
Symptoms of Prolapse
- A feeling of heaviness, pressure or dragging in the pelvis, worse by evening
- A bulge that you can see or feel at or through the vaginal opening
- Lower back ache that eases when lying down
- Urinary problems: leakage, urgency, a slow stream, incomplete emptying or repeated infections
- Bowel problems: constipation, difficulty passing stool, needing to press on the vagina to help
- Discomfort or a feeling of looseness during sex
What Causes Prolapse?
- Pregnancy and vaginal childbirth — the leading risk, especially with multiple or difficult deliveries
- Menopause — reduced oestrogen weakens supporting tissue
- Increased abdominal pressure — chronic cough, chronic constipation and straining, heavy lifting, obesity
- Previous pelvic surgery, including hysterectomy
- Genetic factors — some women have naturally weaker connective tissue
- Ageing
How Prolapse Is Diagnosed
Diagnosis is mainly by history and a pelvic examination, sometimes while you cough or bear down to show the full extent. Tests such as a urine test, an ultrasound with a check on bladder emptying, and urodynamic studies help assess how the prolapse affects the bladder and whether hidden leakage may appear once a prolapse is repaired.
Treatment Options
| Option | Suits | What to know |
|---|---|---|
| Watchful waiting and lifestyle measures | Mild or non-bothersome prolapse | Treat constipation and cough, manage weight, avoid heavy lifting |
| Pelvic floor muscle training | Mild to moderate prolapse | Can reduce symptoms and sometimes the degree of descent; needs regular, correct practice |
| Vaginal oestrogen | Post-menopausal women | Improves tissue quality; helps comfort and reduces urinary irritation |
| Pessary | Any stage, especially if surgery is unsuitable or not wanted | Removable support device; needs periodic cleaning and review |
| Anterior or posterior wall repair | Cystocele or rectocele | Repair of the stretched supporting tissue through the vagina; see Cystocele Repair and Rectocele Repair |
| Uterine or vault suspension / hysterectomy | Uterine or vault prolapse | Restores the top of the vagina; the choice depends on age, uterus health and plans for childbearing |
| Pelvic floor reconstruction | Complex or multi-compartment prolapse | Combined repairs to restore support; see Pelvic Floor Reconstruction |
The use of synthetic mesh in prolapse repair is limited and is discussed carefully, weighing benefits against risks for each woman. Many women do very well with native-tissue repairs. Surgery is generally advised only when symptoms are bothersome and other measures have not worked.
Can Prolapse Be Prevented?
- Start pelvic floor exercises during and after pregnancy
- Avoid straining — treat constipation with fibre and fluids
- Get a persistent cough evaluated and stop smoking
- Maintain a healthy weight and lift with correct technique (exhale as you lift)
When to Consult Dr. Raju R
A vaginal bulge, pelvic heaviness, or bladder and bowel symptoms that do not settle deserve an assessment. Read more about pelvic organ prolapse care. Where a gynaecological component is involved, care is coordinated with a gynaecologist. Dr. Raju R evaluates and treats women’s urinary problems at Genesiss Multi-Speciality Hospital, BTM Layout, Bangalore — book an appointment or explore the Female Urology department.
Consult Dr. Raju R at Genesiss Multi-Speciality Hospital, Bangalore.
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Frequently Asked Questions
Most women describe a feeling of heaviness or dragging in the pelvis, a bulge in or at the opening of the vagina, or a sensation of sitting on a ball. Symptoms are often worse at the end of the day or after standing, and ease on lying down.
Mild prolapse often does not progress and can be managed with pelvic floor training, weight and constipation management and, if needed, a pessary. The prolapse itself does not reverse, but symptoms frequently improve. Surgery is reserved for bothersome prolapse that non-surgical measures do not control.
It is rarely dangerous. However, a prolapse that blocks the flow of urine, causes recurrent infections, or is very large and ulcerated should be treated without delay.
A pessary is a soft silicone support device placed in the vagina to hold the prolapsed organs in position. It is removable, avoids surgery, and many women use it long term with regular check-ups.
There is a chance of recurrence, particularly with heavy lifting, chronic cough, constipation or obesity. Choosing the right operation for the type and severity of prolapse, and reducing these risk factors, lowers the chance.
Both are involved. Prolapse that affects the bladder and urinary function (such as a cystocele) is assessed by a urologist, and care is coordinated with a gynaecologist when the uterus or complex repairs are involved.
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