Pelvic Organ Prolapse: Symptoms and When to See a Doctor
What is pelvic organ prolapse, what are its symptoms, and when should you see a doctor? Risk factors and treatment options explained.
Do you feel like "something is falling down" but hesitate to mention it? This is the most common and most typical symptom of pelvic organ prolapse — a condition seen to some degree in about half of women who have given birth, yet rarely talked about.
What Is Pelvic Organ Prolapse?
When the pelvic floor muscles, tissues (fascia) and supporting ligaments weaken or become damaged, the uterus, bladder, bowel or vaginal vault can no longer stay in their normal position and descend into the vaginal canal. This is called pelvic organ prolapse.
On physical exam, some degree of prolapse is found in about 40-50% of women who have given birth, especially those over 50. However, most of these findings cause no symptoms at all; the proportion of women with noticeable symptoms in the general population is around 3-6%. A woman's lifetime risk of needing surgery for this reason is about 11-19%, meaning roughly 1 in 10 women.
Which Organs Can Prolapse?
- Cystocele: The bladder pushes against and descends through the front wall of the vagina. The most common type.
- Uterine prolapse: The uterus and cervix descend down the vaginal canal.
- Vaginal vault prolapse: In women who have previously had a hysterectomy, the top of the vagina turns outward.
- Rectocele: The lower part of the large bowel bulges into the back wall of the vagina.
- Enterocele: The small intestine bulges into the upper/back wall of the vagina.
What Are the Symptoms?
- A feeling of fullness in the vagina, a lump you can feel, or a sensation that "something is falling down"
- Heaviness, pulling or pressure in the groin and lower abdomen — usually mild in the morning, worsening later in the day, with prolonged standing or straining, and relieved by lying down
- Urinary symptoms: frequent urination, difficulty starting to urinate, a feeling of incomplete bladder emptying, leaking urine when coughing or sneezing
- Bowel symptoms: chronic constipation, difficulty straining; about 18-25% of women need to press with their fingers against the back wall of the vagina to complete a bowel movement
- Pain or a catching sensation during intercourse, a feeling of vaginal looseness
When Should You See a Doctor?
Mild-degree prolapse (stage 1-2) without symptoms does not need treatment — regular follow-up is enough. However, you should see an obstetrician-gynecologist if:
- You feel discomfort from a lump that protrudes from the vaginal opening, which you can feel or see
- Pelvic pressure, heaviness or pain starts affecting your daily life and physical activity
- You have difficulty urinating, urine leakage, a feeling of incomplete bladder emptying, or repeated urinary tract infections
- You develop difficulty with bowel movements or need to press with your fingers through the vagina to complete one
- You notice irritation, a sore, or bleeding on the protruding tissue
What Are the Risk Factors?
- Number and type of deliveries: The most important trigger. A first vaginal delivery raises the risk about 4-fold, a second about 8-fold. Deliveries involving forceps/vacuum, a large baby (over 4500 grams), and severe perineal tears further increase the risk.
- Age and menopause: Risk rises by about 20% with every 10 years of age; after menopause, declining estrogen leads to loss of tissue elasticity.
- Excess weight: Women with a body mass index over 25 have a 1.6-3.1 times higher risk.
- Conditions that constantly raise abdominal pressure: Chronic constipation and straining, chronic cough (COPD, asthma, smoking), heavy lifting at work, or high-impact sports.
- Previous pelvic surgery and genetic factors: Prior hysterectomy or prolapse surgery, a family history of prolapse, connective tissue disorders.
What Are the Treatment Options?
Treatment is tailored to the severity of symptoms, age, general health, and future plans for pregnancy.
Non-surgical options:
- Weight loss, treating chronic cough and constipation, a high-fiber diet, avoiding heavy lifting
- Pelvic floor muscle training (Kegel exercises): a first-line option for mild-to-moderate prolapse; with regular practice it can significantly ease symptoms and delay the need for surgery
- Vaginal pessary: a medical device placed inside the vagina to hold the organs up; used by women who prefer not to have surgery or who carry higher surgical risk, providing long-term benefit in about 60% of users
Surgical options: Considered for women with ongoing symptoms who have not responded to non-surgical treatment. Depending on the case, this may involve repairing the affected area, suspending the top of the vagina to strong supporting tissue, or, for women with uterine prolapse who have completed childbearing, removing the uterus together with a supportive procedure. Your doctor decides which approach fits your situation.
Results of any surgical or interventional procedure can vary from person to person. It is recommended to get detailed advice from your doctor before any procedure.
Frequently Asked Questions
Does pelvic organ prolapse only happen at an older age?
No. Because it is linked to childbirth, it can appear at younger ages too; the risk increases with age and menopause.
Does mild prolapse always require surgery?
No. Mild prolapse without symptoms can often just be monitored; when there are symptoms, non-surgical options are considered first.
Do Kegel exercises fully correct prolapse?
In mild-to-moderate prolapse they can reduce symptoms and slow progression, but they do not fully resolve advanced-stage prolapse on their own.