Pelvic organ prolapse: symptoms, causes and treatment

What is pelvic organ prolapse?

Pelvic organ prolapse happens when the muscles and tissues that support the pelvic organs weaken or stretch, letting one or more organs drop into or out of the vagina. It can involve the bladder, the uterus, the rectum, the small bowel or the top of the vagina after a hysterectomy. Prolapse is common, especially after childbirth and with age. It is usually not life-threatening, but it can affect comfort, bladder and bowel function, and sex. Many treatment options exist, and not everyone needs surgery.

Symptoms

Mild prolapse often causes no symptoms. When symptoms happen, the most common is a feeling of pressure, heaviness or a bulge in the vagina, or seeing or feeling tissue at the vaginal opening. Symptoms often feel worse after standing for a long time or at the end of the day and better when lying down. Other symptoms can include urine leakage, trouble starting to urinate or fully emptying the bladder, frequent bladder infections, trouble having a bowel movement, low back aching and discomfort during sex.

Causes and risk factors

Vaginal childbirth is one of the main risk factors, especially after several births or the birth of a large baby. Aging and lower estrogen levels after menopause can also weaken support tissues. Anything that puts extra pressure on the pelvic floor over time can play a role, including long-term constipation and straining, a chronic cough, obesity and frequent heavy lifting. Some people have a family history or a connective tissue condition that makes prolapse more likely. Previous pelvic surgery can also be a factor.

How prolapse is diagnosed

A gynecologist or urogynecologist can usually diagnose prolapse with a pelvic exam. You may be asked to bear down, cough or stand during the exam so the doctor can see how far the organs move. Your doctor will also ask about bladder, bowel and sexual symptoms. Tests can include a urine test, a check of how well your bladder empties, and urodynamic testing to measure bladder function, especially if you have leakage or are considering surgery. Imaging tests are sometimes used.

Treatment options

If prolapse does not bother you, you may not need treatment. Options can include pelvic floor muscle exercises, often with help from a pelvic floor physical therapist, along with managing constipation, coughing and weight. A pessary is a removable device placed in the vagina to support the organs; it is fitted in the office and comes in many shapes and sizes. Vaginal estrogen may be suggested for some people after menopause. Surgery can repair and support the pelvic organs, or for people who do not plan to have vaginal intercourse, narrow or close the vagina.

Questions to ask and when to get care right away

Questions to ask your doctor include: What type of prolapse do I have? What happens if I wait? Would a pessary work for me? Which surgery would you suggest, will mesh be used and why, and what is recovery like? Could the prolapse come back? Get prompt care if you suddenly cannot pass urine, or if tissue that sticks out becomes very painful, bleeds or cannot be pushed back in. For any medical emergency, call 911 or go to an emergency department.

Finding a urogynecologist or gynecologist near you

Gynecologists and OB-GYNs treat many cases of prolapse. Urogynecologists complete extra training in female pelvic medicine and reconstructive surgery, focus on prolapse and bladder control, and often handle more complex cases or repeat surgery. Our directory lists physicians from public federal registries. Call the office to confirm that they fit pessaries or perform prolapse repair, which insurance they accept and whether they are seeing new patients. Bring a list of your symptoms and when they bother you most.

Frequently asked questions

Can pelvic organ prolapse be treated without surgery?

Many people manage prolapse without surgery. Pelvic floor exercises can ease mild symptoms, and a pessary can support the organs and relieve pressure. These options do not cure prolapse, but they can help you stay comfortable and active. Surgery remains an option later if your symptoms change.

Is pelvic organ prolapse dangerous?

Prolapse is usually not dangerous, though it can be uncomfortable and affect daily life. In rare cases, severe prolapse can block the flow of urine or cause sores on tissue that sticks out. See a doctor if your symptoms bother you, and get care quickly if you cannot urinate.

Can I exercise if I have a prolapse?

Many people with prolapse can stay active. Pelvic floor exercises are often recommended, and a pelvic floor physical therapist can show you how to do them correctly. Ask your doctor about high-impact activities and heavy lifting, which may make symptoms worse for some people.

What is a pessary and how does it work?

A pessary is a flexible device, usually made of silicone, that is placed in the vagina to hold the pelvic organs in place. Your clinician fits the right size in the office. Pessaries need regular cleaning and follow-up visits to prevent irritation, and many people learn to remove and reinsert them on their own.

Find care near you

• Urogynecology — find a physician by state
• Gynecology — find a physician by state
• Obstetrics and gynecology (OB/GYN) — find a physician by state
• Pessary fitting — physicians with 2024 Medicare-billed services
• Pelvic organ prolapse repair — physicians with 2024 Medicare-billed services
• Bladder function (urodynamic) testing — physicians with 2024 Medicare-billed services

Sources

• MedlinePlus: Pelvic Floor Disorders
• ACOG: Pelvic Organ Prolapse
• AUGS: Voices for Pelvic Floor Disorders

Written from the public health sources listed above. A physician has not yet reviewed this guide. It is general information, not medical advice; talk with your clinician about your situation.