Pelvic Organ Prolapse: Symptoms, Causes and Treatment

You could have pelvic organ prolapse—a common condition that occurs when the muscles and tissues supporting the pelvic organs weaken.

Prolapse affects one in three women in their 60s, though the true number might be higher. Many women assume symptoms are a normal part of aging. Others feel embarrassed and don’t seek care.

But prolapse is treatable. While benign, it can cause bothersome symptoms that can be eased with surgical and nonsurgical treatment options.

“Prolapse is common, but you don’t have to live with the symptoms,” said Brittni Boyd, MD, a urogynecologist at Cedars-Sinai. “If you are bothered by it, you should seek care.”

What Is Pelvic Organ Prolapse?

The pelvic floor is made up of muscles, ligaments and connective tissues that support the bladder, uterus, rectum and vagina. Pelvic organ prolapse occurs when these supports weaken, causing organs to shift downward and press into or bulge outside the vagina.

There are five main types of pelvic organ prolapse:

• Cystocele, or dropped bladder, is when the bladder bulges into the front wall of the vagina.
• Rectocele is when the rectum presses into the back wall of the vagina.
• Uterine prolapse is when the uterus descends into the vaginal canal.
• Vaginal vault prolapse is when the top of the vagina drops down. This can happen after a hysterectomy.
• Enterocele is when the small intestine pushes against the vaginal wall. This is the least common type of prolapse and rarely occurs in women who have a uterus.

Prolapse can cause symptoms that significantly impact a person’s quality of life, but it’s not life-threatening. “Prolapse in itself is a benign condition,” Boyd said.

Prolapse is common, but you don’t have to live with the symptoms. If you are bothered by it, you should seek care.

What Causes Pelvic Organ Prolapse?

Pelvic organ prolapse happens when the pelvic floor weakens.

Pregnancy and vaginal delivery are the two biggest contributors to pelvic organ prolapse, Boyd said. Other risk factors include:

• Excess body weight
• Chronic constipation
• Chronic coughing
• Heavy lifting
• A family history of prolapse
• Connective tissue conditions

Sometimes, there is no clear cause.

Pelvic Organ Prolapse Symptoms

Some women don’t realize they have pelvic organ prolapse because they have no symptoms. Those with symptoms most commonly experience pelvic pressure, fullness or heaviness, and feeling like something is falling out of the vagina.

Other possible symptoms of prolapse include:

• Frequent or urgent urination
• Difficulty emptying the bladder or bowels
• Constipation
• Discomfort during sex

Stages of Pelvic Organ Prolapse

There are four stages of pelvic organ prolapse. A doctor determines the stage by measuring how far the organs have shifted.

The stages help clinicians communicate with each other about the degree of prolapse, Boyd said.

“You could have mild prolapse and be very bothered, or have severe prolapse and not be bothered,” she said. “The staging is not so important because it comes down to how the patient is feeling. That’s how I tailor my counseling.”

Stage 1 is the mildest. Most women who have been pregnant and delivered babies likely have this level of prolapse, Boyd said, and experience no symptoms.

Stage 2 is when prolapse symptoms might begin to occur. This is often because organs have shifted close to the opening of the vagina. Many women begin treatment at this stage.

Stage 3 is a wide spectrum that occurs when an organ is partially protruding from the vagina.

Stage 4 is when the organ has completely protruded from the vagina.

Prolapse doesn’t always get worse. It could remain in the same stage for the rest of your life, or it could advance.

“People always worry that it will get worse,” she said. “Not necessarily.”

When to See a Doctor

Contact a healthcare provider if you’re experiencing pelvic pressure, difficulty emptying your bladder or bowels, or the sensation of a vaginal bulge. Let your doctor know any time you have bothersome symptoms, even if they’re not severe, Boyd said.

If you think you have pelvic organ prolapse, your primary care provider or gynecologist might refer you to a urogynecologist, a specialist who focuses on pelvic floor disorders.

A urogynecologist can diagnose pelvic organ prolapse through a pelvic exam and measurements. In some cases, they may also recommend imaging or bladder function testing. They can outline your treatment options and help you decide which approach is right for you.

Nonsurgical Treatment Options

Many women manage their pelvic organ prolapse symptoms with nonsurgical treatments.

Pelvic floor physical therapy involves working with a trained specialist who assesses muscle strength and teaches you targeted exercises. Physical therapy won’t make the prolapse disappear, but it might reduce bothersome symptoms enough without other interventions, Boyd said.

Kegels are a popular exercise meant to strengthen the pelvic floor, but they are often performed incorrectly. Guided physical therapy can help you learn how to do these exercises properly and determine whether they’re appropriate for you.

A vaginal pessary, a removable silicone ring inserted into the vagina to help support the vaginal walls, is a popular nonsurgical prolapse treatment. A well-fitting pessary should be comfortable to wear long term, Boyd said.

Lifestyle changes, such as weight management, constipation prevention and activity modification, might also help reduce prolapse symptoms.

Vaginal estrogen is sometimes prescribed to treat skin irritation caused by prolapse. It does not treat the prolapse itself, Boyd said.

Surgical Treatment Options

Your doctor might suggest surgery when prolapse symptoms significantly affect your quality of life and nonsurgical options don’t provide enough relief.

One option is reconstructive surgery, which repairs weak areas of the pelvic floor and repositions the organs. During vaginal reconstructive surgery, doctors use the patient’s own tissue and stitches to repair the walls of the vagina. In laparoscopic reconstructive surgery, doctors repair the pelvic floor through incisions in the abdomen. In some cases, they use mesh, which is more durable than human tissue. (Mesh is no longer used in the vagina for prolapse repairs.)

Another option is obliterative surgery, which narrows or closes part of the vaginal canal. Doctors may consider this for women with advanced prolapse who do not intend to have vaginal intercourse in the future.

Surgery is a personal decision and should be discussed with a specialist. Every surgery has risks, Boyd said, and it is possible for the prolapse to recur after surgery.

Living Well With Pelvic Organ Prolapse

Pelvic organ prolapse is common, but tat doesn’t mean you have to live with its symptoms, Boyd said. There’s no cause for embarrassment, she said, and a doctor can help.

“My subspecialty exists because of patients just like you,” Boyd said. “There are a lot of women out there who have this.”