What Is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) occurs when the muscles, ligaments, and connective tissue that support the pelvic organs — the bladder, uterus, vagina, and rectum — weaken or stretch, allowing one or more organs to drop from their normal position and bulge into or out of the vagina.

POP is extremely common: it affects up to 50% of women at some point in their lives, and nearly 1 in 9 women will undergo surgery for prolapse or incontinence by age 80. Despite how common it is, many women feel isolated or embarrassed — but prolapse is not dangerous and is very treatable.

Types of Prolapse

Anterior Compartment

  • Cystocele — the bladder drops into the front wall of the vagina. Often called a "dropped bladder."
  • Urethrocele — the urethra bulges into the vaginal wall (often combined with a cystocele).

Posterior Compartment

  • Rectocele — the rectum bulges into the back wall of the vagina.
  • Enterocele — the small intestine bulges into the upper vaginal wall.

Apical (Top) Compartment

  • Uterine prolapse — the uterus descends into the vagina.
  • Vaginal vault prolapse — after hysterectomy, the top of the vagina drops down.

Multiple Compartments

Most women have prolapse in more than one compartment. A careful exam identifies each affected area so treatment can address all of them together.

What Causes Prolapse?

Prolapse develops gradually over years as the pelvic floor support system is stretched or weakened. No single factor is to blame — it is usually a combination of life events, genetics, and time.

Primary Risk Factors

  • Vaginal childbirth — especially multiple deliveries, large babies, long pushing stages, or forceps/vacuum-assisted births
  • Menopause — declining estrogen weakens connective tissue and vaginal support
  • Aging — cumulative stretching and weakening
  • Prior pelvic surgery — including hysterectomy
  • Genetics — inherited connective tissue quality

Contributing Factors

  • Obesity — sustained pressure on the pelvic floor
  • Chronic cough — from smoking, asthma, or COPD
  • Chronic constipation — repetitive straining
  • Heavy lifting — occupational or recreational
  • High-impact exercise — long-term repetitive strain

Symptoms of Pelvic Organ Prolapse

Early prolapse often causes no symptoms. As it progresses, symptoms typically reflect which organ has descended and how far.

Common Symptoms

  • A bulge or pressure in the vagina — "something is falling out"
  • Feeling of fullness or heaviness in the pelvis, worse as the day goes on
  • Seeing or feeling tissue at the vaginal opening
  • Urinary symptoms — incomplete emptying, frequency, leakage, or having to push the bulge back to urinate
  • Bowel symptoms — difficulty emptying the rectum, needing to press on the vaginal wall (splinting) to have a bowel movement
  • Low back or pelvic ache that improves when lying down
  • Discomfort with intercourse or loss of sensation
  • Difficulty exercising, wearing tampons, or using a menstrual cup

When to Seek Care Promptly

Contact us if you cannot empty your bladder, have bleeding from prolapsed tissue, are unable to reduce the prolapse back inside, or have severe pain. These are uncommon but should be evaluated quickly.

How Is Prolapse Diagnosed & Staged?

Diagnosis is made through a careful history and a thorough pelvic exam. Additional tests are sometimes needed if surgery is being planned or if there are bladder-emptying concerns.

Office Evaluation

  • Symptom history and impact on daily life
  • Pelvic exam at rest and with straining, often in standing and lying positions
  • POP-Q staging — a standardized measurement system (Stage 0–4)
  • Bladder assessment — cough stress test, post-void residual measurement
  • Urinalysis — to rule out infection

POP-Q Stages at a Glance

  • Stage 0 — no prolapse
  • Stage 1 — prolapse is >1 cm above the hymen
  • Stage 2 — prolapse is within 1 cm of the hymen (in or out)
  • Stage 3 — prolapse extends more than 1 cm beyond the hymen but not fully out
  • Stage 4 — complete eversion of the vagina or uterus

Additional Testing (When Needed)

  • Urodynamics — if bladder emptying or incontinence is a concern, especially before surgery
  • Cystoscopy — camera evaluation of the bladder and urethra
  • Pelvic floor ultrasound or MRI — in complex or recurrent cases
  • Defecography — for complex posterior prolapse with bowel symptoms

Treatment Options

Treatment is individualized. The right choice depends on the type and stage of prolapse, symptoms, age, sexual activity, future childbearing plans, and overall health. Prolapse is quality-of-life condition — we only treat it as aggressively as needed to make you comfortable.

Our Philosophy

Watchful waiting is appropriate for many women with mild, asymptomatic prolapse. When treatment is needed, we begin with the least invasive option that will meet your goals.

1. Observation & Lifestyle Measures

For mild prolapse with few or no symptoms, no treatment may be needed. Simple steps can prevent progression.

  • Weight management — even modest weight loss reduces pressure on the pelvic floor
  • Treating constipation — fiber, fluids, and stool softeners to avoid straining
  • Treating chronic cough — stop smoking, optimize asthma/COPD control
  • Avoiding heavy lifting and repetitive Valsalva straining
  • Topical vaginal estrogen — in postmenopausal women, to strengthen vaginal tissue and support

2. Pelvic Floor Physical Therapy

A pelvic floor physical therapist teaches you to identify, strengthen, and coordinate the muscles that support the pelvic organs. PT is most effective for early-stage prolapse (Stage 1–2) and for reducing symptoms such as pelvic pressure and associated urinary leakage.

  • What it involves: targeted Kegel exercises, biofeedback, breathing coordination, and home programs
  • Timeline: 6–12 weeks of consistent therapy
  • Best for: mild prolapse, prolapse after pregnancy, patients who prefer non-surgical care
  • Pairs well with: pessary use and lifestyle changes

3. Pessary

A pessary is a small, removable silicone device placed inside the vagina to support the pelvic organs. It is an excellent first-line option for many women — especially those who wish to avoid surgery, are not yet done having children, or are not surgical candidates.

Advantages

  • Non-surgical, immediately effective
  • Many shapes and sizes — tailored to anatomy
  • Can be removed and reinserted by the patient
  • Often covered by insurance

Considerations

  • Requires fitting and occasional size adjustments
  • Needs routine cleaning and maintenance
  • Regular follow-up to prevent irritation or erosion
  • Topical estrogen is often added to keep tissue healthy

For more detail, see our Pessary placement and maintenance guide.

4. Surgical Repair

When symptoms persist despite conservative care, or when prolapse is advanced, surgery offers durable relief. We tailor the approach to which compartment is affected and to your anatomy, activity level, and preferences.

Procedure Compartment Approach
Anterior repair Anterior (cystocele) Vaginal — native-tissue repair
Posterior repair Posterior (rectocele) Vaginal — native-tissue repair
Sacrospinous ligament fixation Apical (uterine or vault) Vaginal — suspension to ligament
Robotic sacrocolpopexy Apical (vault or uterine) Abdominal — mesh to sacrum (robotic)
Colpocleisis All compartments Vaginal closure — for women no longer sexually active

If you also have stress urinary incontinence, a midurethral sling can be performed at the same operation. See our Female SUI page for details.

What About Mesh?

The FDA safety concerns you may have heard about were specifically related to transvaginal mesh for prolapse, which is no longer used. The mesh used in robotic sacrocolpopexy is placed abdominally, with decades of excellent safety and durability data, and the mesh used in midurethral slings for incontinence remains FDA-cleared and well studied. Your surgeon will discuss your individual risks and benefits before recommending any mesh procedure.

Recovery After Prolapse Surgery

Recovery varies by procedure but follows a general pattern. Most prolapse surgery is done as outpatient or with a short hospital stay.

First 1–2 Weeks

  • Rest, light walking, pain controlled with oral medication
  • No heavy lifting (>10 lbs), straining, or vigorous exercise
  • Some vaginal spotting and discharge are normal

Weeks 2–6

  • Gradual return to daily activities
  • No intercourse, tampons, or swimming until cleared (typically 6 weeks)
  • Follow-up exam to confirm healing

Beyond 6 Weeks

  • Resume exercise and intercourse
  • Continue lifestyle measures (weight, bowel habits, cough control) to protect the repair
  • Ongoing pelvic floor physical therapy as recommended

Frequently Asked Questions

Is prolapse dangerous?

No. Prolapse is not cancerous and is rarely urgent. It is treated based on how much it bothers you.

Will prolapse get worse?

Prolapse usually progresses slowly. Pregnancy, menopause, weight gain, and chronic strain all tend to accelerate it. Conservative measures can slow or stop the progression.

Do I need a hysterectomy to fix uterine prolapse?

Not always. Uterine-preserving repairs (hysteropexy) are available. We discuss what is right for your anatomy and preferences.

Can prolapse come back after surgery?

Any surgery can fail over time, but modern repairs — especially robotic sacrocolpopexy for the apical compartment — have excellent long-term durability (85–95% at 5–10 years).

Is surgery covered by insurance?

Yes. Both non-surgical and surgical prolapse treatments are covered by most plans including Medicare. Our team will verify your benefits before scheduling.

Should I wait to have surgery until I'm done having children?

Generally yes — pregnancy and vaginal delivery can undo a surgical repair. A pessary is a great option in the meantime.

Get Comfortable Again

Pelvic organ prolapse is common, treatable, and should not limit your life. Our experienced female pelvic medicine team will evaluate you carefully and walk you through the full range of options — from a well-fitted pessary to durable surgical reconstruction.

  • ✅ Comprehensive evaluation and POP-Q staging
  • ✅ Pessary fitting and maintenance
  • ✅ On-site pelvic floor physical therapy
  • ✅ Vaginal, robotic, and hybrid surgical options
  • ✅ Combined repair for prolapse + incontinence
Schedule Your Consultation

Call 678-344-8900 to speak with our team