Pelvic organ prolapse (POP) is a condition in which the pelvic floor muscles and connective tissue weaken, allowing one or more pelvic organs — the uterus, bladder, rectum, or vaginal walls — to descend or bulge into or beyond the vaginal canal 1.
Pelvic organ prolapse affects an estimated 3–6% of women worldwide, though symptomatic prolapse that prompts women to seek care is more common with advancing age. Research suggests that nearly half of all women have some degree of pelvic organ descent on examination — though most do not experience bothersome symptoms 2. Understanding the causes, symptoms, and treatment options empowers women to make informed decisions with their healthcare providers.
For related gynecological conditions, see our women's health hub.
Types of Pelvic Organ Prolapse
Prolapse is classified by which organ or structure is displaced. A cystocele (anterior vaginal wall prolapse) occurs when the bladder drops and presses against the front wall of the vagina — it is the most common type. A rectocele (posterior vaginal wall prolapse) occurs when the rectum bulges into the back wall of the vagina. A uterine prolapse involves the uterus descending into or beyond the vaginal canal.
Vault prolapse (or vaginal cuff prolapse in women who have had a hysterectomy) occurs when the top of the vagina sags. An enterocele is a prolapse of the small intestine into the vaginal space. Many women have more than one type simultaneously 1.
Causes and Risk Factors
Childbirth
Vaginal childbirth — particularly prolonged second-stage labor, delivery of large babies, and operative vaginal delivery using forceps or vacuum — is the most significant risk factor for pelvic organ prolapse. The pushing and stretching involved in vaginal delivery can stretch or tear the levator ani muscles and connective tissue that form the pelvic floor, reducing their ability to support the pelvic organs.
The risk increases with the number of vaginal deliveries 2.
Aging and Estrogen Decline
Aging is associated with a gradual loss of muscle tone and connective tissue elasticity throughout the body, including the pelvic floor. The decline in estrogen that occurs at menopause accelerates these changes, as estrogen plays a role in maintaining the strength and elasticity of pelvic connective tissue.
Low estrogen symptoms in women include changes to connective tissue and vaginal tissue health that can contribute to prolapse risk. This is why prolapse most often becomes symptomatic in the years following menopause 1.
Elevated Intra-abdominal Pressure
Conditions that chronically increase pressure on the pelvic floor from above increase prolapse risk. These include chronic constipation and straining with bowel movements, chronic cough (from conditions such as asthma or COPD, or from smoking), obesity, heavy lifting occupations, and high-impact exercise. Over time, repeated episodes of elevated intra-abdominal pressure place sustained stress on the pelvic support structures.
Genetics and Connective Tissue Factors
Women with inherited connective tissue disorders — such as Ehlers-Danlos syndrome or Marfan syndrome — have a higher risk of prolapse, reflecting the role of connective tissue quality in pelvic floor support. Family history of prolapse is an independent risk factor, suggesting a genetic component beyond specific syndromes 2.
Previous Pelvic Surgery
Hysterectomy (surgical removal of the uterus) is associated with increased risk of subsequent vaginal vault prolapse because removal of the uterus alters the structural support of the vaginal apex. Other pelvic surgeries may also affect support structures.
Symptoms of Pelvic Organ Prolapse
Many women with prolapse have no symptoms, and prolapse is discovered incidentally during a pelvic examination. When symptoms do occur, the most common is a sensation of pelvic heaviness, fullness, or a feeling that 'something is falling out' of the vagina 1. A visible or palpable bulge at or beyond the vaginal opening may be noticeable, particularly after prolonged standing or physical activity.
Urinary symptoms are common with anterior prolapse (cystocele) and include urinary urgency, frequency, difficulty fully emptying the bladder, and sometimes urinary incontinence. Bowel symptoms — including difficulty with bowel movements or the need to manually support the vaginal wall to defecate — suggest posterior prolapse (rectocele). Sexual difficulties including discomfort during intercourse and reduced sensation may also occur.
Symptoms typically worsen throughout the day and with activity, and improve with rest and lying down.
Treatment Options
Conservative Management
For mild or asymptomatic prolapse, conservative management is appropriate. This includes pelvic floor muscle training (Kegel exercises) — which research shows can reduce prolapse symptoms and stage in some women when performed correctly and consistently 3. Pelvic floor physical therapy with a specialized therapist is more effective than self-directed exercises for many women.
Lifestyle modifications such as weight loss (if overweight), treating constipation, avoiding heavy lifting, and managing chronic cough can reduce the progression of prolapse. Magnesium benefits for women include supporting muscle function, which may complement pelvic floor rehabilitation.
Pessary
A pessary is a removable silicone device inserted into the vagina to mechanically support the prolapsed organ. Pessaries are an effective non-surgical option for many women and are particularly suitable for those who are not surgical candidates, prefer to avoid surgery, or want to try conservative management first. They require fitting by a healthcare provider and routine follow-up for cleaning and assessment 1.
Surgical Treatment
Surgical repair is recommended for women with significant symptoms not adequately controlled by conservative measures.
Surgical options include native tissue repair (using the patient's own tissue to restore support), vaginal mesh procedures (with important regulatory considerations — the FDA has restricted transvaginal mesh for POP due to safety concerns), and sacrocolpopexy (an abdominal or laparoscopic procedure attaching the vaginal apex to the sacrum with mesh) 3.
The choice of surgery depends on the type and degree of prolapse, the patient's health status, desire for future pregnancy, and other factors.
When to See a Doctor
Seek medical evaluation for any symptom that suggests pelvic organ prolapse: a sensation of pelvic pressure or fullness; a bulge felt or seen at the vaginal opening; difficulty with urination including incomplete emptying, urinary leakage, or recurrent urinary tract infections; difficulty with bowel movements; or new sexual discomfort.
Vaginal atrophy and vaginal dryness may coexist with prolapse and should also be addressed with a provider. A urogynecologist, gynecologist, or urology specialist can perform a pelvic exam to stage the prolapse using standardized systems and recommend appropriate management.
Early evaluation and pelvic floor therapy can sometimes prevent progression and avoid the need for surgery.
Frequently asked questions
Is pelvic organ prolapse dangerous?
POP itself is rarely life-threatening. However, it can significantly affect quality of life, urinary and bowel function, and sexual wellbeing. In severe cases, advanced anterior prolapse with bladder outlet obstruction can impair kidney drainage. The primary concern in most women is the impact on quality of life and the desire for treatment to relieve symptoms.
Can pelvic organ prolapse heal on its own?
Prolapse does not spontaneously reverse, but symptoms can remain stable or even improve with pelvic floor muscle training, weight loss, and lifestyle modifications. Progression is variable — not all prolapse worsens over time. Conservative management can keep symptoms manageable for many women.
Do Kegel exercises help pelvic organ prolapse?
Research suggests pelvic floor muscle training can reduce prolapse symptoms and in some cases reduce the measurable stage of prolapse, particularly when exercises are performed correctly and consistently. Pelvic floor physical therapy is more effective than self-directed Kegels for most women with symptomatic prolapse.
Can I still have sex with pelvic organ prolapse?
Many women with prolapse have no sexual difficulties, particularly with mild prolapse. More significant prolapse can cause discomfort during intercourse. Treatment — including pelvic floor therapy, pessary, or surgery — often improves sexual function. Discuss sexual concerns openly with your healthcare provider.
What is the difference between a cystocele and a rectocele?
A cystocele is a prolapse of the bladder into the front wall of the vagina (anterior prolapse), causing urinary symptoms. A rectocele is a prolapse of the rectum into the back wall of the vagina (posterior prolapse), causing bowel symptoms. Both can occur simultaneously.