Pelvic Organ Prolapse
Health topics Vulva and vagina Pelvic Organ Prolapse Pelvic organ prolapse is when the ligaments, connective tissues and muscles that support the pelvic organs stretch, causing the organs to drop down. The word prolapse means to ‘fall out of place’. There are different types of prolapse, including bladder and bowel prolapse (vaginal prolapse) and uterine prolapse. Print / PDF Bladder and bowel prolapse (vaginal prolapse) Uterine prolapse Symptoms of a prolapse What causes a prolapse? How is a prolapse diagnosed? Stages of prolapse Treatments for a prolapse Reducing the risk for prolapse What you can do to manage a prolapse When to see your doctor about a prolapse Reviewed For the most up to date information on this topic, please visit jeanhailes.org.au Key takeaways A vaginal prolapse is when the bladder, bowel or both bulge into the walls of the vagina. Anything that puts pressure on your pelvic floor muscles can cause a prolapse (e.g. pregnancy and childbirth). Symptoms include a feeling of vaginal heaviness, bulging in the vagina, and problems with the bladder and bowel. See your doctor if you notice any symptoms, as early treatment may reduce the severity of prolapse. Sections on this page Bladder and bowel prolapse (vaginal prolapse) Uterine prolapse Symptoms of a prolapse What causes a prolapse? How is a prolapse diagnosed? Stages of prolapse Treatments for a prolapse Reducing the risk for prolapse What you can do to manage a prolapse When to see your doctor about a prolapse Print / PDF Key takeaways A vaginal prolapse is when the bladder, bowel or both bulge into the walls of the vagina. Anything that puts pressure on your pelvic floor muscles can cause a prolapse (e.g. pregnancy and childbirth). Symptoms include a feeling of vaginal heaviness, bulging in the vagina, and problems with the bladder and bowel. See your doctor if you notice any symptoms, as early treatment may reduce the severity of prolapse. Bladder and bowel prolapse (vaginal prolapse) Bladder and bowel prolapse is also known as vaginal prolapse because the walls of the vagina become overstretched and bulge downwards towards the vaginal entrance. A prolapse may affect the front or back vaginal walls. Bladder prolapse (cystocele) occurs when the bladder bulges into the front wall of the vagina. When the rectum bulges into the back wall of the vagina, it’s called a bowel prolapse (rectocele). These conditions usually happen together. Uterine prolapse A uterine prolapse is when the uterus (womb) and cervix (opening to the uterus) drop down towards the vaginal entrance and may protrude outside the vagina. Symptoms of a prolapse The symptoms of a prolapse depend on the severity of the prolapse and your physical health. Symptoms may include: an inability to completely empty your bladder or bowel when going to the toilet straining to get your wee flow started, or to empty your bowel a slow flow of wee that tends to stop and start a sensation of fullness or pressure inside your vagina a sensation of vaginal heaviness or dragging a feeling of bulging or swelling in your vagina a need to wee or poo quickly an inability to control your wee or poo (incontinence) lower back ache. In severe cases, your vaginal wall or cervix may protrude outside your vaginal entrance. What causes a prolapse? Anything that puts pressure on your pelvic floor muscles can cause a prolapse. For example: pregnancy and childbirth constipation or regularly straining when going to the toilet repetitive lifting of heavy weights – at the gym, at work, in the garden or even lifting children squatting for long periods of time being overweight or obese coughing caused by smoking and chronic lung diseases connective tissue disorders such as Ehlers Danlos syndrome and Marfan’s syndrome. Sexual activity doesn’t cause or worsen prolapse. The risk of prolapse increases: with previous pelvic surgery after menopause – when oestrogen hormone levels drop and the pelvic floor muscles weaken. How is a prolapse diagnosed? Your doctor will ask about your symptoms and medical history. They will also ask to do a pelvic examination. The pelvic examination will determine: the severity of the prolapse how well the pelvic floor muscles are working which organs are part of the prolapse. You may need other tests. For example: a pelvic ultrasound – to check for any masses or cysts in the pelvic area a bladder function assessment (urodynamic studies) – to check for different types of incontinence a bladder ultrasound – to see if wee isn’t emptying completely from the bladder after going to the toilet a mid-stream urine (wee) test – to rule out infection if there are bladder symptoms. Stages of prolapse Gynaecologists with a special interest in prolapse (urogynaecologists) use a grading system to understand the stages of prolapse. This is called the POP-Q system. The stage of prolapse is defined by how much the uterus or vaginal walls are pushing down into the vagina. There are 4 stages: Stage 1: the wall or organ drops into the upper part of the vagina. Stage 2: the wall or organ drops into the lower part of the vagina. Stage 3: the wall or organ protrudes from the vaginal opening. Stage 4: the wall or organ slips completely outside the vagina. Treatments for a prolapse There are different ways to treat and manage a prolapse. But without intervention the symptoms of prolapse usually worsen over time. Treatment depends on the severity of the prolapse and how it affects your normal routine. Your doctor will explain the problem and your treatment options so you can make an informed decision. Reducing the risk for prolapse Pelvic floor exercises and changes in your daily routine, along with weight management, may be all you need to reduce the risk for prolapse. Learn more about pelvic floor exercises and why they’re important. What you can do to manage a prolapse There are different ways to help reduce the risk of a prolapse. These might also help you to recover well after a prolapse. Want to learn more about pelvic floor exercises? Join pelvic floor physiotherapist Janetta Webb on our podcast for simple exercises that strengthen your pelvic floor. Listen to the podcast When to see your doctor about a prolapse It’s important to see your doctor as soon as possible if you notice any symptoms of a prolapse. Early treatment will prevent or reduce the severity of prolapse. Ask your doctor about treatment options for any condition that causes coughing and sneezing, for example: asthma chest infections hay fever. Repetitive sneezing and coughing may cause or worsen bladder prolapse. If you have reached menopause, you can ask your doctor about MHT to increase your levels of oestrogen. This may help to strengthen your vaginal walls and pelvic floor muscles. Personal stories about vulva and vagina Story ‘I wanted to have sex but it was physically impossible’: Life with severe vaginismus 5 min Story What this mum wants young girls to know about their vulvas 4 min Review process Our review process This information has been reviewed by clinical experts and is based on the latest evidence. Our content review process ensures our health information is accurate, trustworthy, current and useful. We regularly check our information to make sure it reflects the latest clinical guidelines and key findings from large, reliable studies. Where possible, we focus on Australian research to make our information more relevant locally. Experts play a key role in reviewing our content. Clinicians at Jean Hailes check information for accuracy and real‑world relevance. These include GPs, gynaecologists, endocrinologists, psychologists and allied health professionals. We also work with partner organisations, independent specialists and people with lived experience to make sure our content reflects both expert knowledge and the experiences of the community. Health information in your language view all You might want to know more about Topic Vulval irritation and treatment Topic Vulval and vaginal conditions Topic Vulval and vaginal pain Topic Gynaecological cancers Cervical cancer • Fallopian tube cancer • Ovarian cancer • Uterine cancer (cancer of the uterus) • Vaginal cancer • Vulval cancer

Pelvic Organ Prolapse

Pelvic organ prolapse is when the ligaments, connective tissues and muscles that support the pelvic organs stretch, causing the organs to drop down. The word prolapse means to ‘fall out of place’. There are different types of prolapse, including bladder and bowel prolapse (vaginal prolapse) and uterine prolapse.

Print / PDF

Reviewed

Key takeaways

A vaginal prolapse is when the bladder, bowel or both bulge into the walls of the vagina.
Anything that puts pressure on your pelvic floor muscles can cause a prolapse (e.g. pregnancy and childbirth).
Symptoms include a feeling of vaginal heaviness, bulging in the vagina, and problems with the bladder and bowel.
See your doctor if you notice any symptoms, as early treatment may reduce the severity of prolapse.

Key takeaways

A vaginal prolapse is when the bladder, bowel or both bulge into the walls of the vagina.
Anything that puts pressure on your pelvic floor muscles can cause a prolapse (e.g. pregnancy and childbirth).
Symptoms include a feeling of vaginal heaviness, bulging in the vagina, and problems with the bladder and bowel.
See your doctor if you notice any symptoms, as early treatment may reduce the severity of prolapse.

Bladder and bowel prolapse (vaginal prolapse)

Bladder and bowel prolapse is also known as vaginal prolapse because the walls of the vagina become overstretched and bulge downwards towards the vaginal entrance. A prolapse may affect the front or back vaginal walls.

Bladder prolapse (cystocele) occurs when the bladder bulges into the front wall of the vagina.

When the rectum bulges into the back wall of the vagina, it’s called a bowel prolapse (rectocele).

These conditions usually happen together.

Uterine prolapse

A uterine prolapse is when the uterus (womb) and cervix (opening to the uterus) drop down towards the vaginal entrance and may protrude outside the vagina.

Symptoms of a prolapse

The symptoms of a prolapse depend on the severity of the prolapse and your physical health.

Symptoms may include:

an inability to completely empty your bladder or bowel when going to the toilet
straining to get your wee flow started, or to empty your bowel
a slow flow of wee that tends to stop and start
a sensation of fullness or pressure inside your vagina
a sensation of vaginal heaviness or dragging
a feeling of bulging or swelling in your vagina
a need to wee or poo quickly
an inability to control your wee or poo (incontinence)
lower back ache.

In severe cases, your vaginal wall or cervix may protrude outside your vaginal entrance.

What causes a prolapse?

Anything that puts pressure on your pelvic floor muscles can cause a prolapse. For example:

pregnancy and childbirth
constipation or regularly straining when going to the toilet
repetitive lifting of heavy weights – at the gym, at work, in the garden or even lifting children
squatting for long periods of time
being overweight or obese
coughing caused by smoking and chronic lung diseases
connective tissue disorders such as Ehlers Danlos syndrome and Marfan’s syndrome.

Sexual activity doesn’t cause or worsen prolapse.

The risk of prolapse increases:

with previous pelvic surgery
after menopause – when oestrogen hormone levels drop and the pelvic floor muscles weaken.

How is a prolapse diagnosed?

Your doctor will ask about your symptoms and medical history. They will also ask to do a pelvic examination.

The pelvic examination will determine:

the severity of the prolapse
how well the pelvic floor muscles are working
which organs are part of the prolapse.

You may need other tests. For example:

a pelvic ultrasound – to check for any masses or cysts in the pelvic area
a bladder function assessment (urodynamic studies) – to check for different types of incontinence
a bladder ultrasound – to see if wee isn’t emptying completely from the bladder after going to the toilet
a mid-stream urine (wee) test – to rule out infection if there are bladder symptoms.

Stages of prolapse

Gynaecologists with a special interest in prolapse (urogynaecologists) use a grading system to understand the stages of prolapse. This is called the POP-Q system.

The stage of prolapse is defined by how much the uterus or vaginal walls are pushing down into the vagina.

There are 4 stages:

Stage 1: the wall or organ drops into the upper part of the vagina.
Stage 2: the wall or organ drops into the lower part of the vagina.
Stage 3: the wall or organ protrudes from the vaginal opening.
Stage 4: the wall or organ slips completely outside the vagina.

Treatments for a prolapse

There are different ways to treat and manage a prolapse. But without intervention the symptoms of prolapse usually worsen over time.

Treatment depends on the severity of the prolapse and how it affects your normal routine.

Your doctor will explain the problem and your treatment options so you can make an informed decision.

Reducing the risk for prolapse

Pelvic floor exercises and changes in your daily routine, along with weight management, may be all you need to reduce the risk for prolapse.

Learn more about pelvic floor exercises and why they’re important.

What you can do to manage a prolapse

There are different ways to help reduce the risk of a prolapse. These might also help you to recover well after a prolapse.

Want to learn more about pelvic floor exercises?

Join pelvic floor physiotherapist Janetta Webb on our podcast for simple exercises that strengthen your pelvic floor.

Listen to the podcast

When to see your doctor about a prolapse

It’s important to see your doctor as soon as possible if you notice any symptoms of a prolapse. Early treatment will prevent or reduce the severity of prolapse.

Ask your doctor about treatment options for any condition that causes coughing and sneezing, for example:

asthma
chest infections
hay fever.

Repetitive sneezing and coughing may cause or worsen bladder prolapse.

If you have reached menopause, you can ask your doctor about MHT to increase your levels of oestrogen. This may help to strengthen your vaginal walls and pelvic floor muscles.