What pelvic organ prolapse is
Pelvic organ prolapse happens when the muscles and connective tissue that support the pelvic organs become weakened or stretched, allowing one or more of those organs to drop down into or towards the vagina. The organs involved are usually the bladder, the uterus or the bowel.
It is common, particularly after childbirth and around menopause, and it is not something to be embarrassed about. Many people manage it well with conservative care, and for many it does not require surgery.
Common symptoms
The most frequently described symptom is a feeling of heaviness, dragging or a bulge in the vagina. Some people describe it as a sensation that something is falling or that there is a lump present. Symptoms often feel worse at the end of the day, after standing or lifting, and better after lying down.
Prolapse does not always cause symptoms, and the degree of prolapse does not always match how much it bothers someone. Some people with a milder prolapse are very aware of it, while others with a more significant one notice little.
Other symptoms that may occur
- A visible or felt bulge in the vagina
- Pelvic heaviness or a dragging sensation
- Lower back or pelvic discomfort
- Difficulty emptying the bladder or bowels
- A need to press on the vaginal wall to open the bowels
- Leaking urine, or difficulty starting the flow
- Discomfort during sex
Grades and types of prolapse
Prolapse is usually described by which organ is involved and by how far it has descended. The grading is a clinical judgement made on examination, not something you should try to assess yourself.
The type and grade matter for deciding on management, but they are not the whole story. Symptoms and what you want to return to matter just as much.
A general guide to types and grades
| Category | Description |
|---|---|
| Cystocele | The bladder descends into the front wall of the vagina |
| Rectocele | The bowel descends into the back wall of the vagina |
| Uterine prolapse | The uterus descends into the vagina |
| Grade 1 | The organ has dropped slightly into the vagina |
| Grade 2 | The organ has dropped to the opening of the vagina |
| Grade 3 | The organ protrudes outside the vagina |
| Grade 4 | The organ is fully outside the vagina, also called procidentia |
What makes it more likely
Anything that repeatedly increases pressure inside the abdomen, or that weakens the supporting tissue, contributes. That is why childbirth, chronic constipation and persistent heavy lifting are commonly involved.
Common contributing factors
- Pregnancy and especially vaginal childbirth
- Chronic constipation and straining
- Persistent heavy lifting or occupational load
- A chronic cough, including from smoking
- Menopause, due to the effect of oestrogen change on connective tissue
- Being overweight, which increases abdominal pressure
- Connective tissue conditions affecting tissue strength
- Previous pelvic surgery
- Some genetic factors
How it is managed
Conservative management is usually the first step, and for many people it is enough. Surgery exists and can be effective, but it is typically considered after conservative options have been tried, or when symptoms are significant.
The choice depends on the type and grade of prolapse, your symptoms, whether you want to have more children, and what you want to return to.
What conservative management involves
- Pelvic floor muscle training, taught properly and progressed over time
- Practical strategies for reducing strain on the pelvic floor, including bowel habits and lifting technique
- A vaginal pessary, which is a support device fitted by a health professional
- Managing contributing factors such as weight, constipation and cough
- Local oestrogen therapy, which may be prescribed by a doctor after menopause
- Graded return to the activities you want to do
How physiotherapy helps
A pelvic health physiotherapist can assess the pelvic floor muscles and teach a targeted training programme. This is not the same as a generic sheet of exercises. The right programme depends on whether the muscles are weak, overactive or poorly coordinated.
Physiotherapy also focuses on how you manage pressure in daily life, including how you lift, how you empty your bowels, and how you pace activity. These practical changes often make a significant difference to symptoms.
When to seek advice
See a doctor or a pelvic health physiotherapist if you notice a bulge, heaviness or any of the symptoms described above. Early assessment makes management easier.
Seek urgent medical attention if you have a bulge that suddenly cannot be pushed back inside, a prolapse that becomes painful, swollen or discoloured, difficulty passing urine, a fever, or if you are unable to open your bowels.
Getting assessed in the Lindfield area
If you are in the Lindfield or wider North Shore area and want to discuss prolapse symptoms, start an enquiry with the broad concern you want to discuss and your preferred appointment format. A qualified health professional confirms assessment, suitability and the appropriate next step.
What to do next
- Seek an assessment rather than relying on a description alone, because grading needs examination.
- Pelvic floor training should be taught and progressed, not copied from a generic sheet.
- Seek urgent care for a painful, discoloured or irreducible prolapse, or urinary difficulty.