What is pelvic organ prolapse?

Pelvic organ prolapse happens when the tissues that hold the bladder, womb or bowel in place stretch or weaken, allowing one of those organs to press into the wall of the vagina. Women describe it in very different ways — a bulge, a heaviness, a dragging feeling, or simply the sense that something is “coming down” by the end of a long day.

It is far more common than most women expect. Around one in three women who have given birth will have some degree of prolapse, and roughly one in ten will eventually seek treatment for it. It is not dangerous, and it is not a sign that anything has gone catastrophically wrong. It is a mechanical problem with mechanical solutions.

The main types

Prolapse is named after whichever organ has moved. Most women have more than one type at the same time, which is why an examination matters more than a label:

• Cystocele — the bladder presses into the front wall of the vagina. Often linked with incomplete emptying and stress incontinence.
• Rectocele — the bowel presses into the back wall. Can cause difficulty emptying the bowel completely.
• Uterine prolapse — the womb itself descends. This is the type most often described as a visible bulge.
• Vaginal vault prolapse — the top of the vagina descends after a previous hysterectomy.

Why does it happen?

The pelvic floor is a sling of muscle and connective tissue. Anything that stretches it, weakens it or repeatedly loads it can contribute. Vaginal birth is the single biggest factor, particularly a long second stage, a large baby or an instrumental delivery. The menopause matters too: falling oestrogen thins and weakens the supporting tissues, which is why symptoms so often appear or worsen in a woman's fifties.

Chronic coughing, constipation, heavy lifting and a high body mass index all add load over years. There is also a genuine genetic component — if your mother had a prolapse, your own risk is higher regardless of how many children you have had. If you would like to talk through your own risk factors, you can request an appointment at any time.

“Almost every woman I see has spent years assuming this was simply the price of having children. It is not. It is a treatable condition, and it is never too late to ask.”

Symptoms worth acting on

Not every prolapse needs treatment. The question is never how it looks on examination but how much it interferes with your life. These are the symptoms that most often bring women to clinic:

• A visible or palpable bulge at the vaginal opening
• Heaviness or dragging that worsens through the day or with standing
• Needing to press or reposition to empty the bladder or bowel
• Recurrent urinary infections or a sense of incomplete emptying
• Discomfort during sex, or avoiding it because of the bulge
• Lower back ache that eases when you lie down

How it is treated

1. Conservative care

For mild to moderate prolapse, supervised pelvic floor muscle training with a specialist physiotherapist is the recommended first step in UK practice, and it works well. Vaginal oestrogen, weight management and treating constipation all reduce symptoms meaningfully.

2. Pessaries

A pessary is a soft silicone device fitted into the vagina to support the prolapse. It is quick to fit, immediately effective and completely reversible — an excellent option if you would rather avoid surgery, are still planning a family, or want relief while you think things over.

3. Mesh-free surgical repair

Where symptoms persist, native-tissue repair uses your own tissues to rebuild support, with no vaginal mesh involved. Recovery is usually straightforward: home within a day or two, back to desk work at three to four weeks, and back to the gym at around twelve weeks. You can read more about mesh-free repair at this clinic.