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Pelvic Organ Prolapse - Types, Causes, Symptoms, and Treatment

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Pelvic Organ Prolapse - Types, Causes, Symptoms, and Treatment

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Pelvic organ prolapse results in drooping of pelvic organs from their position. This article explains its causes, symptoms, diagnosis, and treatment.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Sunita Kothari

Published At July 12, 2022
Reviewed AtMay 14, 2024


Pelvic organ prolapse is a disorder causing the pelvic floor's tissues and muscles to become loose and weak, resulting in drooping of the pelvic organs (cervix, uterus, vagina, bladder, urethra, and rectum). The bladder is not involved in pelvic organ prolapse. Pelvic floor disorder can occur after childbirth, causing complications like stretching and torn muscles or aging.

The most common pelvic floor disorders are:

  • Leaking of urine (urine incontinence).

  • Leaking of stools (fecal incontinence).

  • Pelvic organ prolapse (weakening of the supporting tissues and muscles of the pelvic organs).

What Are the Causes of Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles and the tissues of the pelvic floor do not work correctly because of the following:

  • Vaginal birth causes stretching and straining of the pelvic floor muscles. Prolonged, difficult childbirth or delivering large or multiple babies can also cause pelvic floor prolapse.

  • Due to constipation, long-term pressure in the abdominal region may occur due to chronic cough, obesity, or straining during bowel movements.

  • Hysterectomy (surgical removal of the uterus).

  • Changes in the female hormone estrogen during and after menopause can cause pelvic organ prolapse. However, the exact cause is unknown.

  • Pelvic floor disorders are more common in elderly women.

  • Family history.

  • Women in jobs that require lifting heavy objects.

What Are the Types of Pelvic Organ Prolapse?

There are five main types of pelvic organ prolapse.

  • Cystocele (Dropped Bladder) - It is a common type of pelvic organ prolapse. It occurs when the bladder drops into or out of the vagina.

  • Rectocele (Dropped Rectum) - This occurs when the rectum bulges into or out of the vagina.

  • Uterine Prolapse (Dropped Uterus) - It occurs when the uterus bulges into or out of the vagina.

  • Enterocele - An enterocele occurs when the small intestine or small bowel bulges into the vagina.

  • Vaginal Vault Prolapse - This occurs when there is prolapse of the vagina.

What Are the Signs and Symptoms of Pelvic Organ Prolapse?

The symptoms vary in each individual, and some women may have no symptoms. The common symptoms include,

  • Pain and dragging discomfort inside the vagina.

  • A feeling of something coming out of the vagina often feels like sitting on a ball.

  • A feeling of heaviness around the lower belly area and genitals.

  • Seeing or feeling a lump coming out of the vagina.

  • Pain, discomfort, or numbness during sex.

  • Problems during peeing include feeling like going to the toilet more often or leaking a small amount of pee when one sneezes, coughs, or exercises.

  • Loss of bowel control or constipation.

  • Spotting or bleeding from the vagina.

  • Problems while using tampons.

What Are the Risk Factors?

The following are risk factors for pelvic organ prolapse:

  • Multiple births, vaginal births, high birth weight kids, and tool-assisted deliveries.

  • Growing older.

  • Being overweight.

  • After undergoing pelvic surgery.

  • Enduring constipation, prolonged heavy lifting, or a continuing cough, such as that caused by chronic obstructive pulmonary disease that is causing discomfort.

What Is the Staging Method for Pelvic Organ Prolapse?

POP is categorized using the Pelvic Organ Prolapse Quantification (POP-Q) approach according to the degree of prolapse. From zero to four is the range of the scale. Stage Zero indicates that there has been no change in organ positioning. A full prolapse is indicated at stage four. Treatment will be based on the type and severity of the prolapse.

Is Pelvic Organ Prolapse Preventable?

By controlling the following risk factors, pelvic organ prolapse can be prevented.

  • Maintain Average Weight - Women who are overweight or obese have an increased chance of developing pelvic organ prolapse.

  • Prevent Constipation - Food rich in fiber can prevent constipation and strain during bowel movements.

  • Do not smoke, as smoking can affect tissues and cause a chronic cough.

  • Doing Kegel exercises can maintain good muscle strength in the pelvic area.

  • Avoid Heavy Lifting - In case of heavy lifting, use one’s legs and not use the back or abs.

Some risk factors cannot be controlled. They are:

  • Pelvic organ prolapse is associated with aging.

  • Family history of pelvic organ prolapse.

  • A complicated vaginal birth.

  • Surgical history of hysterectomy.

How Is Pelvic Organ Prolapse Diagnosed?

The doctor will take a medical history and examine the pelvic organs to check the strength of the pelvic floor muscles. If the physician suspects pelvic organ prolapse, if more than one organ has moved out of place, and if the patient has other related conditions, then a few tests are to be done to prevent the severity of the prolapse. The tests might include:

  • Intravenous pyelography (X-ray of the urinary tract) is used to view the kidney, bladder, and uterus and its working.

  • A bladder function test is carried out to check the working of the bladder and associated structures.

  • Cystourethrograms help check the bladder before and after urinating and analyze the condition of the ureter and bladder.

  • CT (computerized tomography) of the pelvis.

  • Ultrasound of the pelvic region shows the image of pelvic organs and their position.

What Is the Treatment for Pelvic Organ Prolapse?

According to the medical history and physical examination, the physician will recommend the treatment options. It may be non-surgical or surgical.

Non-Surgical Treatment:

  • Pelvic Floor Exercise - This exercise is also called Kegel exercise, which helps to strengthen the pelvic muscles by contracting and relaxing the muscles surrounding the opening of the vagina, urethra, and rectum.

  • The Pessary - It is a removable device inserted into the vagina to support the prolapsed pelvic organs. Certain types of pessary can treat both pelvic organ prolapse and urinary incontinence.

  • Dietary Changes - Doctors may recommend eating foods with fiber for people with bowel problems. The fiber in food helps prevent constipation and straining during bowel movements.

Surgical Treatment:

Surgery is not often recommended for patients with pelvic organ prolapse. It is recommended for women with severe pain and discomfort, affecting their day-to-day lives. Surgery is carried out depending on the following factors.

  • Age.

  • The severity of prolapse.

  • The severity of symptoms.

  • Sexual activity.

  • The desire for future children.

  • The organ has prolapsed.

Surgery is done to restore the normal position of the vagina, repair the tissue around the vagina and permanently close the vaginal canal with or without removing the uterus (colpocleisis). Surgery of pelvic organ prolapse can be done either through the abdomen or vagina, using stitches, or with the addition of surgical mesh. Some women with pelvic organ prolapse may experience problems with urine leakage. During surgery, a procedure is done to prevent or decrease urine leakage.

What Are the Complications of Pelvic Organ Prolapse (POP)?

Pelvic organ prolapse may increase the difficulty of simultaneous urine problems. Fecal incontinence and blockage can also be a serious POP consequence. While pessary treatment has a remarkable success rate, individuals should be aware of some consequences before receiving a pessary. Pessary issues should be suspected if the individual shows up for monitoring with discharge from the vagina, irritation, ulceration, bleeding discomfort, and ulceration of the vaginal wall. Women who change their pessaries fewer than once a week are at a higher risk of contracting anaerobe infections such as bacterial vaginosis. Mesh implantation has been linked to many POP treatment-related problems. The contentious use of biological tissue grafts and transvaginal mesh in prolapse surgery has prompted several investigations concerning the safety and effectiveness of these procedures.


Pelvic organ prolapse is not a life-threatening disorder. It occurs because pelvic floor tissues become weak, resulting in the prolapse of pelvic organs. The symptoms are not severe. There will only be slight discomfort and pain recorded in most cases. There are non-surgical and surgical treatment options. Only in rare instances, surgical treatments are performed.

Frequently Asked Questions


How Is Pelvic Organ Prolapse Treated?

Pelvic organ prolapse can be treated by kegel exercises to strengthen the muscles of pelvic, physical therapy, mechanical treatment, which includes insertion of a pessary (a small plastic device) into the vagina that supports the drooping organs, and surgical treatments such as laparoscopic, robotic, or open to repair or remove the prolapsed organ.


Is Pelvic Organ Prolapse a Serious Condition?

Pelvic organ prolapse is a condition where the pelvic organs plunge outside or into the vagina due to weak muscles and ligaments. It is not a serious life-threatening condition, but it can cause discomfort, a feeling of a bulge in the vagina, pain, loss of bowel control, backache, and incontinence.


What Are the Causes of Pelvic Organ Prolapse?

Causes of pelvic organ prolapse are vaginal delivery, chronic long-term cough, obesity, constipation, hysterectomy (surgical removal of the uterus), pelvic organ cancer, increased abdominal pressure due to heavy lifting, menopause, hypoestrogenism (low level of estrogen), advancing age and family history of pelvic organ prolapse.


Can Pelvic Organ Prolapse Be Cured?

Yes, pelvic organ prolapse can be effectively cured. In mild cases, physical therapy, kegel exercises, and insertion of a pessary, a small plastic device to support the weakened organs, can be used. In severe cases, surgical treatment is necessary, such as robotic, laparoscopic (minimally invasive surgical procedure), or open surgical procedure can be performed to repair the drooping organ or to remove it.


At What Age Does Pelvic Organ Prolapse Occur?

Half of the women between the age of 50 to 80 years have some degree of pelvic organ prolapse, which is mostly due to vaginal delivery and advancing age. Young adults who are above 30 years of age can develop this prolapse mainly due to chronic cough, lifting heavy objects, a history of surgical removal of the uterus, and having a high body mass index (BMI). Prolapse is uncommon in young adults who are below 30 years of age.


Can a Virgin Get Pelvic Organ Prolapse?

Virginity and pelvic organ prolapse have no connection. So, yes, a virgin can develop pelvic organ prolapse due to repeated application of pressure on the abdomen due to lifting heavy objects, constipation, long-term cough, and cancer of the uterus, bladder, or rectum.


Does Living With a Prolapsed Uterus Cause Problems?

A prolapsed uterus occurs due to weakened pelvic muscles. There are three stages; stage 1, prolapse, where the uterus drops into the upper part of the vagina, does not cause much discomfort. But in the case of stages 3 and 4, where the uterus protrudes and slips out of the vagina, can cause severe discomfort and may limit daily activities which require treatment such as vaginal pessary or surgical treatment.


Can Pelvic Organ Prolapse Be Treated Naturally?

When the prolapse is mild, natural measures such as physiotherapy and kegal exercises can prevent it from developing into a much worse condition. Kegel exercises strengthen pelvic floor muscles by relaxing and contracting the muscles of the pelvic floor.


Can Walking Cause a Problem In Case of Pelvic Organ Prolapse?

If there is a mild prolapse, walking does not cause any problems. With the help of aerobic and kegel exercises, it can be prevented by strengthening the muscles. In case of a severe noticeable bulge, walking can cause discomfort, sores can develop around the cervix along with bleeding, and can lead to infection.


When Does a Prolapse Cause a Problem?

Prolapse can cause a serious problem when there is pressure in the pelvic area, noticeable bulge out of the vagina, urine and fecal incontinence, loss of bowel control, bleeding from the vagina, and pain.


Is Pelvic Prolapse Normal?

It is a common condition, and about 50 percent of women have a mild form of pelvic prolapse. Above the age of  50 to 80 years, prolapse occurs due to vaginal delivery and advancing age. Above 30 years of age is due to having high body mass index, repeated extreme pressure on the abdomen by heavy lifting, cough that lasts for weeks, and constipation.


How Is Self-Examination Done For Pelvic Organ Prolapse?

Self-examination is done in a standing position, along with the mirror placed on the floor between the legs. The bladder should be empty, and muscles should be relaxed. With the help of a strong cough, the movements are observed; when the cervix or vaginal wall bulges like a small ball, then this signifies a prolapse. In the case of front vaginal wall prolapse, two fingers are inserted over the front vaginal wall, with a strong cough if there is a bulge under the fingers, it signifies prolapse.


How Does a Gynecologist Check For Pelvic Organ Prolapse?

A gynecologist may perform the pelvic exam in a lying or standing position; in severe cases, the bulge into the vagina is noticeable, and the doctor may ask to bear down the pressure as if during a bowel movement which indicates the degree of prolapse and strength of muscles. Other tests include an X-ray of the urinary tract, a bladder function test, and a cystourethrogram to analyze the condition of the bladder and ureter.  CT (computerized tomography) scan or an ultrasound of the pelvis is also recommended.


Who Is At Risk For Developing Pelvic Organ Prolapse?

Women who have undergone vaginal delivery have the highest risk. Other risk factors are menopause, smoking, obesity, advancing age, parity (number of births given by a woman), and being diabetic (a metabolic disease that causes increased blood sugar levels).
Dr. Sunita Kothari
Dr. Sunita Kothari

Obstetrics and Gynecology


pelvic organ prolapse
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