Pelvic Organ Prolapse: What It Is, the 4 Types, and How It’s Treated
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
Pelvic organ prolapse happens when the bladder, uterus, rectum, or other pelvic organs drop from their normal position and create a bulge in the vagina. It is caused by weakened pelvic floor muscles and tissues, most often from vaginal childbirth. Many cases improve with nonsurgical care such as pelvic floor exercises and pessaries, and surgery is an option when symptoms affect quality of life.
Quick Answer
Pelvic organ prolapse is a condition in which pelvic organs such as the bladder, uterus or rectum drop from their position because the pelvic floor has weakened, forming a vaginal bulge. It is most often linked to pregnancy, childbirth and menopause. Symptoms include pressure and urinary or bowel changes. Treatment ranges from pelvic floor exercises to pessaries and surgery. [1]
What the research says
Pelvic floor muscle training eases prolapse symptoms. A systematic review and meta-analysis of 13 randomized trials with 2,340 women found that those who did pelvic floor muscle training improved more than controls in prolapse symptom score (mean difference −3.07) and prolapse stage, and were more likely to say their prolapse was getting better (risk ratio 5.48) (Li et al., Int Urogynecol J, 2016).
Surgery beat a pessary-first approach, but most pessary users still improved. In a Dutch randomized trial of 440 women with symptomatic prolapse, 76.3% in the pessary group and 81.5% in the surgery group reported improvement at 24 months. Pessary-first care did not meet the trial’s criteria for being as good as surgery, and 54.1% of the pessary group crossed over to surgery (van der Vaart et al., JAMA, 2022).
Vaginal delivery, age, and weight raise the risk. A meta-analysis of 27 studies covering 47,429 women found that age (odds ratio 1.34), body mass index (odds ratio 1.75), and a levator muscle defect (odds ratio 3.99) were linked to a higher risk of primary prolapse, while cesarean delivery was protective. A higher prolapse stage before surgery predicted recurrence (odds ratio 2.68) (Schulten et al., Am J Obstet Gynecol, 2022).
Research summaries are based on article abstracts retrieved from PubMed.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse is a condition in which one or more pelvic organs drop from their normal position. When this happens, it makes a bulge in the vagina. That bulge is the prolapse. [1]
The pelvic organs include the vagina, bladder, uterus, urethra, and rectum. The muscles and connective tissues of the pelvic floor normally hold these organs in place. Prolapse happens when those muscles and tissues weaken. [1]
The weakening may be due to pregnancy, childbirth, or menopause. The condition is treatable, and nonsurgical treatment often helps. Sometimes surgery is needed to put the pelvic organs back in place. [1]
What Are the Symptoms of Pelvic Organ Prolapse?
Sometimes pelvic organ prolapse causes no symptoms at all. When symptoms do happen, they can affect urination, bowel function, and comfort. [1]
Symptoms may include:
Seeing or feeling a bulge of tissue at or beyond the opening of the vagina
Pelvic pressure, heaviness, or pain
Lower back pain
Not being able to keep in a tampon
Urinary changes, such as urinating more often, feeling an urgent need to urinate, not emptying the bladder all the way, or having a weak urine stream
Bowel changes, such as not emptying stool all the way
Having to put fingers in the vagina to support the bulge to pass stool. This technique is called splinting
Sexual issues, such as pain with sex
Weakness of the pelvic floor often affects more than one area. If one pelvic organ has prolapsed, you are more likely to have another type of pelvic organ prolapse as well. [1]
Symptom Area | What You May Notice |
Vagina | Bulge of tissue at or beyond the vaginal opening; can’t keep in a tampon |
Pelvis and back | Pressure, heaviness, pain, or lower back pain |
Urinary | Urinating more, urgency, incomplete emptying, weak stream |
Bowel | Incomplete stool emptying; splinting with fingers to pass stool |
Sexual | Pain with sex |
When Should You See a Doctor?
Make an appointment with a healthcare professional if you notice a vaginal bulge, pelvic pressure, or changes in urination or bowel habits that worry you. These symptoms are worth evaluating, and early evaluation helps identify the type of prolapse and your treatment options. [1]
For uterine prolapse specifically, you may see a gynecologist, a specialist in conditions affecting the female reproductive system. You may also see a urogynecologist, a specialist in pelvic floor problems and reconstructive surgery. [1]
Reason to Seek Care | What It Involves |
Vaginal bulge | Seeing or feeling tissue at or beyond the vaginal opening |
Pelvic pressure or pain | Pressure, heaviness, or lower back pain affecting daily life |
Urinary changes | Frequency, urgency, incomplete emptying, or weak stream |
Bowel changes | Difficulty emptying stool or needing splinting |
Treatment decision | Symptoms bothering you enough to discuss nonsurgical or surgical options |
What Causes Pelvic Organ Prolapse?
The cause of pelvic organ prolapse is the weakening of the tissues and muscles that support the pelvic organs. The most common cause is having a baby vaginally. [1]
The pelvic organs include the vagina, bladder, uterus, urethra, and rectum. The muscles and connective tissues of the pelvic floor normally hold these organs in place. When those supporting structures weaken — often through pregnancy, childbirth, or menopause — an organ can drop and form a bulge. [1]
Cause Factor | How It Contributes |
Weakened pelvic floor | Muscles and tissues that hold organs in place lose strength |
Vaginal childbirth | The most common cause of the tissue weakening |
Pregnancy | Stretches and stresses the pelvic floor |
Menopause | Can contribute to weakening of pelvic tissues |
What Are the Risk Factors?
The main risk factors for pelvic organ prolapse relate to childbirth, older age, obesity, prior pelvic surgery, ongoing strain on the pelvic floor and family history. [1]
The most important risk factors are having more than one baby, vaginal delivery, delivering high birth weight babies, and deliveries that use tools such as forceps. Being older and being obese also raise risk. [1]
Prior pelvic surgery is another risk factor. Ongoing strain on the pelvic floor matters too, such as straining from a chronic cough (for example, from chronic obstructive pulmonary disease), ongoing constipation, or ongoing heavy lifting. [1]
Family history plays a role as well. Having a family history of pelvic organ prolapse or of connective tissue conditions raises risk. [1]
Risk Factor | Why It Matters |
More than one baby | Repeated stress on pelvic floor tissues |
Vaginal delivery | The most common cause of the weakening |
High birth weight babies | More strain during delivery |
Tool-assisted deliveries | Forceps or vacuum add pressure during birth |
Being older | Tissues weaken with age |
Obesity | Extra pressure on the pelvic floor |
Prior pelvic surgery | Surgery can affect supporting structures |
Chronic cough (e.g., COPD) | Ongoing straining weakens tissues |
Ongoing constipation | Repeated straining during bowel movements |
Ongoing heavy lifting | Continuous strain on the pelvic floor |
Family history | Prolapse or connective tissue conditions run in families |
What Are the Possible Complications?
Pelvic organ prolapse can lead to prolapse of another organ, may not explain urinary or bowel symptoms and can return after surgery.
First, weakness of the pelvic floor often affects more than one area. If one organ has prolapsed, you are more likely to develop another type of pelvic organ prolapse. [1]
Second, the prolapse might not be the cause of urinary and bowel symptoms, although they can be linked. If those symptoms are not linked to the prolapse, then treatment for the prolapse might not improve them. [2]
Third, prolapse can come back after surgery. Surgery only repairs the tissue bulge; it does not repair the weakened tissues, so the prolapse might return. [2]
Concern | What to Know |
More than one prolapse | Pelvic floor weakness often affects multiple areas |
Unlinked urinary or bowel symptoms | Prolapse treatment may not improve symptoms not caused by the prolapse |
Recurrence after surgery | Surgery repairs the bulge, not the weakened tissues, so prolapse may return |
How Can Pelvic Organ Prolapse Be Prevented?
Lifestyle steps can help stop weakness in the pelvic floor tissues. These steps may keep the condition from getting worse and may also help keep symptoms from coming back after a surgical repair. [1]
The recommended steps are:
Quit smoking. Smoking is linked to chronic cough, which strains the pelvic floor.
Treat conditions that strain the pelvic floor, such as a long-term cough or constipation.
Lose weight to reduce pressure on the pelvic floor.
Strengthen your core and your pelvic floor with exercise.
Don’t lift heavy objects.
Don’t strain during bowel movements.
Prevention Step | How It Helps |
Quit smoking | Reduces chronic cough that strains the pelvic floor |
Treat chronic cough or constipation | Removes ongoing strain on pelvic tissues |
Lose weight | Lessens pressure on the pelvic floor |
Strengthen core and pelvic floor | Builds the muscles that support the organs |
Avoid heavy lifting | Prevents repeated strain |
Avoid straining during bowel movements | Protects weakened tissues |
How Is Pelvic Organ Prolapse Diagnosed?
Diagnosis of pelvic organ prolapse begins with a medical history and an exam of the pelvic organs. This helps the healthcare professional find the type of prolapse you may have. [2]
Some tests might also be needed. Pelvic floor strength tests check the strength of the pelvic floor and sphincter muscles during the pelvic exam, testing the muscles and ligaments that support the vaginal walls, uterus, rectum, urethra, and bladder. [2]
Bladder function tests may also be used. Some tests show whether the bladder leaks when it is held in place during the pelvic exam. Other tests measure how well the bladder empties. [2]
Imaging, such as MRI or ultrasound, might be used for people whose pelvic organ prolapse is complex. [2]
Diagnostic Step | What It Reveals |
Medical history and pelvic exam | The type of prolapse present |
Pelvic floor strength tests | Strength of the muscles and ligaments supporting the vaginal walls, uterus, rectum, urethra, and bladder |
Bladder function tests | Whether the bladder leaks when held in place; how well the bladder empties |
MRI or ultrasound | Details for complex cases of prolapse |
What Are the Different Types of Pelvic Organ Prolapse?
Prolapse is named for the organ and the vaginal wall involved. Understanding the type matters because the surgical approach depends on where the prolapse is and whether more than one area is involved. [2]
Anterior prolapse (cystocele) involves the front, or anterior, vaginal wall and most often involves the bladder. It is the most common site of prolapse. [1]
Posterior prolapse (rectocele) involves the rear, or posterior, vaginal wall and involves the rectum. [1]
Uterine prolapse involves the uterus dropping. [1]
Vaginal vault prolapse happens in people who have had a hysterectomy, when the top of the vagina loses its support and drops. This may involve the bladder and rectum, and the small bowel is often involved. When the small bowel is involved, the bulge is called an enterocele. [1]
Prolapse Type | Area Involved | Organ Most Often Involved |
Anterior (cystocele) | Front vaginal wall | Bladder; most common site |
Posterior (rectocele) | Rear vaginal wall | Rectum |
Uterine | Uterus drops | Uterus |
Vaginal vault | Top of vagina after hysterectomy | Bladder, rectum; small bowel (enterocele) |
How Is Pelvic Organ Prolapse Treated?
Treatment depends on your symptoms and how much they bother you. If your pelvic organ prolapse does not bother you, your healthcare professional might suggest no treatment or treating the prolapse without surgery. If symptoms get worse and affect your quality of life, you might need surgery. [2]
Medications
Many people with prolapse are also in menopause. Menopause lowers estrogen levels, and too little estrogen can weaken vaginal tissue and lead to vaginal dryness. Talk with your healthcare professional about whether treatment with estrogen is right for you. The use of vaginal estrogen might be an option. [2]
Physical Therapy
Your healthcare professional may suggest pelvic floor exercises using biofeedback to strengthen the muscles of the pelvic floor. Biofeedback uses monitoring devices with sensors placed in the vagina and rectum or on the skin. As you do an exercise, a computer screen shows whether you are using the right muscles. It also shows the strength of each squeeze, called a contraction. This helps you learn to do the exercises correctly. Over time, stronger pelvic floor muscles might help ease symptoms. [2]
Pessaries
Using a pessary is a nonsurgical way to support prolapsed pelvic organs. These silicone devices come in various shapes and sizes and are placed in the vagina to hold the pelvic organs in place. [2]
Some people who use pessaries can learn to take them out at night, clean them, and replace them in the morning. Others might need to visit their healthcare professional every three months to replace the pessary. [2]
Surgery
If your pelvic organ prolapse bothers you, surgery might help. The goals of surgery are to get rid of the vaginal bulge and improve some symptoms. Most often, the surgery corrects the prolapse and aims to put the pelvic organs back in place. This is called reconstructive surgery. The approach depends on where the prolapse is and whether there is more than one area of prolapse. [2]
Surgical Option | What It Involves |
Anterior prolapse repair (colporrhaphy) | Incision in the vaginal wall; bladder pushed up; connective tissue between bladder and vagina secured; extra tissue removed. A bladder neck suspension or sling may support the urethra if there is urinary incontinence |
Posterior prolapse repair | Connective tissue between vagina and rectum secured to make the bulge smaller; extra tissue removed |
Removal of the uterus for uterine prolapse if you don’t plan to have children | |
Vaginal vault repair | Through the vagina (using ligaments that supported the uterus) or abdomen (laparoscopic, robotic, or open; vagina attached to the tailbone, sometimes with small mesh pieces) |
For vaginal vault prolapse, an abdominal approach might be done laparoscopically, robotically, or as an open procedure. The surgeon attaches the vagina to the tailbone, and small pieces of mesh might be used to help support vaginal tissues. This operation is known as sacrocolpopexy. If you are concerned about the use of mesh materials, talk with the surgeon about the benefits and possible risks. [2]
Two important points about surgery deserve emphasis. Prolapse surgery only repairs the tissue bulge — if the bulge does not bother you, surgery is not needed. And surgery does not repair the weakened tissues, so the prolapse might come back. [2]
What About Alternative Medicine?
Alternative or complementary treatments for pelvic organ prolapse are not covered in the medical guidance this article draws on. If you are considering any alternative approach, discuss it with your healthcare professional first, since treatment decisions for prolapse are based on symptoms and how much they bother you.
How can people cope with and manage pelvic organ prolapse day to day?
Living with pelvic organ prolapse often comes down to daily habits that protect the pelvic floor. The lifestyle steps described in the prevention section — quitting smoking, treating chronic cough and constipation, losing weight, strengthening your core and pelvic floor, avoiding heavy lifting, and not straining during bowel movements — also serve as everyday management. [1]
Because treatment decisions depend on how much symptoms bother you, keeping track of your symptoms helps you have a useful conversation with your healthcare professional. Be clear about what improves or worsens your symptoms, and ask about all of your options, including no treatment, nonsurgical support, and surgery.
How should you prepare for a pelvic organ prolapse appointment?
For uterine prolapse, you may see a gynecologist or a urogynecologist. When you make the appointment, ask if there is anything you need to do beforehand, such as fasting before certain tests. [2]
What you can do. Before the appointment, make a list of your symptoms, including any that seem unrelated to the reason for your visit and when they began. Include key personal information such as major stresses, recent life changes, and family medical history. List all medicines, vitamins, or other supplements you take, including doses, along with your questions. If possible, take a family member or friend along to help you remember the information you are given. [2]
Questions to ask your healthcare professional:
What’s likely causing my symptoms?
What are other possible causes for my symptoms?
What tests do I need?
Is my condition likely to go away or be long-lasting?
What are my treatment choices?
I have other health conditions. How can I best manage them together?
Are there restrictions I need to follow?
Should I see a specialist?
Are there brochures or other printed material I can have? What websites do you think might be helpful?
Be sure to ask all the questions you have.
What to expect from your doctor. Your healthcare professional is likely to ask questions such as whether your symptoms come and go or are constant, how severe they are, and what seems to make them better or worse. [2]
Appointment Preparation | Details |
Before booking | Ask whether fasting is needed before certain tests |
Symptom list | All symptoms and when they began, including unrelated ones |
Personal information | Major stresses, recent life changes, family medical history |
Medicines and supplements | Everything you take, including doses |
Support | Bring a family member or friend to help remember information |
Conclusion
Pelvic organ prolapse is a common, treatable condition in which pelvic organs drop from their position because the supporting pelvic floor tissues have weakened, usually after vaginal childbirth, pregnancy, or menopause. Symptoms range from a noticeable vaginal bulge to urinary and bowel changes, though some people have no symptoms at all. Diagnosis starts with a pelvic exam and may include pelvic floor strength tests, bladder function tests, and imaging for complex cases. Treatment follows a stepwise path: lifestyle changes and pelvic floor exercises first, then pessaries and vaginal estrogen as nonsurgical options, and reconstructive surgery when symptoms affect quality of life.
Your next step: If you notice a bulge, pelvic pressure, or changes in urination or bowel habits, make an appointment with a gynecologist or urogynecologist. Write down your symptoms, your questions, and your daily habits so your visit leads to a clear treatment plan — and remember that many cases improve without surgery.
Related Reading
Learn more in our guide to Rectocele Repair: Surgery Types, Procedure, Risks and Recovery.
Frequently Asked Questions
What is pelvic organ prolapse?
Pelvic organ prolapse is when one or more pelvic organs, such as the bladder, uterus, or rectum, drop from their normal position because the pelvic floor muscles and tissues have weakened, forming a bulge in the vagina. It is treatable, often without surgery.
What does pelvic organ prolapse feel like?
Pelvic organ prolapse can feel like pelvic pressure, heaviness, or pain, lower back pain, a vaginal bulge you can see or feel, urinary changes such as frequency or a weak stream, and bowel changes such as difficulty fully emptying stool. Some people have no symptoms at all.
What causes pelvic organ prolapse?
The cause is weakening of the tissues and muscles that support the pelvic organs. The most common cause is having a baby vaginally. Pregnancy, childbirth, and menopause can all contribute to the weakening.
What are the 4 types of pelvic organ prolapse?
The four types are anterior prolapse (cystocele, involving the bladder and front vaginal wall), posterior prolapse (rectocele, involving the rectum and rear vaginal wall), uterine prolapse, and vaginal vault prolapse (after hysterectomy, sometimes with small bowel involvement called enterocele).
What is the most common type of pelvic organ prolapse?
Anterior prolapse, or cystocele, is the most common. It involves the front, or anterior, vaginal wall and most often involves the bladder.
What is splinting with pelvic organ prolapse?
Splinting is when you put fingers in the vagina to support the bulge in order to be able to pass stool. It is a bowel change symptom of pelvic organ prolapse.
What are the risk factors for pelvic organ prolapse?
Risk factors include having more than one baby, vaginal delivery, high birth weight babies, tool-assisted deliveries, being older, obesity, prior pelvic surgery, chronic cough, ongoing constipation, heavy lifting, and family history of prolapse or connective tissue conditions.
Can pelvic organ prolapse be treated without surgery?
Yes. Many cases improve with nonsurgical treatment. Options include lifestyle changes, pelvic floor exercises with biofeedback, vaginal estrogen, and pessaries — silicone devices placed in the vagina to hold the organs in place. If the prolapse does not bother you, no treatment may be suggested at all.
Does pelvic organ prolapse require surgery?
Not always. Surgery might be needed if symptoms get worse and affect your quality of life. Reconstructive surgery aims to put the organs back in place and get rid of the vaginal bulge, but surgery does not repair the weakened tissues, so the prolapse might come back.
What are the surgical options for pelvic organ prolapse?
Options include anterior prolapse repair (colporrhaphy) for the bladder, posterior prolapse repair for the rectum, hysterectomy for uterine prolapse if you don't plan children, and vaginal vault repair through the vagina or abdomen (sometimes with mesh) after a hysterectomy.
What doctor treats pelvic organ prolapse?
A gynecologist, who specializes in the female reproductive system, or a urogynecologist, who specializes in pelvic floor problems and reconstructive surgery, treats pelvic organ prolapse.
References
Mayo Clinic Staff. Pelvic organ prolapse — Symptoms and causes. Mayo Clinic. April 26, 2024. https://www.mayoclinic.org/diseases-conditions/pelvic-organ-prolapse/symptoms-causes/syc-20360557
Mayo Clinic Staff. Pelvic organ prolapse — Diagnosis and treatment. Mayo Clinic. April 26, 2024. https://www.mayoclinic.org/diseases-conditions/pelvic-organ-prolapse/diagnosis-treatment/drc-20562951
Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(7):981-992. PMID: 26407564. DOI: 10.1007/s00192-015-2846-y
van der Vaart LR, Vollebregt A, Milani AL, et al. Effect of pessary vs surgery on patient-reported improvement in patients with symptomatic pelvic organ prolapse: a randomized clinical trial. JAMA. 2022;328(23):2312-2323. PMID: 36538310. DOI: 10.1001/jama.2022.22385
Schulten SFM, Claas-Quax MJ, Weemhoff M, et al. Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis. Am J Obstet Gynecol. 2022;227(2):192-208. PMID: 35500611. DOI: 10.1016/j.ajog.2022.04.046
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have about a medical condition.
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