SEXUAL HEALTH CONCERN

Prolapse

Also called: prolapse, uterine prolapse, dropped womb

Pelvic organ prolapse occurs when one or more pelvic organs move downward because the muscles and supporting tissues of the pelvic floor have weakened.

TYPICALLY OCCURS

Childbirth, ageing, menopause and pelvic floor weakness

TREATED BY

Prolapse surgery, pessaries and pelvic floor therapy

ALSO LINKED TO

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Why it happens?

The pelvic floor is a network of muscles, ligaments and connective tissues that supports the bladder, uterus, vagina and bowel. Pelvic organ prolapse develops when these supporting structures become weakened, stretched or damaged, allowing one or more organs to descend towards or into the vagina. Different forms can occur depending on the structures involved, including uterine prolapse, bladder prolapse (cystocele), rectal prolapse into the vaginal wall (rectocele) and prolapse of the upper vagina following hysterectomy.

Pregnancy and vaginal childbirth are important risk factors because they can stretch or injure pelvic floor muscles and connective tissues. The likelihood of prolapse can also increase with age as supporting tissues naturally become less resilient. Hormonal changes after menopause may further influence pelvic tissues. Previous pelvic surgery, including hysterectomy, can alter the support structures within the pelvis in some people. Genetics and natural differences in connective-tissue strength may also explain why some individuals develop prolapse while others with similar childbirth histories do not.

Repeated or prolonged pressure within the abdomen can place additional strain on an already weakened pelvic floor. Chronic constipation and straining, persistent coughing, obesity and repeated heavy lifting may contribute to the development or progression of prolapse. Symptoms depend on which organs are involved and how far they have descended. Some people experience heaviness, dragging or pressure in the pelvis, while others notice tissue bulging from the vagina, urinary leakage, difficulty emptying the bladder, bowel difficulties or discomfort during sex. Importantly, the anatomical degree of prolapse does not always correspond with symptom severity, and not every prolapse requires treatment.

How far along is it?

Early

The pelvic organ has begun to descend but remains well within the vagina. There may be no symptoms, or mild pelvic heaviness or pressure may occur.

Moderate

The prolapse approaches the vaginal opening. Pressure, heaviness or a bulging sensation may become more noticeable, particularly after prolonged standing or physical activity. Bladder or bowel symptoms may also develop.

Advanced

Tissue reaches or extends beyond the vaginal opening. A visible or palpable bulge may be present, and symptoms can significantly affect movement, bladder or bowel function, sexual activity and everyday comfort.

What addresses it?

Treatments that address this

Uterine prolapse surgery→Perineal repair→

Professional assessment is worthwhile when you notice persistent vaginal pressure or heaviness, feel or see a bulge around the vaginal opening, or develop new bladder or bowel difficulties. Symptoms that interfere with exercise, work, sexual activity or everyday comfort are also a reason to seek advice.

Mild prolapse does not necessarily require surgery, and management depends on the type and severity of prolapse, symptoms, general health and individual circumstances. Assessment can establish which pelvic structures are involved and whether monitoring or active management is appropriate.

Quick Questions:

What does pelvic organ prolapse feel like?

Common symptoms include pelvic heaviness, dragging or pressure and a sensation that something is coming down into the vagina. Some people can feel or see a vaginal bulge, while others mainly experience bladder or bowel symptoms.

What causes pelvic organ prolapse?

Prolapse develops when pelvic floor muscles and supporting tissues weaken or become damaged. Pregnancy and childbirth, ageing, menopause, chronic constipation, persistent coughing, obesity and previous pelvic surgery can contribute.

Can pelvic organ prolapse get worse over time?

It can, although progression varies considerably. Some mild prolapses remain stable for years, while others become more noticeable, particularly when additional strain is placed on weakened pelvic floor tissues.

Does prolapse always require surgery?

No. Mild or moderately symptomatic prolapse may sometimes be managed with pelvic floor therapy, lifestyle measures or a vaginal pessary. Surgery may be considered when symptoms are significant or other approaches are unsuitable or unsuccessful.