Pelvic Organ Prolapse: When Your Support System Fails
If you’ve ever stood up at the end of the day and thought, “Why does it feel like everything is… lower?” - you’re not alone.
Pelvic organ prolapse is one of those conditions people whisper about, Google late at night, and feel deeply awkward bringing up at a doctor’s visit. Some people worry that something is going to completely fall out, or that they’ve done something wrong to cause it. Many are afraid to bring it up to friends, partners, or even their doctor - even though it’s very likely they know someone else going through the same thing. That silence can make prolapse feel isolating.
The truth is much calmer than that. Pelvic organ prolapse is common, manageable, and rarely dangerous. It’s a structural issue - not a personal failure - and there are multiple ways to approach it, including doing nothing at all.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse (often shortened to POP) is the medical term for when one or more pelvic organs shift downward because their support system weakens.
Your pelvic organs — including the uterus, bladder, rectum, and vaginal walls — are supported by pelvic floor muscles, ligaments, and connective tissue. When those supports stretch or weaken, the organs they hold up can descend lower than usual.
Many people are told they have “uterine prolapse,” which is one type of pelvic organ prolapse. In reality, it’s common for more than one structure to be involved, because they all rely on the same support system.
The Different “Types” of Pelvic Organ Prolapse
Over the years, the terminology around prolapse has shifted as medicine’s understanding of pelvic support has evolved. You may hear different names used depending on which organ appears to be affected the most.
· Uterine prolapse: the uterus descends downward
· Cystocele: the bladder presses into the front vaginal wall
· Rectocele: the rectum presses into the back vaginal wall
· Enterocele: the small intestine descends into the pelvic space
· Vaginal vault prolapse: prolapse of the top of the vagina after hysterectomy
While these names can sound intimidating, they’re all part of the same underlying issue: weakening of pelvic support structures. Many people have more than one type at the same time. Regardless of the name used, what matters most is how prolapse is affecting your quality of life — and what can be done to address it.
What Does Pelvic Organ Prolapse Feel Like?
Some people with pelvic organ prolapse have very few or no symptoms at all. When symptoms do happen, they often include:
· A feeling of pelvic pressure or heaviness
· A dragging or pulling sensation
· A feeling that something is “in the way” vaginally
· Symptoms that worsen at the end of the day or after standing for long periods
· Changes in how sex, tampons, or pelvic exams feel
· In more severe cases, changes in urinary or bowel habits
Importantly, pelvic organ prolapse is often not painful. Many people describe it more as discomfort, awareness, or pressure rather than sharp pain.
Why Does Pelvic Organ Prolapse Happen?
Pelvic organ prolapse is the result of multiple factors that can weaken the scaffolding of the pelvis, rather than one single cause. Common contributors include:
· Vaginal childbirth, especially prolonged pushing or delivery of larger babies
· Pregnancy itself, even if delivery was by C-section, due to sustained pressure on the pelvic floor
· Aging and menopause, as declining estrogen - and simply the passage of time - can weaken connective tissue
· Chronic pressure on the pelvis, such as long-standing constipation, frequent coughing, physically demanding or standing-heavy jobs, or heavy lifting
· Genetic differences in connective tissue strength
· Prior pelvic or gynecologic surgery (such as hysterectomy)
· Obesity, which can increase ongoing pressure on pelvic support structures
Pelvic organ prolapse can also develop when none of these risk factors are present. Not everybody follows the same rulebook.
How Is Pelvic Organ Prolapse Diagnosed?
Pelvic organ prolapse is typically diagnosed during a pelvic exam, often while bearing down. Many people first bring up symptoms with a primary care or women’s health provider, who can usually identify whether prolapse is present.
In most cases, patients are then referred to a urogynecologist — also called a female pelvic medicine and reconstructive surgery (FPMRS) specialist — for a more detailed evaluation. Imaging is rarely required unless another pelvic condition is suspected.
Degrees (Stages) of Pelvic Organ Prolapse
Clinically, prolapse is also described by stages, based on how far the organs have descended. Providers often use a standardized system called the POP-Q (Pelvic Organ Prolapse Quantification) exam, which involves measuring specific points in the vagina during an exam.
· Stage I (mild): organs are lower than usual but remain well inside the vagina
· Stage II (moderate): organs descend to or near the vaginal opening
· Stage III–IV (severe): organs protrude outside the vagina
One crucial point: the stage of prolapse does not always match how someone feels. Some people with early-stage prolapse have significant symptoms, while others with advanced prolapse feel relatively comfortable.
Treatment Options
Treatment for pelvic organ prolapse is based on symptoms — not appearance, exam findings, or expectations.
Conservative (Non-Surgical) Options
· Pelvic floor physical therapy to strengthen and retrain support muscles
· Vaginal estrogen for menopausal patients to improve tissue health
· Managing chronic pressure, such as improving bowel habits or modifying physical strain
These approaches are best at preventing prolapse from worsening and improving symptoms. They rarely reverse prolapse that has already occurred — but they can make a meaningful difference in comfort and function.
Pessaries
A pessary is a removable support device worn inside the vagina to help support prolapsed organs. Some people manage their pessary independently, while others prefer regular follow-up visits with their provider. Both approaches are common and valid.
Using a pessary is effective, flexible, and not a sign of failure.
Surgical Options
Surgery is considered when symptoms are severe or significantly affect quality of life. Options may include uterus-sparing repairs or hysterectomy-based approaches, depending on anatomy, symptoms, and personal goals. Some surgeries use mesh and others do not. Some are performed entirely through the vagina, while others involve surgery through the abdomen.
These options are complex and are reviewed in more detail in our dedicated article on pelvic organ prolapse surgery.
Possible Complications
Most pelvic organ prolapse does not lead to serious medical problems. Complications are uncommon and usually occur in higher-stage or more severe prolapse. When they do occur, they can include:
· Difficulty fully emptying the bladder
· Kinking or obstruction of the urethra
· Urinary retention or recurrent urinary tract infections
· Vaginal irritation or bleeding from exposed tissue
· Difficulty with bowel movements
These complications are uncommon, but they’re one reason it’s worth checking in with a provider if symptoms change or worsen.
What Happens If You Do Nothing?
For many people, pelvic organ prolapse is not dangerous and does not require urgent treatment.
· Progresses slowly, if at all
· Remains stable for long periods
· Fluctuates depending on activity, hormones, and time of day
Severe complications are rare. Decisions about treatment are guided by comfort and quality of life — not fear, and not how prolapse looks on an exam.
When Should You See a Doctor or Provider?
Consider seeing a provider if:
· Symptoms or worry are interfering with daily life or activity
· You’re having trouble emptying your bladder or bowels
· You notice vaginal bleeding or irritation
· Prolapse is affecting your sex life
· You simply want reassurance or clarity
Wanting to understand what’s going on in your body is reason enough.
The Bottom Line
Pelvic organ prolapse is common — even if it doesn’t feel that way, because most people don’t talk about it out loud. You didn’t cause it, and you didn’t fail. Sometimes support systems — including pelvic ones — just wear down over time.
Most cases are not dangerous, and many people live comfortably without intervention. If symptoms bother you, there are options. If they don’t, it’s okay to leave things alone.
Your body isn’t broken. It just deserves support — in whatever form that takes for you.
Tell us how you really feel
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