Pelvic organ prolapse is one of the most common conditions in women’s health,
yet many women suffer in silence — unsure of what is happening, whether it is normal,
or what can be done. This guide covers the types of prolapse, how it is staged, and the
full range of treatment options from physical therapy and pessary support to surgical repair.
Pelvic organ prolapse (POP) occurs when weakened pelvic floor muscles
and connective tissue allow pelvic organs — the bladder, uterus, or rectum —
to descend into or through the vaginal canal. It is remarkably common: up to
50% of women who have given birth vaginally have some degree of prolapse
on examination, though many are asymptomatic ACOG PB #214.
Prolapse is classified by type (cystocele, rectocele, uterine, vault)
and stage (POP-Q system, Stage 0–IV). Conservative
treatment — including pelvic floor physical therapy and pessary devices —
is first-line for mild to moderate prolapse Cochrane 2020.
Surgical repair is considered when conservative measures fail or prolapse
is severe, with options ranging from native tissue repair to laparoscopic sacrocolpopexy
AUGS/SUFU 2021. At Broad Medical Group,
Dr. Jennifer Broad provides individualized prolapse evaluation and treatment
for women in Newport Beach and Orange County.
Medically reviewed by Dr. Jennifer Broad, MD, FACOGBoard-Certified Obstetrician-Gynecologist · Newport Beach, CA
Last reviewed: April 2026Next review: October 2026
What Is Pelvic Organ Prolapse?
The pelvic floor is a complex structure of muscles, ligaments, and
connective tissue that forms a supportive “hammock” at the base of the pelvis.
It holds the pelvic organs — the bladder, uterus, and rectum — in their
normal anatomic positions. When this support system weakens or is damaged, one or more
of these organs can descend (prolapse) into or through the vaginal canal.
Pelvic organ prolapse is extremely common. Studies estimate that up to
50% of women who have given birth vaginally have some degree of prolapse on physical
examination, though many have no symptoms and require no treatment. Symptomatic prolapse
— meaning prolapse that causes bothersome symptoms — is estimated to affect
approximately 3–6% of women.
Prolapse is classified by which organ or structure is descending:
Cystocele (Anterior Prolapse)
The bladder drops into the front wall of the vagina. This is the most common type
of prolapse and often causes urinary symptoms such as frequency, urgency, incomplete
emptying, or stress incontinence.
Rectocele (Posterior Prolapse)
The rectum pushes into the back wall of the vagina. May cause difficulty with bowel
movements, a sensation of incomplete evacuation, or the need to splint (press on the
vaginal wall) to facilitate defecation.
Uterine & Vault Prolapse
The uterus descends into the vaginal canal (uterine prolapse). In women who have
had a hysterectomy, the top of the vagina (vault) may descend instead (vaginal vault
prolapse). Both represent loss of apical support.
Many women have more than one type of prolapse simultaneously. For example, a woman
may have both a cystocele and uterine prolapse, reflecting generalized weakening of
pelvic floor support. The specific types present and their severity guide the treatment
approach.
Recognizing Prolapse Symptoms
Many Women Have Prolapse Without Symptoms
It is important to understand that anatomic prolapse does not always cause symptoms.
Many women have mild prolapse on examination that causes no discomfort and requires no
treatment. Intervention is recommended only when prolapse produces bothersome
symptoms that affect quality of life. The decision to treat — and how —
is always driven by the patient’s experience, not by the exam finding alone.
When prolapse does cause symptoms, the most common complaints include:
Pelvic pressure or heaviness — a feeling of fullness, weight,
or “something falling out” in the pelvis. This is often the most prominent
symptom and tends to worsen throughout the day, with prolonged standing, or with
physical activity.
Vaginal bulge — feeling or seeing a bulge at or protruding
from the vaginal opening. This is the symptom most specific to prolapse and is often
what prompts women to seek evaluation.
Urinary symptoms — stress urinary incontinence (leaking with
coughing, sneezing, or exercise), urinary frequency, urgency, difficulty starting
urination, or a sense of incomplete bladder emptying. Some women find they need to
manually reduce the prolapse (push the bulge back) to urinate effectively.
Bowel symptoms — difficulty with bowel movements, straining,
sensation of incomplete evacuation, or the need to apply pressure to the vaginal wall
(splinting) to complete a bowel movement. These are more common with rectocele.
Sexual dysfunction — discomfort during intercourse, vaginal
looseness, or self-consciousness about the bulge. Many women avoid discussing these
concerns, but they are common and treatable.
Lower back pain or pelvic aching — a dull ache in the lower
back or pelvis that worsens with activity and improves with lying down.
Symptoms typically worsen with gravity and exertion — standing, walking, lifting —
and improve with rest and lying down. Many women report that symptoms are mild in the
morning and progressively worse by evening.
Grades & Staging
POP-Q SystemACOG PB #214
Prolapse severity is measured using the Pelvic Organ Prolapse Quantification
(POP-Q) system, which is the standardized clinical staging system used
internationally. The POP-Q uses specific anatomic measurements taken during a pelvic
exam to assign a stage from 0 to IV.
Stage
Description
Clinical Significance
Stage 0
No prolapse
Normal pelvic support
Stage I
Most distal prolapse is >1 cm above the hymen
Mild — usually asymptomatic; observation and pelvic floor exercises
Stage II
Most distal prolapse is within 1 cm above or below the hymen
Moderate — may or may not cause symptoms; conservative treatment often effective
Stage III
Most distal prolapse >1 cm below the hymen but not complete eversion
Moderate-severe — typically symptomatic; surgical repair may be warranted
Stage IV
Complete eversion of the vagina or uterus
Severe — surgical repair usually recommended; may cause ulceration or obstruction
Clinical Illustration â€" Prolapse types (cystocele, rectocele, uterine prolapse) shown in side-view anatomic cross-section with labeled structures
Types of pelvic organ prolapse. Anterior (cystocele), posterior (rectocele), and apical (uterine) prolapse shown relative to normal anatomy.
The correlation between stage and symptoms is imperfect. Some women with Stage II prolapse
have significant bothersome symptoms, while others with Stage III have minimal complaints.
This is why treatment decisions are based on symptom burden and patient goals,
not stage alone. The staging system is most useful for standardizing communication between
providers and tracking changes over time.
Conservative Treatment
For women with mild to moderate prolapse (Stage I–II, and some
Stage III), conservative treatment is appropriate and often very effective. Even for women
who may eventually need surgery, conservative measures can provide symptom relief while
preparing for or delaying intervention. Conservative treatment is also the appropriate
choice for women who prefer to avoid surgery, are not medically suitable for surgery,
or have not completed childbearing.
Pelvic Floor Physical Therapy
Pelvic floor physical therapy (PFPT) is the first-line treatment
for mild to moderate prolapse. A Cochrane systematic review demonstrated that pelvic floor
muscle training can improve prolapse symptoms, reduce prolapse severity by one stage in
some women, and significantly improve quality of life.
Pelvic floor therapy goes far beyond “doing Kegels.” A specialized pelvic floor
physical therapist provides:
Assessment of pelvic floor muscle strength, coordination, and endurance
Individualized exercise programs targeting the specific muscles involved
Biofeedback training to ensure correct muscle activation (many women
perform Kegels incorrectly without guidance)
Education on posture, body mechanics, and daily habits that affect
pelvic floor function
Functional integration — learning to engage the pelvic floor during
activities like lifting, coughing, and exercise
Dr. Broad refers to specialized pelvic floor physical therapists and coordinates care to
ensure optimal outcomes.
Pessary
A pessary is a removable silicone device inserted into the vagina to
physically support the prolapsed organs. Pessaries have been used for centuries and remain
one of the most effective conservative treatments for prolapse of any stage.
Pessaries come in many shapes and sizes — ring, Gellhorn, donut,
cube, and others — and are fitted in the office. Dr. Broad will trial different
types and sizes to find the one that provides the best support while remaining comfortable.
A well-fitted pessary should not be felt during normal activities.
Key points about pessary use:
Can be used for any stage of prolapse — from mild to severe
Some types are designed to be self-managed (removed and cleaned by
the patient); others require periodic office visits for removal and cleaning
Vaginal estrogen cream is often recommended alongside pessary use to maintain
tissue health and prevent irritation
Pessaries can be used indefinitely as long-term treatment, or as a
bridge while deciding on or preparing for surgery
Sexual intercourse is possible with some pessary types (ring pessary) in place;
others need to be removed first
Patient Tip
A pessary fitting is a simple office visit. There are no incisions, no
anesthesia, and no downtime. Dr. Broad will try several options to find the right fit.
Many women experience immediate relief of their heaviness and bulge symptoms once a
well-fitting pessary is in place. If the first pessary does not work perfectly, adjustments
are normal — finding the right fit sometimes takes more than one visit.
Lifestyle Modifications
Supporting pelvic floor health through daily habits is an important complement to
physical therapy and pessary use:
Weight management — excess weight places additional pressure
on the pelvic floor. Even modest weight loss can reduce prolapse symptoms.
Avoiding heavy lifting — or learning proper lifting mechanics
that engage the pelvic floor and core to reduce strain.
Treating chronic cough — persistent coughing (from smoking,
asthma, or allergies) repeatedly increases intra-abdominal pressure and can worsen
prolapse. Smoking cessation is particularly important.
Managing constipation — chronic straining with bowel movements
is a significant contributor to prolapse. Adequate fiber, hydration, and stool softeners
can reduce straining.
Vaginal estrogen — for postmenopausal women, topical vaginal
estrogen can improve tissue quality, reduce urinary symptoms, and support pessary
tolerance.
Surgical Treatment
Surgery is considered when conservative treatment has failed to adequately
relieve symptoms, when prolapse is severe (Stage III–IV),
or when the patient prefers a definitive repair after understanding all
options. The goal of surgery is to restore normal anatomy, relieve symptoms, and
achieve a durable result.
Surgical options are individualized based on the type and severity of prolapse, the
patient’s anatomy, prior surgeries, medical comorbidities, sexual function goals,
and whether the patient has completed childbearing. Dr. Broad discusses all options
thoroughly so that each patient can make an informed decision.
Native Tissue Repair
Native tissue repair uses the patient’s own tissues — without
synthetic mesh — to reconstruct pelvic support. This includes anterior colporrhaphy
(for cystocele), posterior colporrhaphy (for rectocele), and uterosacral or sacrospinous
ligament suspension (for apical/uterine prolapse). Native tissue repairs avoid mesh-related
complications and are well-suited for many patients, though long-term recurrence rates are
higher than with some mesh-augmented approaches.
Sacrocolpopexy (Laparoscopic / Robotic)
Sacrocolpopexy is considered the gold standard for apical prolapse repair,
particularly vaginal vault prolapse after hysterectomy. A synthetic mesh is used to
suspend the top of the vagina from the sacrum (tailbone). When performed
laparoscopically or robotically, this procedure offers excellent long-term
durability with a minimally invasive approach — smaller incisions, less pain, and
faster recovery compared to open surgery. See our
minimally invasive surgery page for more on
laparoscopic techniques.
Hysterectomy with Vault Suspension
For women with uterine prolapse who have completed childbearing, hysterectomy
combined with vaginal vault suspension may be recommended. This removes the
prolapsed uterus and simultaneously repairs the vaginal support to prevent vault prolapse
in the future. This can be performed vaginally, laparoscopically, or robotically depending
on the clinical situation.
Uterine-Sparing Options
For women who wish to preserve their uterus — whether for future fertility, personal
preference, or cultural reasons — uterine-sparing prolapse repair is
an option. Procedures such as sacrohysteropexy (suspending the uterus from the sacrum)
or Manchester repair can address prolapse while preserving the uterus. Dr. Broad discusses
the relative advantages and limitations of uterine-sparing approaches compared to
hysterectomy-based repair.
Important Safety Information
The FDA has issued safety communications regarding transvaginal mesh for
prolapse repair. In 2019, the FDA ordered manufacturers to stop selling and
distributing transvaginal mesh products for pelvic organ prolapse repair due to
complications including mesh erosion, pain, infection, and organ perforation. This
applies specifically to mesh placed through the vagina. Mesh used in
abdominal sacrocolpopexy (placed through the abdomen, not the vagina)
was not included in this action and continues to have a strong safety and efficacy profile.
Dr. Broad thoroughly discusses the risks and benefits of all surgical options, including
the role of mesh when appropriate.
Risk Factors
Understanding the risk factors for pelvic organ prolapse helps with both prevention and
clinical decision-making. While some risk factors (like vaginal delivery and genetics)
cannot be changed, others (like obesity and chronic straining) are modifiable.
Vaginal delivery — the single biggest risk factor for prolapse.
The stretching and potential tearing of pelvic floor muscles and nerves during vaginal
birth, particularly with prolonged pushing, large babies, or forceps-assisted delivery,
is the primary mechanism of pelvic floor injury. Risk increases with each additional
vaginal delivery.
Aging — pelvic floor tissues naturally weaken with age,
independent of childbirth. Prolapse incidence increases steadily after age 50.
Menopause and estrogen decline — estrogen supports the
strength and elasticity of pelvic floor connective tissue. The decline in estrogen after
menopause contributes to tissue weakening and is one reason prolapse often worsens or
becomes symptomatic around and after menopause.
Obesity — increased body weight places chronic elevated
pressure on the pelvic floor. Weight loss is one of the most effective modifiable
interventions for reducing prolapse symptoms.
Chronic straining — from constipation, chronic cough, or
heavy lifting. Repeated increases in intra-abdominal pressure strain the pelvic
floor over time.
Genetics — some women have an inherited predisposition to
connective tissue weakness. Women with conditions such as Ehlers-Danlos syndrome or
joint hypermobility are at higher risk.
Prior pelvic surgery — including hysterectomy, which removes
one of the apical support structures and can predispose to vault prolapse if support
is not adequately addressed at the time of surgery.
Important Note
Having risk factors does not mean prolapse is inevitable. Pelvic floor
exercises during and after pregnancy, maintaining a healthy weight, managing constipation,
and treating chronic cough can all reduce your risk. If you have risk factors and are
noticing early symptoms, early evaluation allows Dr. Broad to implement conservative
strategies before the condition progresses.
Key Takeaways
Pelvic organ prolapse is very common — up to 50% of women who
have given birth vaginally have some degree of prolapse, though many have no symptoms
(ACOG PB #214).
Types include cystocele, rectocele, and uterine or vault prolapse,
classified by the POP-Q staging system (Stage 0–IV).
Conservative treatment is first-line for mild to moderate prolapse —
pelvic floor physical therapy, pessary devices, and lifestyle modification are effective
for many women (Cochrane 2020).
Surgery is individualized when conservative measures are insufficient.
Options include native tissue repair, laparoscopic sacrocolpopexy, and hysterectomy with
vault suspension.
The FDA transvaginal mesh action applies to vaginally placed mesh only —
abdominally placed mesh (sacrocolpopexy) was not affected and maintains strong evidence
for durability.
Treatment is based on your symptoms and goals — not staging alone.
Dr. Broad creates an individualized plan at Broad Medical Group.
References & Clinical Sources
American College of Obstetricians and Gynecologists. Practice Bulletin No. 214: Pelvic Organ Prolapse. Obstetrics & Gynecology, 134(5), e126–e142. 2019.
Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 12, CD003882. 2011. Updated 2020.
U.S. Food and Drug Administration. Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ Prolapse. FDA Safety Communication. 2019.
American Urogynecologic Society (AUGS) / Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU). Joint Position Statement on Mesh Midurethral Slings for Stress Urinary Incontinence. 2021.
If you are experiencing pelvic pressure, a bulge, urinary leakage, or bowel difficulties,
you do not have to accept these symptoms as normal. Dr. Broad provides compassionate,
thorough evaluation and individualized treatment at Broad Medical Group.
Medical Disclaimer: This content is for educational purposes only and does not
constitute medical advice, diagnosis, or treatment. Consult Dr. Jennifer Broad or your healthcare
provider for guidance specific to your situation. Current as of April 2026.
If you are experiencing a medical emergency, call 911 immediately.
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