Understanding Pelvic Organ Prolapse: Causes, Types, and Early Signs
- Catherine McKelvey
- Jun 24
- 5 min read
If you've ever felt a strange heaviness “down there,” a bulge, or just that something isn’t sitting quite right in your body, you’re not imagining it. And you’re definitely not alone.
Pelvic Organ Prolapse (POP) is notably more common in women over the age of 50 but can occur at a younger age (e.g. within our post-partum population). While the overall prevalence in the general population is estimated at 11.4%, this figure rises significantly to approximately 41% in women aged 50 and above.
Although the exact prevalence of POP remains uncertain, research indicates that 41–50% of women may show signs of prolapse during a physical exam. However, only a small proportion, around 3%, actually experience noticeable symptoms.
Pelvic Organ Prolapse is something many women experience, especially after childbirth, as we age, or from everyday activities that may be placing added stress on our bodies such as repetitive heavy lifting. Even though it’s common, it’s not often talked about. It can leave you feeling confused, isolated, or even a little embarrassed.
So let’s talk about it. Openly. Kindly. In a way that makes sense. Because the more you understand what’s happening in your body, the more empowered you are to support it and gain support for it.
Key Points:
The definition of Pelvic Organ Prolapse is the descent of at least one of the vaginal walls to or beyond the hymen with maximal Valsalva effort, WITH the presence of bothersome characteristic symptoms, most commonly the sensation of vaginal bulge, or of functional or medical compromise due prolapse without symptoms.
To improve symptoms we need to restore support to the pelvic organs, not treat the organs themselves as the organs are not damaged.
What is Pelvic Organ Prolapse?
Your pelvic organs, like your bladder, uterus, or bowel, are held in place by muscles and fascial tissue inside your pelvis. The pelvic organs themselves are NOT damaged, it is the structures that are supporting the various portions of the vagina and uterus that are. If those structures become weakened or overstretched, which can happen for lots of reasons, the organs can start to drop or press into the vaginal wall. This doesn’t necessarily happen as soon as there is a pelvic floor muscle or fascial deficiency and can occur over time.
The definition of Pelvic Organ Prolapse is the descent of at least one of the vaginal walls to or beyond the hymen with maximal Valsalva effort, WITH the presence of bothersome characteristic symptoms, most commonly the sensation of vaginal bulge, or of functional or medical compromise due prolapse without symptoms.
Clients often describe symptoms such as, it feels like a bulge, a dragging heaviness, or like something is “falling out.” It might be mild and barely noticeable. Other times, it can affect how you move, exercise, go to the toilet, or just how you feel in your own body.
To improve symptoms we need to restore support to the pelvic organs, not treat the organs themselves.
The Types of Prolapse (yes, there’s more than one)
Pelvic organ prolapse is typically classified based on which part of the vaginal wall is affected and which organ is descending:
Anterior Vaginal Wall Prolapse of the bladder causing the front wall of the vagina to bulge.
Posterior Vaginal Wall Prolapse of the rectum causing the back wall of the vagina to bulge.
Uterine Prolapse is the descent of the uterus (cervix) into the vaginal canal.
Enterocele Prolapse is the descent of the small intestine into the vaginal space.
Vaginal Vault Prolapse is the descent of the top of the vagina (vaginal “vault”) after a hysterectomy.
You can have more than one type at the same time. That’s why thorough assessment is so important.
What are the Signs & Symptoms of Prolapse?
Every woman’s experience is different. Symptoms vary depending on how severe the prolapse is and your overall physical health. They can include:
Dragging or heavy feeling in your vagina
A “something’s falling out” of your vagina sensation
Noticing a bulge at the entrance of your vagina
A dull ache in the lower back or lower abdomen
Leaking or trouble emptying your bladder
Painful intercourse or less sensation with intercourse
In severe cases, the vaginal wall or cervix may protrude outside the vaginal opening. Bleeding, discharge, or infection may also occur in more severe cases.
Some women feel very little and only discover the prolapse during a routine check-up. Others feel these symptoms daily. Either way, there is help available.
What Causes Pelvic Organ Prolapse?
Anything that puts additional pressure on your pelvic floor muscles can lead to prolapse. Common causes include:
Pregnancy and Childbirth: The pelvic floor undergoes significant strain during pregnancy and delivery. Even with a caesarean birth, carrying a baby for nine months places pressure on these muscles and tissues.
Ageing and Menopause: As estrogen levels decline with age, the pelvic tissues can lose strength and elasticity.
Chronic Intra-Abdominal Pressure: Ongoing pressure within the abdomen can weaken pelvic support. This may result from:
Constipation or regular straining during bowel movements
Repetitive heavy lifting (e.g. at work, the gym, gardening, or lifting children)
Chronic coughing (due to asthma, smoking, or illness)
Obesity or significant weight gain
Genetic Predisposition: Some individuals have naturally weaker connective tissues, making them more susceptible.
Pelvic Surgery: Procedures like a hysterectomy can disrupt the support structures of the pelvic organs.
Connective Tissue Disorders: Conditions such as Ehlers-Danlos syndrome or Marfan’s syndrome can affecmt tissue strength and resilience.
Pelvic Floor Muscle Dysfunction: Weak, tight, or imbalanced pelvic floor muscles can contribute to poor support and prolapse.
Severity of Prolapse
The severity or stage of a prolapse is determined by how far the pelvic organ (such as the bladder, uterus, or bowel) has descended into or beyond the vaginal opening. This helps guide treatment and management options.
There are four stages of prolapse:
Stage 1: Mild Prolapse
A mild prolapse where the affected organ bulges slightly into the upper half of the vagina. Often, there may be no obvious symptoms at this stage.
Stage 2: Moderate Prolapse
The organ descends further and reaches the lower half of the vagina, possibly near the vaginal opening. This is when many women start noticing pressure or a dragging sensation.
Stage 3: Advanced Prolapse
The organ or vaginal wall begins to protrude (bulge) outside the vaginal opening. Discomfort and more noticeable symptoms are common here.
Stage 4: Complete Prolapse (Procidentia)
A severe prolapse where the organ is completely outside the vaginal opening. This can interfere with daily activities and usually requires more involved treatment.
Each stage affects women differently. Some may feel minimal discomfort even with a higher-grade prolapse, while others experience more symptoms earlier on.
Learn more about what you can do to reduce your risk of prolapse or support your recovery:
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