Pelvic organ prolapse: patient guide
Understand pelvic organ prolapse: types, causes, severity, conservative treatment with PFMT and pessary, and when to consider surgery.
Pelvic organ prolapse (POP) is the descent of one or more pelvic organs —bladder, uterus, rectum or bowel— toward the vagina when pelvic floor supports no longer hold them in place. The most common types are cystocele, rectocele and uterine prolapse. In mild or moderate grades, conservative treatment with PFMT and, where appropriate, a pessary is the first option; surgery is usually reserved for severe symptomatic grades.
Pelvic organ prolapse is the descent of one or more pelvic organs —bladder, uterus, rectum or small bowel— toward or through the vagina. It happens when muscular and ligament supports of the pelvic floor are not strong enough to keep organs in position.
It affects 30–50% of women who have had children, although many early cases are asymptomatic or mild.
See the complete pelvic floor guide →
Types of prolapse
Cystocele: the bladder presses the anterior vaginal wall downward.
Rectocele: the rectum presses the posterior vaginal wall and may make defecation difficult.
Uterine prolapse: the uterus descends toward the vaginal canal.
Enterocele: the small bowel herniates through the vaginal vault.
Vaginal vault: prolapse of the vaginal vault after hysterectomy.
Severity grades
| Grade | Description |
|---|---|
| 0 | No prolapse |
| I | Most distal point is more than 1 cm above the hymen |
| II | Between 1 cm above and 1 cm below the hymen |
| III | More than 1 cm below the hymen |
| IV | Complete eversion |
Causes and risk factors
Vaginal birth, multiple births, overweight, chronic constipation, menopause and genetic predisposition can contribute to prolapse.
Conservative treatment: PFMT
PFMT is the first-line option for symptomatic grade I-III prolapse. Evidence shows it improves subjective symptoms, can reduce prolapse grade, improves quality of life and reduces progression in mild-to-moderate prolapse.
Explore the evidence sources →
Conservative treatment: pessary
A pessary is a silicone device inserted into the vagina to provide mechanical support to pelvic organs. It is reversible, avoids surgery and is compatible with PFMT or long-term use.
Surgery
Surgery is generally reserved for symptomatic grade III-IV prolapse that does not respond to conservative treatment. Surgery does not remove the risk factors that caused prolapse, so postoperative PFMT is fundamental for long-term maintenance.
FAQ
Does prolapse always worsen over time?
Not necessarily. With conservative treatment and risk-factor management, some prolapses remain stable and others may improve in symptoms.
Can I exercise if I have prolapse?
It depends on the grade and activity type. Low-impact sport is usually better tolerated with suitable modifications. High-impact activity in moderate-to-severe grades should be assessed individually.
Is a pessary permanent?
No. A pessary is reversible. Many women use it temporarily, for example for sport, or while doing PFMT.
Does prolapse surgery have good results?
Well-indicated prolapse surgeries have high success rates, but recurrence and complications are possible. Most guidelines recommend exhausting conservative options before surgery except in severe symptomatic grades.
Related articles
Learn what the pelvic floor is, which symptoms suggest dysfunction, and how to train it with evidence-based exercises.
Understand how menopause affects the pelvic floor, incontinence and prolapse risk, and how to adapt PFMT.
Understand stress, urgency and mixed incontinence, their main causes, and why PFMT is first-line conservative treatment.
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