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Women's Health
Pelvic Organ Prolapse
A very common condition affecting up to half of women who have given birth — effective treatments are available to restore comfort and confidence.
Clinically Reviewed By
Honorary Associate Professor Jeremy Ockrim MD BSc(Hons) FRCS(Urol)
Consultant Urological Surgeon · Reviewed May 2026 · Review due May 2027
What is Pelvic Organ Prolapse?
Pelvic organ prolapse (POP) occurs when the muscles, ligaments, and connective tissues that form the pelvic floor become weakened or stretched, allowing one or more of the pelvic organs — the bladder, uterus, bowel, or vaginal vault — to descend from their normal position and bulge into or through the vaginal wall.
The pelvic floor acts like a supportive hammock, holding the pelvic organs in place. When this support system is compromised, the organs can shift downward under the influence of gravity, pressure from above, and everyday activities such as standing, coughing, or lifting.
Prolapse is remarkably common — studies suggest that up to 50% of women who have given birth have some degree of pelvic organ prolapse, although not all will experience troublesome symptoms. It is important to understand that prolapse is not dangerous and that highly effective treatments are available, ranging from simple lifestyle measures and physiotherapy to surgery.
Source: NICE NG123
You are not alone
Pelvic organ prolapse is one of the most common gynaecological and urological conditions. Many women feel embarrassed to seek help, but specialist assessment and treatment can make an enormous difference to quality of life. Our team provides compassionate, expert care in a confidential setting.
Types of Pelvic Organ Prolapse
Prolapse is classified according to which organ has descended and through which vaginal wall it protrudes. Many women have more than one type of prolapse simultaneously.
Cystocoele
Anterior Wall Prolapse
The bladder descends into the front (anterior) wall of the vagina. This is the most common type of prolapse and can cause urinary symptoms such as frequency, urgency or incomplete emptying.
Rectocoele
Posterior Wall Prolapse
The rectum (lower bowel) pushes into the back (posterior) wall of the vagina. This can cause difficulty with bowel movements and a feeling of incomplete emptying.
Uterine Prolapse
Uterus & Cervix
The uterus descends into the vaginal canal. In severe cases, it may protrude beyond the vaginal opening (procidentia). Uterine prolapse is usually combined with other compartment prolapse.
Vault Prolapse
Post-Hysterectomy
Following a hysterectomy, the top of the vagina (the vault) can lose its support and descend. This can occur months or even years after the original surgery.
Enterocoele
Small Bowel Prolapse
The small intestine herniates into the upper part of the posterior vaginal wall. This is less common and often occurs alongside vault prolapse after hysterectomy.
Symptoms of Pelvic Organ Prolapse
Symptoms vary depending on the type and severity of prolapse. Many women with a mild prolapse have no symptoms at all, while others may experience a combination of the following:
Primary Symptoms
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Dragging sensation — a feeling of heaviness or pulling in the pelvis, often worse by the end of the day
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Vaginal bulge or lump — a visible or palpable bulge at or beyond the vaginal opening
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Lower back pain — aching discomfort in the lower back that worsens with prolonged standing
Associated Symptoms
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Urinary symptoms — frequency, urgency, difficulty emptying, stress incontinence, or recurrent UTIs
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Bowel symptoms — constipation, incomplete emptying, or the need to digitally assist bowel movements
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Sexual difficulties — discomfort during intercourse, reduced sensation, or embarrassment affecting intimacy
Symptoms tend to worsen towards the end of the day, after prolonged standing, or following heavy lifting. They often improve when lying down.
What Causes Pelvic Organ Prolapse?
Prolapse develops when the pelvic floor is damaged or weakened. A number of factors increase the risk, and often several of these together contribute to prolapse developing:
Childbirth
Carrying a baby through pregnancy increases pressure on the pelvic floor. Multiple pregnancies increase the risk of prolapse (along with incontinence). Vaginal delivery is the single greatest risk factor, particularly prolonged or difficult labour, large babies, or forceps delivery. The muscles, nerves, and connective tissue of the pelvic floor can be stretched or torn during delivery.
Menopause & ageing
The drop in oestrogen levels after the menopause weakens the pelvic floor tissues. Collagen, which gives connective tissue its strength, becomes thinner and less elastic, making prolapse more likely to develop or worsen.
Heavy lifting & straining
Repetitive heavy lifting, whether occupational or recreational, places sustained downward pressure on the pelvic floor. Over time, this can weaken the support structures and contribute to prolapse.
Chronic cough & constipation
Chronic respiratory conditions, smoking-related cough, and long-standing constipation all cause repeated increases in abdominal pressure, gradually straining the pelvic floor.
Obesity
Excess body weight increases the load on the pelvic floor continuously. Weight management can reduce symptoms and lower the risk of prolapse progressing.
Previous pelvic surgery & connective tissue disorders
Previous hysterectomy or pelvic surgery can alter the support structures. Conditions affecting connective tissue, such as Ehlers-Danlos syndrome or hypermobility, may predispose some women to prolapse at a younger age.
How is Prolapse Diagnosed?
Diagnosis is usually straightforward and based on a careful clinical assessment. Your specialist will discuss your symptoms, medical and obstetric history, and then carry out an examination:
Clinical Examination
A gentle pelvic examination is performed to identify which compartments are affected and the degree of descent. You may be asked to cough or bear down to reproduce the prolapse. The examination is carried out sensitively and with full explanation.
POP-Q and Baden-Walker Grading Systems
Baden-Walker and Pelvic Organ Prolapse Quantification (POP-Q) systems are used to precisely measure the extent of prolapse, grading it from Stage 0 (no prolapse) to Stage 4 (complete eversion). This provides an objective record for monitoring and treatment planning.
Urodynamic Studies
If you have significant urinary symptoms, urodynamic testing may be recommended to assess how well your bladder stores and empties urine. This helps to identify any underlying bladder dysfunction and guides treatment decisions, particularly before surgery.
MRI (Complex Cases)
In complex or recurrent cases, a dynamic MRI of the pelvic floor may be performed. This provides detailed imaging of all three compartments — anterior (cystocoele), middle (uterine), and posterior (rectocoele) — and can reveal abnormalities not apparent on clinical examination alone.
Treatment Options
Treatment is tailored to the type and severity of your prolapse, your symptoms, your general health, and your personal preferences. Many women with mild-to-moderate prolapse can be managed effectively without surgery.
Conservative Management
Pelvic Floor Physiotherapy
Supervised pelvic floor muscle training (Kegel exercises) with a specialist women's health physiotherapist is the first-line treatment. A structured programme over 3-6 months can significantly improve symptoms, particularly for mild-to-moderate prolapse.
Vaginal Pessaries
A pessary is a removable device inserted into the vagina to support the prolapsed organs. Available in many shapes and sizes, pessaries are a safe and effective non-surgical option, particularly for women who are not suitable for or do not wish to undergo surgery. Pessary fitting and regular exchange should be monitored for comfort and safety (particularly vaginal skin irritation and erosion).
Lifestyle Modifications
Weight management, treating chronic cough or constipation, avoiding heavy lifting, and local (vaginal) oestrogen therapy after menopause can all help to reduce symptoms and slow the progression of prolapse.
Surgical Treatment
When conservative measures are not sufficient, or for moderate-to-severe prolapse, surgery may be recommended. The choice of procedure depends on the compartments affected, your age, general health, and whether you wish to preserve the uterus.
In general, prolapse surgery can be approached from the vagina to tighten the tissues, or from the abdomen to lift the pelvic organs.
Vaginal Surgery
Anterior (Cystocoele) & Posterior (Rectocoele) Repair (Colporrhaphy)
The traditional vaginal repair involves tightening the weakened tissue of the front (anterior) or back (posterior) vaginal wall using sutures. These procedures are performed through the vagina with no external incisions and have well-established outcome data.
Sacrospinous Fixation (SSF)
A vaginal operation designed to treat uterine or vault prolapse by suspending the top of the vagina to the sacrospinous ligament using stitches. It restores pelvic support without abdominal incisions, although it is generally less effective than abdominal surgery. It can be a good option for women with mild-to-moderate vault prolapse after hysterectomy.
Manchester Repair
A surgical procedure used to treat uterine or cervical prolapse (dropped womb) by amputating (shortening) the cervix and plicating (tightening) the cardinal ligaments, allowing the patient to keep their uterus. Often chosen to avoid hysterectomy, especially for women seeking to maintain their uterus.
Colpocleisis
A surgical treatment for severe prolapse that involves sewing the vaginal walls together to permanently support the pelvic organs. It is primarily performed on older, non-sexually-active women who are not fit for abdominal surgery, because it makes future vaginal intercourse impossible.
Abdominal Surgery
Colposuspension / Paravaginal Repair
A surgical procedure used to treat female stress urinary incontinence (leaking urine when coughing, sneezing, or moving) by lifting and supporting the bladder neck. It is often used as part of prolapse repair to support the anterior vaginal wall and correct cystocoele descent, and can be performed via open or keyhole (laparoscopic or robotic) surgery.
Mesh Sacrocolpopexy
A keyhole (laparoscopic or robotic) operation in which the top of the vagina or uterus is suspended to the sacrum (the base of the spine) using a synthetic mesh placed via the abdominal route. This remains the gold standard for vault prolapse, with the best anatomical and functional outcomes.
Mesh Sacrohysteropexy (Uterus-Preserving Surgery)
For women who wish to retain their uterus, hysteropexy involves suspending the uterus back to its normal position rather than removing it. This is increasingly recognised as a safe and effective alternative to hysterectomy for uterine prolapse.
Note on mesh: The UK mesh restrictions apply to vaginally-placed mesh — abdominally-placed mesh for sacrocolpopexy / sacrohysteropexy continues to be allowed and is not subject to the same pause. Mesh implants carry a small but important risk of mesh complications, such as mesh erosion or mesh pain.
Mesh-Free Approaches (Pioneering Autologous Sacrocolpopexy, Sacrohysteropexy & Rectopexy)
Following the NHS England pause on transvaginal mesh for prolapse repair, there is growing demand for mesh-free vaginal surgical options. Using the patient's own tissue and advanced surgical techniques, excellent outcomes can be achieved for vaginal prolapse repair without the risks associated with synthetic mesh implantation.
Honorary Associate Professor Ockrim is one of the surgical pioneers in the UK using autologous (patient's own) tissue grafts as an alternative to mesh implants, performing autologous sacrocolpopexy, sacrohysteropexy and rectopexy.
Our commitment to mesh-free options reflects our dedication to patient safety and the latest evidence-based practice.
Meet your Specialists
Assessment and treatment of pelvic organ prolapse is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
Pelvic organ prolapse is extremely common and nothing to be embarrassed about. Whether your symptoms are mild or more advanced, effective treatments are available — from supervised physiotherapy and pessaries to cutting-edge, mesh-free surgical repair. Early assessment means earlier relief, so please do not hesitate to seek expert advice.
Further Reading
Frequently Asked Questions
Pelvic organ prolapse (POP) is a condition in which one or more of the pelvic organs — the bladder, uterus, vagina, small bowel or rectum — descend from their normal position and bulge into the vaginal canal or beyond. It occurs when the pelvic floor muscles and supporting tissues become weakened or stretched. Prolapse is very common, particularly in women who have had children, and it can range from mild and asymptomatic to severe and life-limiting.
Common symptoms include a feeling of pressure or heaviness in the pelvis or vagina, a bulge or lump that can be felt or seen at the vaginal opening, discomfort during intercourse, difficulty emptying the bladder or bowel, urinary urgency and frequency, stress urinary incontinence, and low back or pelvic pain. Symptoms are often worse at the end of the day, after standing for long periods, or with lifting.
The main types are cystocoele (bladder prolapse into the front vaginal wall), rectocoele (rectum prolapse into the back vaginal wall), uterine prolapse (descent of the uterus into the vagina), vaginal vault prolapse (descent of the top of the vagina, usually after hysterectomy), and enterocoele (small bowel prolapse into the upper vagina). Many women have more than one type at the same time, and treatment is tailored accordingly.
Diagnosis is made from a detailed history and a careful pelvic examination — often performed in both lying and standing positions and with the woman straining, to assess the full extent of the prolapse. The extent is graded using the POP-Q or Baden-Walker systems. Additional tests such as urodynamic studies, and dynamic pelvic MRI proctography may be used if there are urinary symptoms or if surgery is being considered.
No — many women with prolapse are managed successfully without surgery. First-line options include supervised pelvic floor physiotherapy, lifestyle adjustments (weight management, treating constipation and chronic cough, avoiding heavy lifting) and vaginal pessaries, which are silicone devices worn inside the vagina to support the prolapse. Surgery is considered when non-surgical measures have not provided enough relief or when a woman prefers a more definitive solution.
Non-mesh surgery uses the woman’s own tissues to repair the prolapse and avoids the complications associated with synthetic mesh. Options include anterior and posterior colporrhaphy (native-tissue vaginal repair), vaginal hysterectomy with support of the vault, sacrospinous fixation, uterosacral ligament suspension, and autologous (mesh-free) sacrocolpopexy or sacrohysteropexy. The right procedure depends on the type and severity of the prolapse and the woman’s preferences.
Recovery depends on the operation but most women stay in hospital for 1 to 2 nights and return to light activity within 2 to 3 weeks. Heavy lifting, intense exercise and sexual intercourse are usually avoided for 8–12 weeks. Full recovery and healing of the internal repair takes around 3 months. Long-term outcomes are excellent for most women, with high satisfaction rates and durable results at 5 to 10 year follow-up.
Prolapse can recur after surgery, either in the same compartment or in a different one. Recurrence rates vary depending on the type of prolapse, the operation performed, and factors such as tissue quality, ongoing straining, chronic cough or heavy lifting. Careful surgical planning, treating all compartments together where necessary, and lifestyle measures after surgery all reduce the risk of recurrence. If prolapse does return, further treatment options are available.
Concerned About Pelvic Organ Prolapse?
Effective treatments are available. Book a consultation with one of our specialist consultants to discuss your symptoms and the treatment options available to you.