Pelvic organ prolapse sounds much more intimidating (and slightly catastrophic) than it actually is.

The condition is quite common, yet underdiagnosed and undertreated. This is largely due to patients waiting years to seek care, either because they assume symptoms are natural consequences of postpartum or aging, or because they feel too embarrassed by the experience.

While these are understandable feelings, neither should prevent you from seeking answers and treatment with a urogynecologist. Pelvic organ prolapse is a largely treatable condition, and for those with it, life will likely feel much better once symptoms are addressed.

What is pelvic organ prolapse?

First, a quick anatomy lesson. Your pelvic floor is made up of muscles, ligaments and connective tissue that support your pelvic organs: the bladder, urethra, uterus, vagina, rectum and small intestine. Think of it as a hammock that holds everything in its place so that each can properly function.

When that support system weakens or stretches, one or more of these organs can bulge into the vagina. When that happens, it’s called pelvic organ prolapse. It may feel like a “bulge,” “pressure” or as if “something is falling out”–which, understandably, doesn’t feel great. Those who have it may also leak urine or bowel contents.

While prolapse can be physically uncomfortable or unsettling, it’s not dangerous. It’s also surprisingly common, affecting one in four women in their 40s and one in three in their 60s.

Causes and risk factors of pelvic organ prolapse

There’s no single cause of prolapse. It’s usually the result of several overlapping factors.

Common causes can include:

  • Pregnancy and childbirth, which stretches the pelvic floor muscles
  • Obesity, which increases pressure on the pelvic floor over time
  • Chronic constipation with repeated straining that worsens pelvic support
  • Genetics or connective tissue disorders, which can make support structures more prone to weakening
  • Continual and forceful coughing
  • Extreme, repeated heavy lifting

Life stages that naturally increase your risk:

  • Postpartum – During this time, the pelvic floor needs to heal, but it also needs strengthening. Around 6-8 weeks after birth, gentle exercises can help recondition these muscles.
  • Perimenopause – As estrogen levels decline, the pelvic tissues become thinner and less elastic, increasing the risk of prolapse or worsening existing symptoms like incontinence.

Signs of pelvic organ prolapse and when to seek treatment

Pelvic organ prolapse doesn’t always show up all at once, but when it does, it can catch you off guard. It can happen suddenly, for example, while bearing down during a tough workout. Usually, this happens when what was once a mild weakness in the pelvic floor gives way.

More commonly, the signs are slower and more subtle, making them easier to dismiss.

Common signs to watch for include:

  • A vaginal bulge or pressure
  • The feeling that something is falling out of your vagina
  • A heaviness or dragging sensation in the pelvis
  • Discomfort during activities like walking or exercising

People often describe bladder issues—leaking urine, struggling to fully empty or feeling pressure in the lower back. Sex might feel different or uncomfortable.

It’s important to distinguish between what’s normal and what’s not. Yes, your vulva and vagina may look or feel different after something like childbirth. But a symptom that impacts your ability to move comfortably, enjoy your daily routine or feel at ease in your body is not normal. It deserves care, and that’s when you should seek treatment with a urogynecologist.

Your options for treating pelvic organ prolapse

If you suspect you might have pelvic organ prolapse, diagnosis will begin with a conversation—what’s bothering you, when symptoms show up and how they’re affecting your daily life. From there, a pelvic exam will provide more information. You may be asked to bear down or push to help your provider see which organ is prolapsing and by how much.

If you receive a diagnosis, treatment is never one-size-fits-all. And it’s important to know that prolapse doesn’t require emergency care. We treat it when—and only when—it bothers you, so we may not need to do anything at all. You get to decide when symptoms cross that line.

There are two non-surgical treatment options offered as the first line of defense:

  • Pelvic floor physical therapy is proven to reduce symptoms and severity and is a great first step for many people.
  • Pessaries are small, silicone support devices (similar to a diaphragm) worn in the vagina that help hold pelvic organs in place. Some are removable and self-managed, while others are maintained during office visits. Many of my patients find them surprisingly effective and easy to use.

If surgery is needed, there are two main options:

  • Native tissue repair uses your own tissues to support the prolapsed organs. With this, prolapse has a recurrence rate of about 20-30%.
  • Mesh-augmented repair uses a lightweight, medically safe mesh for added durability. This approach has a lower recurrence rate (around 1-2%) and uses mesh that’s placed differently than the older vaginal mesh kits you may have heard concerns about. This updated method has been used safely for decades.

Surgery isn’t the first step, and it’s not for everyone. But for those who need it, it can be transformative. That said, prolapse can return, even after surgery. This isn’t a failure; it’s part of how the body changes over time.

To reduce the chance of recurrence, it’s important to:

  • Manage and reduce any constipation through a healthy diet
  • Maintain a healthy-for-you weight
  • Continue pelvic floor strengthening exercises long-term

How pelvic floor treatment can improve your quality of life

Many people don’t realize how much prolapse has been shaping their routines until after they’ve been treated. Maybe they’ve been avoiding exercise, or constantly checking for the nearest bathroom “just in case.” These coping strategies are so ingrained that they can feel invisible until they’re no longer necessary.

Even small changes, like starting pelvic floor physical therapy, can make a difference in pelvic organ prolapse symptoms and help breathe a sigh of relief back into your life.

At WHA, we take your symptoms seriously, even if others haven’t, and we’ll empower you with the information to help you decide what’s best for your body and your life. Pelvic organ prolapse is a treatable condition that is absolutely worth addressing.

If something in your body doesn’t feel right, we’re here to help. Talk with your provider today. Find a provider >