What Causes Pelvic Organ Prolapse? Symptoms, Risk Factors and Treatment

What Causes Pelvic Organ Prolapse? Symptoms, Risk Factors and Treatment

Pelvic organ prolapse (POP) affects millions of women worldwide, yet it remains under-discussed and underdiagnosed. If you feel a bulge or pressure in your pelvis, or have been recently diagnosed, this guide explains what’s happening inside your body, why it happens, and what can be done — including non-surgical options like a vaginal pessary for prolapse.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles, ligaments, and connective tissues of the pelvic floor weaken, allowing one or more pelvic organs to descend (prolapse) from their normal position into or through the vaginal canal.

The pelvic organs that can prolapse include:

• Bladder (cystocele — the most common type)
• Uterus (uterine prolapse)
• Rectum (rectocele — back wall prolapse)
• Small bowel (enterocele)
• Vaginal vault (vault prolapse — in women who have had a hysterectomy)

Prolapse is graded in stages from I (mild — organ descends slightly) to IV (complete prolapse beyond the vaginal opening). Most women with prolapse are Stage I–III.

What Causes Pelvic Organ Prolapse?

The pelvic floor is a hammock of muscles and connective tissue supporting the bladder, uterus, and bowel. When this support system weakens or tears, prolapse can occur. The most common causes and risk factors include:

• Childbirth — especially vaginal deliveries, large babies, long labours, or instrumental deliveries (forceps/vacuum). This is the single biggest risk factor.
• Menopause — falling oestrogen levels reduce collagen and tissue elasticity in the pelvic floor.
• Chronic straining — constipation, chronic cough, or heavy lifting increases downward pressure on the pelvic floor over time.
• Ageing — natural tissue changes reduce support strength over decades.
• Obesity — excess body weight increases constant downward pressure.
• Genetics — some women have naturally weaker connective tissue (hypermobility conditions like Ehlers-Danlos syndrome increase risk).
• Previous pelvic surgery — including hysterectomy.

Symptoms of Pelvic Organ Prolapse

Symptoms vary by prolapse type and severity. Common signs include:

• A feeling of heaviness, pressure, or dragging in the pelvis — often worse after standing or exercise
• A bulge or lump at or beyond the vaginal opening
• A sensation that something is “falling out”
• Urinary leakage with coughing, sneezing, or exercise (stress urinary incontinence)
• Difficulty fully emptying the bladder or needing to apply manual pressure (with a cystocele)
• Constipation or difficulty emptying the bowel (with a rectocele)
• Reduced sensation or discomfort during intercourse

Many women with Stage I–II prolapse have no symptoms at all and only discover it during a routine examination.

Treatment Options for Pelvic Organ Prolapse

1. Pelvic Floor Physiotherapy

The first-line recommendation for most women. A pelvic floor physiotherapist teaches targeted Kegel exercises and lifestyle modifications to strengthen the pelvic floor and reduce prolapse symptoms. Evidence shows this is effective for Stage I–II prolapse and improves quality of life across all stages.

2. Vaginal Pessary for Prolapse

A pessary for prolapse is a removable silicone device inserted into the vagina to mechanically support prolapsed organs. The most commonly prescribed type is the ring pessary (vaginal ring pessary), which is easy to self-manage at home.

Pessary use is appropriate for:

• Women who want to avoid or delay surgery
• Women who are pregnant or planning pregnancies
• Women with health conditions that make surgery higher risk
• Any woman with symptomatic prolapse who prefers a non-surgical approach

Studies show that up to 60–70% of women successfully use a pessary long-term. The Ring Pessary With Support from SciMed Store is available in all sizes for fast delivery.

3. Lifestyle Modifications

Weight loss, treating chronic constipation, stopping smoking (to reduce coughing), and avoiding heavy lifting can slow prolapse progression and improve symptoms.

4. Topical Oestrogen

Post-menopausal women may benefit from local oestrogen therapy (vaginal cream, pessary, or ring) to improve tissue quality in the vagina and pelvic floor. This does not treat prolapse directly but supports other treatments.

5. Surgery

Surgical repair (colporrhaphy, sacrocolpopexy, or hysterectomy) is reserved for women with significant symptoms who have not responded to conservative treatment. Surgery is generally effective but carries risks and has a recurrence rate of 10–30%. It is usually not recommended for women who plan future pregnancies.

When Should I See a Doctor?

See your GP, gynaecologist, or pelvic floor physiotherapist if you have any of the prolapse symptoms listed above, or if you have been diagnosed and are looking for treatment options. Early intervention produces better outcomes.

Explore Your Pessary Options

Browse our complete vaginal pessaries guide or shop our best-selling Ring Pessary With Support — available in Sizes 0–8, USA-stocked, fast delivery nationwide.