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Pelvic Organ Prolapse

What is Pelvic Organ Prolapse?

Learn more about pelvic organ prolapse.
Kathie Hullfish, MD, discusses pelvic organ prolapse.

Pelvic organ prolapse occurs when one or more of the pelvic organs (bladder, uterus, vagina, and rectum) fall downward and bulge out through the opening of the vagina. Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs.

While prolapse is not considered a life- threatening condition it may cause a great deal of discomfort and distress.

Types of Pelvic Prolapse

There are a number of different types of prolapse that can occur in a woman's pelvic area and these are divided into three categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. It is not uncommon to have more than one type of prolapse.

  • Cystocele (Fallen Bladder) - When the bladder falls down into the vagina it is referred to as a cystocele. When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall which may cause discomfort and difficulty emptying the bladder.
  • Uterine Prolapse (Fallen Uterus) - Uterine prolapse is when the womb drops down into the vagina. It is the second most common type of prolapse and is classified into three grades depending on how far the womb has fallen. This condition may cause discomfort and problems with difficulty having bowel movements.
  • Vaginal vault prolapse (Fallen/Bulging Vagina) - In women who have previously had a hysterectomy, it is still possible for the vagina itself to fall down even though the uterus is no longer present. This is referred to as a post hysterectomy ("after hysterectomy") vaginal prolapse. 
  • Enterocele (Bulging of small bowels) - An entrocele occurs when a space between the vagina andrectum opens and small bowel bulges through.
  • Rectocele (Bulging rectum)- If the rectum falls it is called a rectocele. This condition may cause discomfort and problems with difficulty having bowel movements.

Causes of Prolapse

  • Childbirth - During vaginal delivery a woman's muscles have to stretch in order for the baby to come through the vagina. Vaginal delivery may cause a ligament to break as the baby's head comes through the pelvic floor. When this occurs the muscle does not contract as it normally would. In most women the damage is minor, but in others enough muscle may be lost to the point that it can no longer hold the pelvic organs up.
  • Menopause - Decreased estrogen, such as during menopause, may also contribute to pelvic organ prolapse. During menopause, estrogen levels, collagen and certain connective tissue proteins decline.Causes of Prolapse, Anatomy
  • Obesity - Weight contributes to an increased pressure in the abdomen so women who are overweight often have a higher rate of pelvic organ prolapse.
  • Chronic cough - Chronic coughing caused by smoking, asthma or chronic bronchitis puts increased pressure on the abdomen and pelvis. Smoking alone reduces collagen and can increase the chances of a connective tissue tear.
  • Prior pelvic floor surgery - Prior surgery may cause damage to the support of the pelvic organs.
  • Neurologic diseases - Diseases affecting the nervous system such as Parkinson’s, multiple sclerosis or a spinal cord injury also increase the chances of developing pelvic organ prolapse.
  • Ethnicity/Race -Pelvic organ prolapse is found more often in women of Caucasian and Hispanic backgrounds.

Symptoms of Pelvic Prolapse

Do You Have These Symptoms?

You may also have:

Physical symptoms can include:

  • A bulge or lump on the outside of the vagina
  • Feeling as though something is bulging out of the vagina, like a tampon is about to fall out
  • Lower back pain or increased pelvic pressure that interferes with daily activities
  • Irregular vaginal spotting or bleeding
  • Frequent urinary incontinence, urinary tract infections, difficulty urinating, frequent urination or any of the above that interfere with a daily routine
  • Sexual intercourse that is painful or difficult
  • Difficult bowel movements, constipation, liquid stools

How We Diagnose Prolapse

An evaluation begins in your doctor’s office with questions about your health and health history. Pelvic organ prolapse occurs when one or more of the pelvic organs (bladder, uterus, vagina, and Prolapserectum) fall downward and bulge out through the opening of the vagina.

  • Pelvic Exam - usually done while you lie on an exam table, or sometimes while standing. The doctor may ask you to push down or cough to see the full extent of the prolapse. A pelvic exam may be performed where a speculum in inserted into your vagina. 
  • Rectal Exam - performed to check the strength of these muscles which can weaken with age or childbirth. 
  • Post-Void Residual (PVR) - used to determine how much urine is left behind after you urinate. 
  • Urinalysis - used to determine if you have an infection or other substances found in the urine. 

Stages of Pelvic Organ Prolapse

  • Stage 0 means that there is no prolapse. The pelvic organs like the vagina, bladder and rectum are perfectly supported by the ligaments in the pelvis.
  • Stage 1 means that there is virtually no prolapse. The pelvic organs are very well-supported by the ligaments in the pelvis.
  • Stage 2 prolapse means that the pelvic organs are not as well supported by the ligaments and have begun to fall down. In Stage 2 prolapse, the organs are still inside the vagina.
  • Stage 3 prolapse means the pelvic organs are beginning to bulge to or beyond the opening of the vagina.
  • Stage 4 prolapse means the pelvic organs are completely outside of the vagina.


Find out your pelvic organ prolapse treatment options at UVA.

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