Pelvic organ prolapse is common, but with the right support many women can continue to live active, confident lives.
Many women experience symptoms such as vaginal heaviness, a dragging sensation, bladder problems or the feeling of “something coming down” but are often unsure what is causing it.
These symptoms may be due to pelvic organ prolapse, a common condition that affects many women, particularly after childbirth and during or after the menopause.
The good news is that there are several treatment options available, and surgery is not always necessary.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when the muscles and tissues that support the pelvic organs become weakened.
As a result, one or more pelvic organs may bulge into the vaginal wall.
This may involve:
- The bladder (cystocele)
- The uterus
- The bowel (rectocele)
- The top of the vagina in women who have previously had a hysterectomy
Prolapse is common and often becomes more noticeable over time.
What Symptoms Can Pelvic Organ Prolapse Cause?
Symptoms vary from woman to woman, but may include:
- A feeling of heaviness, fullness or pressure in the vagina or lower abdomen.
- A sensation that something is “coming down” or a feeling of a lump or bulge in the vagina.
- Seeing or feeling a bulge at the entrance to the vagina.
- Bladder problems, such as leaking urine, needing to rush to the toilet or difficulty emptying the bladder completely.
- Bowel problems, including constipation or a feeling that the bowel has not emptied fully.
- Discomfort, pain or reduced sensation during sexual intercourse.
- Lower back pain or a dragging sensation in the pelvis.
Some women experience only mild symptoms, whilst others find that prolapse has a significant impact on their daily activities, exercise, confidence and quality of life.
Why Does Pelvic Organ Prolapse Happen?
Pelvic organ prolapse is extremely common and often develops as a result of several factors occurring together over time.
Common causes and risk factors include:
Childbirth
Vaginal delivery is one of the most common causes, as pregnancy and childbirth can stretch and weaken the muscles and tissues that support the pelvic organs.
Ageing and Menopause
As oestrogen levels decline during and after menopause, the pelvic tissues naturally become thinner, less elastic and less supportive.
Chronic Pressure
Anything that repeatedly increases pressure inside the abdomen can contribute to prolapse. This includes chronic coughing, obesity, long-term constipation, repeated straining and regular heavy lifting.
Genetics
Some women inherit connective tissues that are naturally less strong or elastic, making them more prone to prolapse.
Most women who develop prolapse have more than one of these risk factors, and it is important to remember that prolapse is common and not something you have caused or brought upon yourself.
What Can Be Done About Pelvic Organ Prolapse?
The good news is that there are several effective treatment options available, and surgery is not always necessary.
The best approach depends on the severity of symptoms, the type of prolapse and your individual circumstances.
Pelvic Floor Training
For many women, pelvic floor exercises are the first step.
Strengthening the pelvic floor muscles can improve support, reduce symptoms and help prevent prolapse from worsening.
Working with a specialist women’s health physiotherapist can be particularly helpful, as they can ensure you are exercising the correct muscles and using the right technique.
A Simple Pelvic Floor Exercise Plan
Step 1: Find the Right Squeeze
Think about the muscles you would use to stop yourself passing wind and wee at the same time, then gently squeeze and lift them upwards.
You should feel a lifting and tightening sensation inside the pelvis.
Practise this when you don’t actually need to wee.
Step 2: Practise the Squeeze
Long Squeezes
Tighten and lift the pelvic floor muscles and hold the contraction for up to 10 seconds.
If you can only manage a few seconds initially, that is perfectly normal. Gradually build up over time.
Relax fully for 5 seconds between each contraction.
Aim for:
✓ 10 long squeezes
Short Squeezes
Tighten and lift the muscles quickly, then release.
Aim for:
✓ 10 short squeezes
Complete the routine three times each day.
Like any muscle group, the pelvic floor becomes stronger with regular practice. Consistency is more important than perfection.
Many women find it helpful to link their exercises to daily routines such as brushing their teeth, waiting for the kettle to boil or sitting at traffic lights.
Weight Management
Excess weight increases pressure on the pelvic floor and may contribute to prolapse symptoms.
Even modest weight loss can reduce this pressure and improve symptoms.
If weight management is an area you would like support with, you may find our article The Truth About Weight Loss: It’s Not Really About Weight and our 4-Week Metabolic Health Reset helpful starting points.
Bowel Care
Constipation and straining place significant pressure on the pelvic floor.
Simple measures can make a real difference, including:
- Eating a high-fibre diet
- Drinking adequate fluids
- Regular physical activity
- Using a small footstool when opening your bowels to improve positioning and reduce straining
Vaginal Oestrogen
For women during and after menopause, vaginal oestrogen can help improve the health, strength and elasticity of vaginal tissues.
It may also help with symptoms such as vaginal dryness, irritation and urinary symptoms.
Vaginal Pessaries
Vaginal pessaries are medical devices, usually made from soft silicone or plastic, that come in a variety of shapes, sizes and degrees of flexibility.
They are inserted into the vagina to support the pelvic organs and help lift the prolapse back into a more comfortable position.
Pessaries can be very effective at reducing symptoms such as vaginal heaviness, pressure, a feeling of “something coming down” and some bladder symptoms.
For many women, a pessary provides an excellent alternative to surgery or may help delay the need for an operation.
What Happens During a Pessary Fitting?
During your appointment, the doctor will carry out an internal examination to assess the type and degree of prolapse and determine the most appropriate pessary.
As every woman is different, we may need to try different types or sizes before finding the one that is most comfortable and effective. Occasionally, this can take more than one appointment.
Once the correct pessary has been fitted, most women are able to continue with their normal daily activities, including exercise and work, with improved comfort and confidence.
Follow-Up Care
Women using a pessary require periodic review to ensure the pessary remains comfortable and that the vaginal tissues remain healthy.
Surgical Options
For women with more severe symptoms or those who do not respond to conservative treatment, surgery may be an option. A referral to a specialist uro-gynaecologist can help determine which procedures may be appropriate and allow a discussion of the potential benefits and risks.
A Final Thought
Pelvic organ prolapse is a common condition and is often the result of very natural phases in a woman’s life, including pregnancy, childbirth and menopause.
It is not something to feel embarrassed about, and it is certainly not something you simply have to put up with.
A range of effective treatments are available, from pelvic floor exercises and lifestyle measures through to pessaries and surgical options.
Most importantly, please don’t suffer in silence. Help is available, and no woman should feel she has to put up with symptoms that affect her quality of life.
Thank you for reading. You can find more practical health articles in the Practical Health section of the blog.
Notes from a GP 
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