What Is Pelvic Organ Prolapse?

Pelvic organ prolapse, or POP, happens when a pelvic organs shifts out of its usual position and starts to press downward. It’s something we most often see in women, but it can affect men too when the rectum begins to bulge into the anus. In women, prolapse usually involves the bladder, uterus, or rectum moving into the vaginal canal—and sometimes it’s a mix of more than one.

Surprisingly, up to 80% of women with prolapse are asymptomatic, meaning they don’t feel or notice any symptoms. For this reason, we don't know exactly how common POP is. Some studies based on prolapse symptoms estimate that 3–6% of women are affected, while studies based on physical exams suggest the number could be as high as 41–50% of women.

Types of Pelvic Organ Prolapse

1. Cystocele (Bladder Prolapse)

This is when the bladder drops into the anterior wall of the vagina. This is the most common type of prolapse that women experience, with up to 90% of prolapses being that of the bladder.

Symptoms include:

Vaginal bulging or heaviness
Incontinence or urinary urgency
Feelings of incomplete bladder emptying

2. Rectocele

A rectocele occurs when the rectum pushes into the posterior wall of the vagina. It accounts for 70% of pelvic organ prolapses.

Symptoms include:

The same as a cystocele, plus:
Constipation
Rectal pain
Feeling like bowels have not fully emptied after a bowel movement

3. Uterine Prolapse

This occurs when uterus drops down into the vaginal canal, and accounts for 89% of pelvic organ prolapses.

4. Vaginal Vault Prolapse

Here, the top of the vagina begins to descend down into the vaginal canal. This is mainly seen in women who have had a hysterectomy. If a woman has a hysterectomy due to a previous pelvic organ prolapse, it is more likely that she will develop a vaginal vault prolapse.

Note: You may have noticed that the prevalence of each individual kind of prolapse does not quite add up to 100%; this is because the majority of women who have a prolapse will have more than one type.

Other, Less Common Types of Prolapse

Urethrocele: the urethra collapses into the anterior wall of the vagina. These prolapses are rather rare and make up less than 1% of prolapse cases.
Cystourethrocele: Both the bladder and the urethra descend into the anterior wall of the vaigna.
Rectal prolapse: The rectum drops and protrudes out of the anus.
Enterocele: The small intestine prolapses into the upper wall of the vagina. This makes up roughly 3% of prolapse cases.

Grading the Severity of Prolapse

The severity of a prolapse is measured in grades relative to the hymen. Of note: the hymen sits just inside the opening of the vagina and usually is no longer intact by the time women reach adulthood. However, remnants of the hymen may remain around the introitus and give a guideline for grading the severity of prolapses.

Grade 0: No prolapse
Grade 1: Prolapse descends halfway to the hymen
Grade 2: Prolapse descends to the hymen
Grade 3: Prolapse descends halfway past the hymen and is visible externally
Grade 4: Maximal descent

Common Symptoms of Pelvic Organ Prolapse

By now, you may be wondering if you have a prolapse. Symptoms vary depending on the organ involved, severity, and activity level. Most women report the following symptoms:

Pressure or heaviness in the vagina
Bulging sensation
Seeing or feeling something protruding from the vagina or the rectum
Feelings of not emptying the bladder or bowels all the way
Feelings of sitting on something
Incontinence
Low back pain
Pain or discomfort during penetrative intercourse

Risk Factors for Prolapse

You may be more likely to experience prolapse if you have one or more of the following risk factors:

Having children, specifically vaginal deliveries
Obesity
Chronic constipation
Age and menopause status
Connective tissue disorders (e.g., Ehlers-Danlos, rheumatoid arthritis, lupus, Sjögren’s syndrome)

Treatment Options for Pelvic Organ Prolapse

Observation. If you're asymptomatic or have mild symptoms, your pelvic floor specialist may recommend careful monitoring over time.
Pelvic floor physical therapy. Conservative management of pelvic organ prolapse often includes pelvic floor physical therapy, which focuses on restoring posture, movement, and breathing mechanics and addressing deficits in the pelvic floor musculature.
Treatment of constipation. Management of constipation can reduce the overall pressure on pelvic organs and can ease symptoms related to a prolapse. Constipation treatment can include biomechanics of defecation, hydration, fiber supplementation, and more.
Pessary use. Pessaries are an inserted device placed in the vaginal canal to improve support to prolapsing pelvic organs. They should be fitted and sized for each individual. Up to 92% of individuals can be successfully fitted for a pessary. (BONUS: We can fit you for a pessary at Pelvic Health & Wellness.)
Surgery. If conservative methods are unsuccessful or symptoms continue to increase, surgery is an option for women with pelvic organ prolapse. Many surgeries to repair a prolapse are done laparoscopically, meaning the incisions are small and minimally invasive.

Putting it all Together

Pelvic organ prolapse is more common than many people realize, and symptoms can range from mild to life-disrupting. If you’re noticing signs like vaginal pressure, bulging, or feelings of incomplete emptying, know this: you are not alone, and there are effective, supportive options available.

Seeing a pelvic floor physical therapist is often a powerful first step. At our pelvic health and wellness clinic, we take the time to understand your experience, assess your posture and movement patterns, and work with you on strategies that can reduce symptoms and improve how you feel in your body. Whether your prolapse is newly diagnosed or something you’ve been living with for a while, we’re here to help you feel more confident, informed, and in control.

About Pelvic Health & Wellness

Pelvic Health & Wellness was built with you in mind. We practice whole-person, individualized pelvic floor physical therapy in a caring and safe environment. Our physical therapists specialize in treating pelvic health concerns such as pelvic floor dysfunction, bowel and gut health, pain, pelvic organ prolapse, constipation, incontinence, fertility, and various pregnancy and postpartum-related conditions.

We understand that being ready to talk about and address your pelvic floor wellness concerns comes from a place of strength. We are here to support and encourage you on your journey back to health so you can return to doing what you love! If you are ready to take the first step in reclaiming your pelvic health and wellness, don't hesitate to get in touch with us today.

What Is Pelvic Organ Prolapse? A Deeper Look Into POP