Quick answer. Pelvic organ prolapse (POP) happens when one or more pelvic organs – the bladder, womb, bowel, or top of the vagina – drops from its normal position and bulges into or out of the vagina, because the pelvic floor muscles and supporting tissues have weakened. It is very common, especially with age and after childbirth, and is thought to be under-reported because women feel embarrassed to raise it. It is not dangerous, but it can affect comfort, bladder and bowel function, sex and quality of life. The good news: it is very treatable – from pelvic floor physiotherapy and a supportive pessary to surgery – and there is no need to suffer in silence.
Have a women’s-health or menstrual concern to talk through?
Message our care team on WhatsApp. Tell us what’s going on and we’ll help you find the right gynaecologist — free, with no obligation.
Chat with our care team on WhatsAppNot sure who to see? Find the right specialist →
In a medical emergency, or for severe or sudden symptoms such as breathing difficulty, chest pain, fainting or stroke signs, call 995 immediately.
Prolapse is common, treatable and nothing to be embarrassed about – and for many women the first-line options avoid surgery entirely.
What it is
The pelvic floor is a “hammock” of muscles, ligaments and connective tissue slung across the base of the pelvis. It holds the pelvic organs – the womb, bladder and bowel – up in their normal positions and helps you control your bladder and bowel. When this support weakens or stretches, one or more organs can sag downwards and press against the vaginal wall, creating a bulge that some women can feel or even see. This is pelvic organ prolapse.
Prolapse is graded by how far the organ has descended, from mild sagging that produces few or no symptoms, through descent to the level of the vaginal opening, to an organ that protrudes outside the vagina. It is important to be reassured that prolapse is a mechanical, benign problem – it is not cancer, it is not an infection, and it does not turn into anything sinister. Many women live comfortably with a mild prolapse for years, and treatment is guided by how much the symptoms bother you rather than by the grade alone.
Types
Prolapse is named for which organ is involved and which part of the vaginal wall bulges:
- Front (anterior) wall – bladder (cystocele): the bladder presses into the front wall of the vagina. This is the commonest type.
- Back (posterior) wall – bowel (rectocele): the rectum bulges into the back wall of the vagina, which can make it harder to empty the bowel completely.
- Uterine prolapse: the womb itself descends into the vagina.
- Vaginal vault prolapse: the top of the vagina drops down, usually after the womb has been removed by hysterectomy.
More than one type can happen at the same time – for example, a bladder and bowel prolapse together – because the same weakening of the pelvic floor affects several areas at once.
Symptoms
The classic symptom is a feeling of heaviness, dragging or a lump or bulge in the vagina – a sense of “something coming down”. Some women notice or feel a bulge at or beyond the vaginal opening. Alongside this, prolapse can cause:
- Urinary symptoms: leakage, a frequent or urgent need to pass urine, a weak or slow stream, or a feeling that the bladder does not empty fully.
- Bowel symptoms: difficulty emptying the bowel, or needing to press on or inside the vagina to help complete a bowel motion.
- Sexual discomfort: discomfort or reduced sensation during sex, or self-consciousness about the bulge.
- Aching or low backache that eases when you lie down.
Symptoms are typically worse by the end of the day, and after long periods of standing, lifting or straining, and better after resting or lying down. Many women have no symptoms at all, especially with mild prolapse, and it is picked up incidentally during a smear or examination.
Causes and who is at risk
Prolapse develops when the pelvic floor is repeatedly stretched, weakened or put under pressure over time. Common contributing factors include:
- Childbirth, especially vaginal deliveries – the single biggest factor. Delivering several babies, or a large baby, or a long or assisted delivery, adds to the risk.
- Ageing and the menopause, as falling oestrogen thins and weakens the supporting tissues.
- Being overweight, which raises pressure inside the abdomen.
- Chronic coughing or repeated straining, including long-standing constipation.
- Heavy lifting, at work or in the gym, done regularly.
- Previous pelvic surgery, such as a hysterectomy, which can weaken support at the top of the vagina.
Some women also have naturally more stretchy connective tissue, which can run in families. Having a risk factor does not mean you will definitely develop prolapse – and many of these factors, such as weight, constipation and lifting technique, can be improved.
How it is diagnosed
Diagnosis is mainly clinical. A GP, gynaecologist or urogynaecologist takes your history and performs a pelvic examination, often asking you to bear down or cough so they can see how far each wall descends, and may grade the prolapse. In Singapore you can start with your GP or a polyclinic, who can refer you to a gynaecologist or a specialist urogynaecology service if needed.
Further tests are not always required. They may be arranged if there are troublesome bladder or bowel symptoms – for example, tests of how the bladder fills and empties (urodynamics), a urine test to exclude infection, or occasionally an ultrasound or other imaging. These help tailor treatment when the picture is more complex.
Complications and impact
Prolapse is not dangerous and rarely causes serious harm, but it can affect quality of life – comfort, confidence, exercise, work, sleep and intimacy. Bladder symptoms such as leakage or incomplete emptying, and bowel symptoms such as difficulty emptying, are the problems women most often want help with. Where a prolapse protrudes outside the body, the exposed skin can occasionally become dry, irritated or, rarely, ulcerated or infected. Very rarely, a large prolapse can affect the flow of urine. These situations are uncommon and treatable, and they are reasons to see a doctor rather than causes for alarm.
Treatment
Treatment depends on how much the prolapse bothers you, its type and severity, your general health and whether you have completed your family. Many women improve without surgery.
- Lifestyle and self-help measures for mild cases: pelvic floor muscle exercises, ideally taught by a women’s-health physiotherapist so you are squeezing the right muscles; managing weight; treating constipation and avoiding straining; and treating a chronic cough.
- Vaginal oestrogen after the menopause, as a cream, tablet or ring, to improve the condition of the vaginal tissues. This is a hormone applied locally rather than a systemic dose.
- A vaginal pessary – a soft, removable silicone device inserted into the vagina to support the organs. It is an effective non-surgical option at any age, useful if you want to avoid surgery, are still planning a family, or are not fit for an operation. It is fitted and checked periodically by a clinician.
- Surgery for more troublesome or advanced prolapse, or when other measures have not helped. A gynaecologist or urogynaecologist can explain the options, which aim to restore support using your own tissues. In line with international safety warnings, transvaginal mesh is generally no longer used for this in routine practice.
There is no single “best” treatment – the right choice is the one that fits your symptoms and preferences, and it is reasonable to start with the simplest options and step up if needed.
Living with it and self-care
Day to day, a few habits help protect the pelvic floor and ease symptoms: keep up pelvic floor exercises regularly, as their benefit fades if you stop; avoid heavy lifting and straining, and brace the pelvic floor before you cough, lift or sneeze; manage constipation with enough fibre and fluids so you do not have to strain; and keep to a healthy weight. Staying active and treating a persistent cough also help. These measures can slow progression and, for mild prolapse, may be all that is needed. HealthHub has further Singapore health information on pelvic floor and women’s health.
When to see a doctor
See a GP, polyclinic doctor or gynaecologist if you notice a vaginal bulge or a feeling of something coming down, pelvic heaviness or dragging, or new urinary, bowel or sexual symptoms – even if they are mild. Early assessment gives you more options and stops symptoms limiting your life. Seek prompt review if a prolapse protrudes and the skin becomes sore, bleeds or is hard to push back, or if you have difficulty passing urine. Please do not put up with symptoms out of embarrassment – prolapse is common, doctors see it every day, and effective help is available.
Related women’s health topics
- Endometriosis
- Hysterectomy
- Endometrial polyps
- Uterine (endometrial) cancer
- HPV vaccine
- Pre-eclampsia
- Breastfeeding problems
- Vulvodynia (vulval pain)
- Ovulation & fertility tracking
- Pap smear & cervical screening
- Menopause
- Gynaecologists in Singapore
Sources
- NHS / RCOG / ACOG — pelvic organ prolapse: definition, types, risk factors, treatments (pessary/physio/surgery), prevention; mesh no longer routinely offered.
- Cleveland Clinic — types (cystocele/rectocele/uterine/vault), causes, treatment overview.
- KK Urogynaecology Centre / SingHealth (Singapore) — local urogynae services; physiotherapy first-line; mesh discontinued ~2021.