Quick answer. Uterine prolapse is when the womb or other pelvic organs descend because the supporting muscles and tissues have weakened, causing a sensation of heaviness or a bulge. It can be managed with pelvic floor exercises, a pessary or surgery.
Uterine prolapse, part of a group of conditions called pelvic organ prolapse, happens when the womb or nearby organs such as the bladder slip downward into or out of the vagina because the muscles and tissues that hold them in place have weakened. It is common after childbirth and around menopause, and many women find it uncomfortable or distressing rather than dangerous.
This guide explains what uterine and pelvic organ prolapse is, why it happens, how it is diagnosed and the treatment options – from pelvic floor exercises and vaginal pessaries to surgery. It also covers the urgent warning signs and which specialist to see for assessment and care.
At a glance
| Approach | What it involves | Typically suited to |
|---|---|---|
| Lifestyle measures | Weight management, treating constipation and chronic cough | Mild prolapse and prevention |
| Pelvic floor exercises | Strengthening the muscles, often with a physiotherapist | Mild to moderate prolapse |
| Vaginal pessary | A removable support device placed in the vagina | Those avoiding or unfit for surgery |
| Vaginal oestrogen | Cream or tablet to improve tissue after menopause | Postmenopausal women, alongside other care |
| Surgery | Repair or removal procedures to restore support | More severe or persistent prolapse |
What is uterine and pelvic organ prolapse?
The pelvic organs – the womb (uterus), bladder and bowel – are held in place by a hammock of muscles and ligaments called the pelvic floor. When this support weakens, one or more organs can sag downward into the vagina. When the womb descends, it is called uterine prolapse; when the bladder or bowel bulge into the vaginal wall, it is part of the broader picture of pelvic organ prolapse.
It is a common condition, particularly in women who have given birth and in those who have been through menopause. Prolapse is graded by how far the organ has descended, from mild to more advanced. While it is rarely dangerous, it can significantly affect comfort, bladder and bowel function and quality of life.
Symptoms and signs
Symptoms vary with the type and severity of prolapse. Common features include:
- A sensation of heaviness, dragging or pressure in the pelvis or vagina
- A noticeable bulge or lump that you can feel or see at the vaginal opening
- Urinary symptoms – needing to pass urine often, leakage, or difficulty emptying the bladder fully
- Difficulty opening the bowels, or a feeling of incomplete emptying
- Discomfort or reduced sensation during sex
- Symptoms that worsen by the end of the day or after standing, lifting or straining
Some women have very mild prolapse with no symptoms at all, picked up only on examination.
Causes and risk factors
Prolapse develops when the pelvic floor support weakens or is damaged. Contributing factors include:
- Childbirth, especially multiple or difficult vaginal deliveries
- Ageing and the fall in oestrogen after menopause, which weakens tissues
- Being overweight, which adds pressure on the pelvic floor
- Chronic constipation and repeated straining
- A long-standing cough, for example from smoking or chest disease
- Heavy lifting and previous pelvic surgery, including hysterectomy
A family tendency toward weaker connective tissue can also play a part.
How it is diagnosed
A gynaecologist usually diagnoses prolapse from your history and a pelvic examination. Assessment may include:
- A pelvic examination, sometimes while you bear down or stand, to see how far the organs descend and grade the prolapse
- Questions about bladder, bowel and sexual symptoms
- Urine tests or bladder function (urodynamic) tests if there are significant urinary symptoms
- Occasionally an ultrasound to assess the pelvic organs
This helps decide which organs are affected and how best to manage it.
Treatment options
Treatment depends on the severity, your symptoms and your preferences, and ranges from simple measures to surgery:
- Lifestyle measures – maintaining a healthy weight, treating constipation and avoiding heavy lifting and straining
- Pelvic floor muscle exercises – strengthening the support, ideally guided by a women’s health physiotherapist, useful for milder prolapse
- Vaginal pessary – a removable silicone device that supports the organs, a good non-surgical option, including for those who wish to avoid surgery
- Vaginal oestrogen – cream or tablets to improve tissue strength after menopause
- Surgery – procedures to repair the support or, in some cases, remove the womb, for more severe or persistent prolapse
Your gynaecologist will discuss the options, including whether you wish to have more children, which can influence the choice.
When to see a doctor and which specialist
See a doctor if you notice a bulge, persistent pelvic heaviness, or bladder or bowel symptoms that bother you – prolapse is common and very treatable, so there is no need to put up with it. Seek urgent care if you are unable to pass urine, have severe pelvic pain, or notice the prolapsed tissue becoming swollen, raw or unable to be pushed back, as these need prompt attention. Go to A&E and call 995 if you are in severe pain and completely unable to pass urine.
Prolapse is assessed and treated by an Obstetrician & Gynaecologist. You can find one through our directory of gynaecologists in Singapore.
Self-care and protecting your pelvic floor
Simple daily habits can ease symptoms and slow prolapse from worsening. Pelvic floor (Kegel) exercises, done regularly, help strengthen the supporting muscles, and a women’s health physiotherapist can teach the correct technique. Avoid constipation by eating enough fibre and drinking plenty of fluids, and try not to strain when opening your bowels. Keep to a healthy weight, treat a long-standing cough, and take care with heavy lifting, bending your knees and keeping loads close to your body. Many women find a vaginal pessary a comfortable, effective option, including those who wish to avoid or delay surgery.
What to expect at the appointment
The gynaecologist will ask about your symptoms and carry out a pelvic examination, sometimes asking you to bear down so they can grade how far the organs descend. This is quick and helps guide treatment.
Questions to ask your doctor
- Which organs are involved, and how advanced is my prolapse?
- Would a pessary or pelvic floor physiotherapy suit me?
- If I want more children, how does that affect my options?
Common questions
Is prolapse dangerous?
It is rarely dangerous, but it can affect comfort and bladder or bowel function. Being unable to pass urine or severe pain needs urgent care.
Will exercises alone fix it?
Pelvic floor exercises help most with mild to moderate prolapse; more advanced cases may need a pessary or surgery.
Related guides
- Best Gynaecology Clinics in Singapore — our editorial shortlist
- gynaecology clinics directory
- Chronic sinusitis
- Labyrinthitis
- Perforated eardrum
- Glue ear
- Vocal cord nodules
Sources
- NHS – Pelvic organ prolapse
- HealthHub Singapore – Pelvic organ prolapse
- Mayo Clinic – Uterine prolapse
- KK Women's and Children's Hospital – Urogynaecology
Part of our Women’s health & gynaecology guides · Browse all health topics