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Vaginal prolapse is a condition where your vagina slips out of position. It happens when the tissues and muscles in your pelvis weaken and overstretch. It’s more common in people who have had multiple vaginal deliveries during childbirth and have gone through menopause.
The American College of Obstetricians and Gynecologists. Pelvic Support Problems. (https://www.acog.org/womens-health/faqs/pelvic-support-problems) Accessed 9/15/2022.
InformedHealth.org [Internet]. Pelvic organ prolapse: Overview. (https://www.ncbi.nlm.nih.gov/books/NBK525783/) 2018 Aug 23. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Accessed 9/15/2022.
Kuncharapu I, Majeroni B, Johnson D. Pelvic Organ Prolapse. (https://www.aafp.org/afp/2010/0501/p1111.html) American Family Physician . May 2010; 81(9): 1111-1117. Accessed 9/15/2022.
Merck Manual Professional Version. Uterine and Apical Prolapse. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/uterine-and-apical-prolapse) Accessed 9/15/2022.
The Women’s, The Royal Women’s Hospital Victoria Australia. Vaginal Prolapse. (https://www.thewomens.org.au/health-information/vaginal-prolapse) Accessed 9/15/2022.
Women’s Health Concern. Prolapse: Uterine and vaginal. (https://www.womens-health-concern.org/help-and-advice/factsheets/prolapse-uterine-vaginal/) Accessed 9/15/2022.
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Vaginal prolapse (also called a vaginal vault prolapse) is when the top of your vagina falls from its normal location in your body. Your vagina, also called your birth canal, is the tunnel that connects your uterus to the opening of your vagina. When the top of your vagina becomes weak, the organs that they should be supporting collapse into your vagina, creating the sensation of a lump or bulge.
Your vagina is one of several organs that rests in the pelvic area of your body. These organs are held in place by muscles and other tissue. These muscles come together to create a support structure called your pelvic floor . Throughout your life, this support structure can start to weaken. This can happen for a variety of reasons, but the result is a sagging of your organs. When your organs sag or droop out of their normal position, this is called a prolapse. Vaginal prolapse is when the top of your vagina weakens and falls into your vaginal canal.
Prolapses can be small or large. A small prolapse is called an incomplete prolapse. A bigger prolapse (a complete prolapse) happens when your organ has shifted significantly. A complete prolapse can cause your organs to come out of your vaginal opening. This is a very severe prolapse.
Vaginal prolapse can cause painful symptoms. Mild to moderate vaginal prolapse may not require surgery. However, more severe cases may need surgical repair.
Your pelvis is comprised of your uterus, vagina, rectum, bladder and urethra. These organs are held up by your pelvic floor muscles, which look like an upside-down umbrella. The umbrella holds your pelvic organs up, but over time or due to other factors like vaginal deliveries, this upside-down umbrella can begin to collapse.
There are several different types of prolapse that have different names depending on where the organ has dropped from. The different types of pelvic organ prolapse can include:
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Vaginal prolapse is fairly common. More than one-third of women or people assigned female at birth (AFAB) have some type of pelvic area prolapse during their lifetime. You’re more likely to experience vaginal prolapse later in life, especially if you’ve had multiple pregnancies with a vaginal birth.
You may not know you have a prolapsed vagina until vaginal tissue from your vaginal wall protrudes from your vaginal opening. Some people have symptoms like pain or feeling like they are sitting on a ball. Others find out about a prolapsed vagina during a routine pelvic exam.
Several other pelvic organs can slip out of position, not just your vagina. Depending on the type of prolapse you have and its severity, other nearby organs may be affected. For example, you may have problems with your kidneys, urethra (the hole you pee from) and rectum (the hole you poop from). Because a prolapse can cause other problems, it’s important to get it checked out by your healthcare provider.
Symptoms of vaginal prolapse can include:
Some people don’t feel a prolapsed vagina because the prolapse is mild. Your healthcare provider may discover a mild prolapse during a routine gynecological exam. In other cases, you may feel like a ball is hanging from your vagina or experience pain when peeing or when having sexual intercourse.
Your vagina is held in place within your pelvis by a group of muscles and other tissue — creating a support structure, of sorts. This structure keeps your organs in your pelvis in place. Over time, this structure can weaken. When that happens, your vagina might slip down out of place, causing a prolapse. Several common causes of vaginal prolapse can include:
Activities or conditions that place extra pressure on your abdominal area can also cause a prolapse. These can include:
A gynecologist usually diagnoses vaginal prolapse during an appointment. They will do a physical exam and talk to you about any symptoms of fullness in your pelvic area or urinary incontinence (leaking pee). You may also be asked about any previous pregnancies and deliveries. In most cases, your provider can feel a prolapse by inserting a gloved finger in your vagina or upon a visual inspection of the area.
In some cases, you may not have any symptoms and your provider discovers a prolapse during a pelvic exam.
If you have problems peeing, your provider may order tests to check your bladder function. They may also order an MRI (magnetic resonance imaging) or pelvic ultrasound if they need a better view of all the other pelvic organs.
A prolapsed vagina is more likely to happen after menopause and after multiple vaginal childbirths. This is more likely to occur if you’re older than 50, but it can happen at any age.
Vaginal prolapse treatment can vary depending on the severity of your prolapse. In some cases, your healthcare provider may want to just watch it over time to make sure it doesn’t get worse.
There are nonsurgical and surgical treatment options for vaginal prolapses. There are a few things your healthcare provider will take into account when forming a treatment plan. These can include:
It’s important to have an open and honest conversation with your healthcare provider about these topics. Talk to your healthcare provider about any questions or concerns you have regarding these treatments.
Nonsurgical treatments are typically used as a first option and work best with minimal or mild prolapses. Specific treatment options can include:
For more severe cases, surgery to correct vaginal prolapse can be an option. These options include:
Not treating vaginal prolapse can cause the condition to worsen. In addition to more pain, you may also get sores on your vagina, infection and increase your risk for injury to other pelvic organs.
No, you can’t push a prolapsed vagina back up. Your healthcare provider is the only person who should treat a prolapsed vagina. You may be able to feel a prolapse, and you may need to push the prolapse back up to poop or pee, but pushing the prolapse back up is temporary and will not permanently fix the prolapse.
You can’t always prevent vaginal prolapse. There are good lifestyle habits you can adopt to decrease your risk of developing vaginal prolapse. These can include:
When you lift something heavy, you can strain your muscles. This strain can lead to a pelvic organ prolapse. By following a few tips, you can lower your risk of prolapse.
Vaginal prolapse can happen again after treatment. However, most treatment plans are very successful. If you have multiple prolapses or a severe prolapse, your healthcare provider may talk to you about surgical treatment options.
In most cases, the outlook for vaginal prolapse is positive. Treatment and lifestyle changes typically work well. Talk to your healthcare provider about all treatment options and what each option would mean for you. Your provider can help you develop good lifestyle habits that might help lower your risk of developing vaginal prolapse in the future.
Contact your healthcare provider if you have symptoms of prolapse like:
Don’t let symptoms of vaginal prolapse interfere with your daily life. See your healthcare provider if you have symptoms of vaginal prolapse like a bulging from your vagina or a feeling of fullness in your pelvis. Prolapse isn’t a serious condition, but it can cause problems if it’s left untreated or worsens. Mild cases of a prolapsed vagina can be fixed with Kegel exercises or a vaginal pessary. Surgery is needed in more severe cases.
Last reviewed by a Cleveland Clinic medical professional on 09/15/2022.
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You are here: Home / Prolapse / How Severe is Your Prolapse? Understanding Your Prolapse Diagnosis
How severe is your prolapse diagnosis?
Are you worried you may need prolapse surgery?
Is your prolapse beyond repair without surgery? It‘s often confusing to understand your prolapse severity – especially if you’re feeling nervous and disappointed when receiving your diagnosis.
You can’t really see the full extent of your prolapse and it’s a little socially awkward to compare it to someone else’s.
The following Pelvic Floor Physiotherapist information is designed to help you understand your prolapse diagnosis:
International best selling prolapse exercise guide for women with prolapse and after prolapse surgery.
Prolapse Exercises teaches you how to:
Your prolapse symptoms may feel awful but this doesn’t necessarily mean your prolapse is severe! Typical prolapse symptoms such as pelvic heaviness or lower back pain don’t correspond with prolapse severity. 1
Some women are quite surprised to learn they have a prolapse during their regular pap smear. Others report quite bothersome symptoms with relatively minor prolapse severity.
Some prolapse symptoms tend to worsen in women with more severe prolapse. Vaginal bulging and being able to see your prolapse at the entrance of your vagina are prolapse symptoms that often worsen with more advanced prolapse. In other words you may or may not necessarily experience some of the established troublesome bowel, bladder or prolapse symptoms with different degrees of prolapse severity.
There is however a trend for some specific and bothersome prolapse symptoms to worsen in women with more advanced or severe prolapse.
Your doctor may have given you a prolapse diagnosis of mild, moderate or severe prolapse.
This is a very simple and general diagnosis of prolapse severity usually based on how troublesome your prolapse symptoms are and the amount of downward movement of your prolapse within your vagina evident during your examination. A big problem with this type of general assessment is that it’s not scientifically accurate or exact.
An accurate prolapse diagnosis must fully reproduce the full extent of the downward movement of your prolapse during your internal examination. This is why your doctor or physiotherapist will ask you to cough and strain downwards during your examination.
Most women need to be examined standing upright to fully reproduce the full extent of prolapse and provide them with an accurate prolapse diagnosis.
The POP-Q 3 or Pelvic Organ Quantification is the internationally recommended prolapse classification system that was introduced to improve the accuracy of measuring prolapse severity. This system allows your health practitioner to provide a more accurate prolapse diagnosis than a general assessment.
If your gynaecologist uses POP-Q he or she will measure how far your prolapse moves downward within and/or out of your vagina by looking at the leading edge or the lowest part of your prolapse and measuring how far this moves downwards with coughing and bearing down or straining. Using this system your gynaecologist may have told you that your prolapse is somewhere on the range of Stage 0 to 4.
If your gynaecologist has used POP-Q to measure, he or she will classify your prolapse as follows:
Stage 0 – no prolapse is demonstrated during your examination
Stage 1 – the lowest part of your prolapse is more than 1 cm above your *hymenal ring
Stage 2 – the lowest part of your prolapse is within 1 cm either side of your hymenal ring
Stage 3 – the lowest part of the prolapse is more than 1 cm below the hymen but the vagina has not completely prolapsed
Stage 4 – the vagina is completely prolapsed outwards.
Prolapse severity is measured using the hymenal ring as a fixed reference point in POP-Q assessment. The hymenal ring sits approximately 1cm within the external entrance or opening to the vagina. When the hymen (thin tissue across the entrance to the vagina) is broken by penetrative intercourse or using tampons the hymenal ring is the level where the hymen was previously positioned.
Some gynaecologists still diagnose a uterine prolapse as first, second or third degree in severity.
This system was used in the past to grade uterine prolapse by assessing how far the cervix had moved downwards in the vagina. The cervix is the muscular ring (feels like a nose tip) that sits at the very top of your vagina at the entrance of your uterus.
Recent research 2 has shown that some women with mild to moderate prolapse (i.e. Stages 1- 2 as measured by POP-Q method), supervised pelvic floor muscle training including home pelvic floor exercises decreased prolapse severity and reduced specific prolapse symptoms.
This means that for women with mild to moderate prolapse (i.e. prolapse above the hymen) it may be possible to reduce prolapse symptoms and even avoid prolapse surgery with pelvic floor muscle training .
A lack of research means that it is currently unknown whether women with more severe prolapse diagnosis can reverse prolapse symptoms and severity with exercises.
Some women with more advanced or severe prolapse will require prolapse surgery or long-term support pessary management. The most appropriate time for you to proceed with prolapse surgery is a matter for you and your gynaecologist to discuss and determine based upon your prolapse diagnosis and other relevant factors.
Understanding your prolapse diagnosis helps you make better informed decision about your future prolapse management.
The evidence suggests that for women with mild to moderate (Stage 1- 2) prolapse diagnosis, pelvic floor muscle training may be an effective method of reversing prolapse and reducing prolapse symptoms. If you can alleviate your prolapse symptoms, you may even feel less likely to need prolapse surgery!
Michelle Kenway is an Australian Pelvic Floor Physiotherapist. Michelle lectures to health professionals and promotes community health through her writing, radio segments, online exercise videos and community presentations. She holds dual post graduate physiotherapy qualifications in women’s health and exercise.
1. Barber MD, Walters MD and Bump R (2003) Association of the magnitude of pelvic organ prolapse and presence of severity of symptoms (abstract #3 103). In International Continence Society, Florence.
2. Brækken, I. H., Majida, M., Engh, M. E., & Bø, K. (2010). Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American journal of obstetrics and gynecology, 203(2), 170-e1.
3. Bump R Mattiason A Bo K, Brubaker L DeLancey J Klarskov P Shull B Smith A (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics & Gynecology, 175:13.
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