Retro Prolapse

Retro Prolapse

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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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Medical Author:

George Lazarou, MD, FACOG

Medical Editor:

Melissa Conrad Stöppler, MD

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What Are Common Causes of Vaginal Prolapse?

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What Are Different Types of Vaginal Prolapse?
Questions to Ask the Doctor About Prolapsed Vagina
When to Call a Doctor and Seek Medical Help for a Prolapsed Vagina
What Self-Care Measures Can Treat Vaginal Prolapse at Home?
What Is the Medical Treatment for Vaginal Prolapse?
What Medications Are Used to Treat Vaginal Prolapse?
What Is Vaginal Prolapse Surgery? What Is the Recovery Time?
What Is Alternative Therapy for Vaginal Prolapse?
What Is the Follow-up for Vaginal Prolapse?
What Is the Prognosis for Vaginal Prolapse?

Lazarou, GL, MD, et al. Uterine Prolapse. Medscape. Updated: Aug 15, 2018.

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The network of muscles, ligaments, and skin in and around a woman's vagina acts as a complex support structure that holds pelvic organs, and tissues in place. This support network includes the skin and muscles of the vaginal walls (a network of tissues called the fascia). Various parts of this support system may eventually weaken or break, causing a common condition called vaginal prolapse.
Vaginal prolapse is a condition in which structures such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself may begin to prolapse, or fall out of their normal positions. Without medical treatment or surgery, these structures may eventually prolapse farther and farther into the vagina or even through the vaginal opening if their supports weaken enough.
The symptoms that result from vaginal prolapse commonly affect sexual function as well as bodily functions such as urination and defecation. Pelvic pressure and discomfort are also common symptoms.
Symptoms most commonly associated with a vaginal prolapse depend on the type of vaginal prolapse present. The most common symptom of all types of vaginal prolapse is the sensation that tissues or structures in the vagina are out of place. Some women describe the feeling as "something coming down" or as a dragging sensation. This may involve a protrusion or pressure in the area of the sensation. Generally, the more advanced the prolapse, the more severe the symptoms.
General symptoms that may be seen with all types of vaginal prolapse include pressure in the vagina or pelvis, painful intercourse ( dyspareunia ), a mass at the opening of the vagina, decrease in pain or pressure when lying down, and recurrent urinary tract infections .
Some women who develop a vaginal prolapse do not experience symptoms.
A network of muscles provides the main support for the pelvic viscera (the vagina and the surrounding tissues and organs within the pelvis). The major part of this network of muscles, which is located below most of the pelvic organs and supports the organs' weight, is called the levator ani. Pelvic ligaments provide additional stabilizing support.
When parts of this support network are weakened or damaged, the vagina and surrounding structures may lose some or all of the support that holds them in place. Collectively, this condition is called pelvic relaxation. A vaginal prolapse occurs when the weight-bearing or stabilizing structures that keep the vagina in place weaken or deteriorate. This may cause the supports for the rectum, bladder, uterus, small bladder, urethra, or a combination of them to become less stable.
Common factors that may cause a vaginal prolapse include:
A large percentage of women develop some form of vaginal prolapse during their lifetime, most commonly following menopause , childbirth, or a hysterectomy. Most women who develop this condition are older than 40 years of age. Many women who develop the symptoms of a vaginal prolapse do not seek medical help because of embarrassment or other reasons. Some women who develop a vaginal prolapse do not experience symptoms.
There are different types of vaginal prolapse:
This type of vaginal prolapse involves a prolapse of the back wall of the vagina (rectovaginal fascia). When this wall weakens, the rectal wall pushes against the vaginal wall, creating a bulge. This bulge may become especially noticeable during bowel movements.
This can occur when the front wall of the vagina (pubocervical fascia) prolapses. As a result, the bladder may prolapse into the vagina. When this condition occurs, the urethra usually prolapses as well. A urethral prolapse is also called a urethrocele. When both the bladder and urethra prolapse, this condition is known as a cystourethrocele. Urinary stress incontinence (urine leakage during coughing , sneezing, exercise , etc) is a common symptom of this condition.
The weakening of the upper vaginal supports can cause this type of vaginal prolapse. This condition primarily occurs following a hysterectomy. An enterocele results when the front and back walls of the vagina separate, allowing the intestines to push against the vaginal skin.
This involves a weakening of a group of ligaments called the uterosacral ligaments at the top of the vagina. This causes the uterus to fall, which commonly causes both the front and back walls of the vagina to weaken as well. Stages of uterine prolapse are:
This type of prolapse may occur following a hysterectomy (surgical removal of the uterus). Because the ligaments surrounding the uterus provide support for the top of the vagina, this condition is common after a hysterectomy. In vaginal vault prolapse, the top of the vagina gradually falls toward the vaginal opening. This may cause the walls of the vagina to weaken as well. Eventually, the top of the vagina may protrude out of the body through the vaginal opening, ultimately turning the vagina inside out. A vaginal vault prolapse is often accompanied by an enterocele.
Any woman who experiences symptoms that may indicate a vaginal prolapse should contact her doctor.
Vaginal prolapse is rarely a life-threatening condition. However, most prolapses gradually worsen and can only be corrected with intravaginal pessaries or surgery. Thus, timely medical care is recommended to evaluate for and to prevent problematic symptoms and complications caused by weakening tissue and muscles surrounding the vagina.
Generally, the most reliable way that a doctor can make a definite diagnosis of any type of vaginal prolapse involves a medical history and a thorough physical examination. This involves the doctor examining each section of the vagina separately to determine the type and extent of the prolapse in order to decide which type of treatment is most appropriate.
During the physical examination, a woman may need to sit in an upright position and strain so that any prolapsed tissues are more likely to become apparent. Some types of vaginal prolapse such as cystocele or rectocele are more easily identifiable during the physical examination than are types such as vaginal vault prolapse or enterocele.
Since many women with vaginal prolapse also have urinary incontinence , these tests can further evaluate the anatomy and function of the pelvic floor.
Most vaginal prolapses will gradually worsen over time and can only be fully corrected with surgery. However, the type of treatment that is appropriate to treat a vaginal prolapse depends on factors such as the cause and severity of the prolapse, whether the woman is sexually active, her age and overall medical status, her desire for future childbearing, and her personal preference.
Treatments at home for vaginal prolapse include the following:
Many women with vaginal prolapse may benefit from estrogen replacement therapy. Estrogen helps strengthen and maintain muscles in the vagina. As with hormone therapy for other indications, the benefits and risks of estrogen therapy must be weighed for each individual patient.
Estrogen replacement therapy may be used to help the body strengthen the muscles in and around the vagina. Estrogen replacement therapy may be contraindicated (such as in a people with certain types of cancer ) and has been associated with certain health risks including increased risk of blood clots and stroke , particularly in older postmenopausal women. Women's bodies cease producing estrogen naturally after menopause, and the muscles of the vagina may weaken as a result.
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