Very Big Prolapse
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Very Big Prolapse
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Ferri FF. Pelvic organ prolapse. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed May 31, 2022.
Rogers RG, et al. Pelvic organ prolapse in females: Epidemiology, risk factors, clinical manifestations, and management. https://www.uptodate.com/contents/search. Accessed May 31, 2022.
AskMayoExpert. Pelvic organ prolapse (adult). Mayo Clinic; 2022.
Hoffman BL, et al. Pelvic organ prolapse. In: Williams Gynecology. 4th ed. McGraw Hill; 2020. https://accessmedicine.mhmedical.com. Accessed May 31, 2022.
Uterine and apical prolapse. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pelvic-organ-prolapse-pop/uterine-and-apical-prolapse#. Accessed Aug. 31, 2022.
Nguyen H. Allscripts EPSi. Mayo Clinic. April 27, 2022.
Kegel exercises. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/kegel-exercises. Accessed June 4, 2022.
Jelovsek JE. Pelvic organ prolapse in woman: Choosing a primary surgical procedure. https://www.uptodate.com/contents/search. Accessed July 2, 2022.
Trabuco EC (expert opinion). Mayo Clinic. July 2, 2022.
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Supporting ligaments and other connective tissues hold the uterus in place. When these supportive tissues stretch and weaken, the uterus can move out of its original place down into the vagina. This is called a prolapsed uterus.
Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken until they no longer provide enough support for the uterus. As a result, the uterus slips down into or protrudes out of the vagina.
Uterine prolapse most often affects people after menopause who've had one or more vaginal deliveries.
Mild uterine prolapse usually doesn't require treatment. But uterine prolapse that causes discomfort or disrupts daily life might benefit from treatment.
Mild uterine prolapse is common after childbirth. It generally doesn't cause symptoms. Symptoms of moderate to severe uterine prolapse include:
See a health care provider to talk about treatment options if symptoms of uterine prolapse bother you and keep you from doing daily activities.
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Uterine prolapse results from the weakening of pelvic muscles and supportive tissues. Causes of weakened pelvic muscles and tissues include:
Factors that can increase the risk of uterine prolapse include:
Uterine prolapse often happens with prolapse of other pelvic organs. These types of prolapse can also happen:
To reduce the risk of uterine prolapse, try to:
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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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This content does not have an English version.
This content does not have an Arabic version.
AskMayoExpert. Pelvic organ prolapse. Mayo Clinic; 2019.
AskMayoExpert. Pelvic floor dysfunction. Mayo Clinic; 2018.
Rogers RG, et al. Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management. https://www.uptodate.com/contents/search. Accessed Jan. 31, 2020.
American College of Obstetricians and Gynecologists. Practice Bulletin No. 176: Pelvic organ prolapse. Obstetrics & Gynecology. 2017; doi:10.1097/AOG.0000000000002016.
Cystocele (prolapsed bladder). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/cystocele-prolapsed-bladder. Accessed Jan. 31, 2020.
Urinary incontinence. Office on Women's Health. https://www.womenshealth.gov/a-z-topics/urinary-incontinence. Accessed Jan. 31, 2020.
DeCherney AH, et al., eds. Urinary incontinence & pelvic floor disorders. In: Current Diagnosis & Treatment: Obstetrics & Gynecology. 12th ed. McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Accessed Jan. 31, 2020.
Magowan BA, et al., eds. Pelvic organ prolapse. In: Clinical Obstetrics & Gynaecology. 4th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Jan. 31, 2020.
Nguyen H. Allscripts EPSi. Mayo Clinic. Feb. 14, 2022.
Occhnio JA (expert opinion). Mayo Clinic. March 17, 2020.
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A dropped or prolapsed bladder (cystocele) occurs when the bladder bulges into the vaginal space. It results when the muscles and tissues that support the bladder give way.
Anterior vaginal prolapse, also known as a cystocele (SIS-toe-seel) or a prolapsed bladder, is when the bladder drops from its usual position in the pelvis and pushes on the wall of the vagina.
The organs of the pelvis — including the bladder, uterus and intestines — are typically held in place by the muscles and connective tissues of the pelvic floor. Anterior prolapse occurs when the pelvic floor becomes weak or if too much pressure is put on the pelvic floor. This can happen over time, during vaginal childbirth or with chronic constipation, violent coughing or heavy lifting.
Anterior prolapse is treatable. For a mild or moderate prolapse, nonsurgical treatment is often effective. In more severe cases, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.
In mild cases of anterior prolapse, you may not notice any signs or symptoms. When signs and symptoms occur, they may include:
Signs and symptoms often are especially noticeable after standing for long periods of time and may go away when you lie down.
A prolapsed bladder can be uncomfortable, but it is rarely painful. It can make emptying your bladder difficult, which may lead to bladder infections. Make an appointment with your health care provider if you have any signs or symptoms that bother you or impact your daily activities.
Your pelvic floor consists of muscles, ligaments and connective tissues that support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments can weaken over time, or as a result of trauma from childbirth or chronic straining. When this happens, your bladder can slip down lower than usual and bulge into your vagina (anterior prolapse).
Causes of stress to the pelvic floor include:
These factors may increase your risk of anterior prolapse:
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .
Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below.
A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.
You are here: Home / Prolapse / Prolapse Symptoms Every Woman Needs to Know
Are you worried about your prolapse symptoms? Prolapse symptoms can vary from one woman to the next, often depending on the type and severity of the prolapse.
This Pelvic Floor Physiotherapist guide teaches you the main prolapse symptoms experienced by women.
Read on now to check prolapse symptoms:
1. Vaginal symptoms
2. Bladder symptoms
3. Bowel symptoms
4. Sexual symptoms
Download this prolapse symptoms article as a user friendly PDF by scrolling down this page.
International best selling prolapse exercise guide for women with prolapse and after prolapse surgery.
Prolapse Exercises teaches you how to:
There are four main groups of symptoms:
There are also other possible medical causes of these symptoms so having one or a number of these symptoms does not conclusively indicate the presence of a prolapse which needs to be medically diagnosed with physical internal examination.
The following general symptoms of pelvic prolapse can exist either in isolation or some women may find that they have a number of the following prolapse symptoms.
These particular symptoms often become worse with prolonged standing, over the course of the day and with straining to use the bowels.
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