Pelvic organ prolapse happens when one or more pelvic organs move down from their usual position and bulge into the vagina. This can involve the bladder, uterus, bowel or top of the vagina.
Bladder prolapse, also called a cystocele or anterior vaginal wall prolapse, is one of the main types of pelvic organ prolapse. It happens when the bladder bulges into the front wall of the vagina and may cause vaginal pressure or bulging, urinary leakage or difficulty emptying the bladder.
Some people with pelvic organ prolapse have no symptoms at all. Others notice heaviness, pressure, a vaginal bulge or changes in bladder, bowel or sexual function.
Not every prolapse needs treatment. The best approach depends on the type of prolapse, how much it affects you, your health and your preferences.
If you think you may have a prolapse, a GP, gynaecologist or pelvic health physiotherapist can assess it. In Australia, you can also call the free National Continence Helpline on 1800 33 00 66 to speak with a nurse continence specialist.
What is pelvic organ prolapse?
Pelvic organ prolapse, often shortened to POP, is when one or more pelvic organs move downwards and bulge into the vagina.
The bladder, uterus, bowel and vaginal walls are supported by pelvic floor muscles, ligaments and connective tissues. If these supports stretch, weaken or change over time, an organ or part of the vaginal wall can descend.
Prolapse can range from mild changes found during an examination to a bulge that reaches or extends beyond the vaginal opening.
For a plain-language look at the anatomy involved, see our guide to female reproductive anatomy.
What are the types of pelvic organ prolapse?
The type of prolapse depends on which organ or part of the vagina is affected. More than one type can occur at the same time.
Bladder prolapse (cystocele)
A bladder prolapse, also called a cystocele or anterior vaginal wall prolapse, happens when the bladder bulges into the front wall of the vagina.
Posterior vaginal wall prolapse
A rectocele occurs when the rectum bulges into the back wall of the vagina.
An enterocele occurs when the small bowel bulges into the upper or back part of the vagina.
Uterine prolapse
Uterine prolapse occurs when the uterus moves down into the vagina. In more advanced prolapse, the cervix or uterus may reach or extend beyond the vaginal opening.
Vaginal vault prolapse
The vaginal vault is the top of the vagina. A vault prolapse occurs when this upper part of the vagina descends, which can happen after a hysterectomy.
What is a bladder prolapse?
Bladder prolapse is one of the better-known forms of pelvic organ prolapse and is also referred to medically as a cystocele.
It occurs when the tissues supporting the bladder and front vaginal wall no longer hold the bladder in its usual position, allowing it to bulge into the vagina.
A mild bladder prolapse may cause no symptoms. When symptoms occur, they can include:
- pressure, heaviness or a dragging feeling in the vagina
- a lump or bulge you can see or feel in the vagina
- difficulty starting urination
- a urine stream that stops and starts
- feeling that the bladder has not emptied completely
- urinary leakage
- frequent urinary tract infections
- discomfort or changes during sex
Bladder prolapse can affect bladder function, but urinary leakage, urgency and difficulty emptying the bladder can have many other causes. Our guide to light bladder leakage explains other common patterns of urinary incontinence and when to seek advice.
Bladder prolapse is assessed and treated in much the same way as other forms of pelvic organ prolapse. Treatment depends on symptoms and may include pelvic floor physiotherapy, a vaginal pessary, watchful waiting or surgery.
How common is pelvic organ prolapse?
Pelvic organ prolapse is common, although estimates vary because studies measure it in different ways.
Mild prolapse found during an examination is considerably more common than prolapse that causes symptoms.
The Royal College of Obstetricians and Gynaecologists estimates that around 1 in 10 women over 50 experience symptoms of pelvic organ prolapse.
This distinction matters because having some degree of prolapse does not necessarily mean it will cause symptoms or need treatment.
What are the symptoms of pelvic organ prolapse?
Some people have no symptoms.
When symptoms occur, they may include:
- a feeling of pressure, fullness, heaviness or dragging in the vagina or pelvis
- a bulge you can see or feel at or inside the vaginal opening
- lower back discomfort
- needing to urinate more often or urgently
- difficulty starting urination
- a feeling that the bladder has not emptied completely
- urinary leakage
- recurrent urinary tract infections
- constipation or difficulty emptying the bowel
- needing to press on the vaginal wall or bulge to help empty the bowel
- discomfort or changes in sensation during sex
The pattern can sometimes give clues about which part of the pelvis is affected. Bladder symptoms may be more noticeable with a bladder prolapse, while bowel-emptying symptoms can occur with a posterior vaginal wall prolapse. However, symptoms alone cannot tell you which type you have.
Symptoms may become more noticeable after being upright for a long time or during some types of physical activity and may improve after lying down.
Our guides to light bladder leakage and painful sex cover two common overlapping symptoms in more detail.
What can contribute to pelvic organ prolapse?
There is no single cause of prolapse, and several factors may contribute over time.
Factors associated with a higher risk include:
- pregnancy and vaginal birth
- ageing and the years after menopause
- long-term constipation and repeated straining
- a chronic cough
- repeated heavy lifting
- higher body weight
- previous pelvic surgery, including hysterectomy
- a family history of prolapse
- connective tissue conditions or joint hypermobility
Pregnancy and vaginal birth are particularly important risk factors for bladder prolapse, but bladder and other pelvic organ prolapses can also occur in people who have never given birth.
Having one or more risk factors does not mean you will develop prolapse.
How is pelvic organ prolapse diagnosed?
A GP, gynaecologist or other appropriately trained healthcare professional will usually ask about your symptoms and medical history and perform a pelvic examination.
They may assess:
- which part of the vagina or which organ is prolapsing
- how far the prolapse descends
- whether you have bladder or bowel symptoms
- how much the prolapse affects your everyday life
An internal vaginal examination is commonly used to assess prolapse. The clinician should explain what the examination involves and why it may be useful. You can ask questions, request a chaperone and ask for the examination to stop at any time.
If bladder prolapse or urinary symptoms are present, additional tests may include a urine test, ultrasound, bladder scan or bladder-function testing depending on your symptoms.
How is prolapse staged?
Prolapse is often described in stages based on how far the organ or vaginal wall has descended.
Some services use a simple scale from stage 1 to stage 4. A more detailed system called POP-Q uses stages 0 to IV, with stage 0 meaning no prolapse.
The stage does not automatically determine whether treatment is needed. A mild prolapse can be bothersome for one person and hardly noticeable to another.
Treatment decisions are based on symptoms, quality of life, health, future pregnancy plans and personal preferences as well as physical findings.
Do you need treatment for prolapse?
Not always.
If your prolapse causes little or no discomfort and does not interfere with your usual activities, you may choose watchful waiting rather than treatment.
This applies to bladder prolapse as well as other types of pelvic organ prolapse. If symptoms are not affecting your quality of life, immediate treatment may not be necessary.
You can change your mind later if symptoms become more bothersome.
Some prolapses remain stable for long periods, while others may change over time. Arrange another assessment if you notice increasing bulging, bladder or bowel problems or other new symptoms.
What are the treatment options for pelvic organ prolapse?
Treatment can include lifestyle changes, pelvic floor physiotherapy, a vaginal pessary, treatment for menopause-related vaginal symptoms or surgery.
These options can also be used in combination.
Lifestyle and symptom management
Some practical strategies may reduce strain on the pelvic floor or help manage symptoms.
These can include:
- treating constipation and avoiding repeated straining
- managing a long-term cough
- stopping smoking
- weight management where this is relevant to your overall health
- modifying activities that consistently worsen your symptoms
Exercise is important for overall health and having prolapse does not mean you need to stop being active.
Some people notice more pressure, heaviness or bulging with high-impact exercise or heavy lifting. If a particular activity consistently worsens your symptoms, a pelvic health physiotherapist can help you adapt it and work out what level of exercise suits your body and goals.
Evidence for lifestyle changes alone improving prolapse is limited, so they are best viewed as part of a broader management plan rather than a guaranteed way to reverse prolapse.
Pelvic floor muscle training
Pelvic floor muscle training is commonly recommended for symptomatic mild to moderate prolapse.
Research suggests supervised pelvic floor training can improve prolapse symptoms, pelvic floor function and quality of life for some people, although it does not necessarily change the anatomical stage of the prolapse.
UK NICE guidance recommends considering a supervised program of at least 16 weeks for symptomatic stage 1 or 2 pelvic organ prolapse.
Pelvic floor exercises are a learned skill rather than simply βdoing more Kegelsβ. A pelvic health physiotherapist can check your technique and determine whether strengthening, coordination work or another approach is appropriate.
Not every pelvic floor problem is caused by weakness. If strengthening has been recommended, see our Kegel exercise guide and guide to pelvic floor trainers.
Vaginal pessaries
A vaginal pessary is a removable silicone or plastic device placed inside the vagina to support the pelvic organs.
Pessaries can be used for bladder prolapse as well as other types of pelvic organ prolapse.
They are fitted by a doctor or appropriately trained pelvic health professional, and finding the right type and size sometimes takes more than one attempt.
Some people learn to remove, clean and reinsert their own pessary. Some types can also remain in place during sex.
A pessary supports the prolapse while it is in place but does not permanently correct it. It may also change bladder symptoms, and some people can develop stress urinary leakage after the prolapse is supported.
Pessaries are generally well tolerated but can sometimes cause:
- increased vaginal discharge
- irritation
- bleeding
- vaginal ulceration
- discomfort
- difficulty removing or retaining the pessary
They need ongoing care and regular review. Follow your clinician's instructions for how often your pessary should be removed, cleaned and checked.
Vaginal oestrogen after menopause
Vaginal oestrogen does not lift a prolapse back into position.
It may be recommended after menopause when vaginal dryness, irritation or other genitourinary symptoms are present. For some people, improving vaginal tissue health may also make pessary use more comfortable.
Vaginal oestrogen is available in forms such as creams, tablets and rings and is not suitable for everyone, so discuss it with your GP or other healthcare professional.
For more information, see our guides to vaginal dryness and vaginal health in perimenopause.
Surgery
Surgery may be considered if prolapse symptoms are significantly affecting your quality of life and conservative options have not helped enough, are not suitable or are not what you want.
There are several different operations for prolapse. Depending on the type of prolapse and your circumstances, options may include:
- repair using your own tissues
- operations using mesh placed through the abdomen
- removal of the uterus in selected cases
- procedures that close part or all of the vaginal canal for people who do not wish to have vaginal intercourse in the future
No operation can guarantee that prolapse will never return. RCOG estimates that around 25 to 30 in every 100 people who undergo prolapse surgery later develop another prolapse.
The risks and expected benefits depend on the exact operation, your health and the type of prolapse.
What about surgical mesh?
In Australia, transvaginal mesh products whose sole purpose was treating pelvic organ prolapse were removed from the Australian Register of Therapeutic Goods from 4 January 2018.
This does not mean all surgical mesh is banned. Mesh placed through the abdomen may still be used in some prolapse procedures.
If mesh is being considered, ask your surgeon why it is recommended, what alternatives are available and what short-term and long-term risks apply to the particular procedure.
What about prolapse sponges?
Prolapse sponges are soft, compressible products marketed for temporary removable support inside the vagina.
Period Shop stocks Jade & Pearl Pink Pearl synthetic sponges and Sea Pearl natural sea sponges that are designed by the manufacturer for prolapse support.
It is important to distinguish these products from a clinically fitted vaginal pessary.
Pessaries are included in Australian and international clinical guidance for pelvic organ prolapse and are fitted and monitored by an appropriately trained healthcare professional. We did not identify clinical trials evaluating vaginal sponges for prolapse, and the clinical guidelines reviewed for this article discuss pessaries rather than sponges.
This means prolapse sponges should not be presented as equivalent to a clinically fitted pessary or as a substitute for assessment.
If you are considering a prolapse sponge:
- speak with a GP, gynaecologist or pelvic health physiotherapist if you are unsure whether internal support is appropriate for your type of prolapse
- do not use one for unexplained vaginal bleeding or a current vaginal infection without seeking medical advice
- seek guidance before use if you have recently given birth or had pelvic surgery
- follow the manufacturer's instructions for insertion, removal, cleaning, storage and replacement
- only trim a sponge if the manufacturer specifically allows it
- never force insertion
- stop using it if you develop pain, irritation, bleeding or worsening symptoms
You can explore Period Shop's prolapse sponges or browse our period care options for pelvic organ prolapse.
Prolapse sponges are different from menstrual sponges used to absorb period flow. Our guide to menstrual sponges covers that separate use.
When should you see a healthcare professional?
See your GP, gynaecologist or pelvic health physiotherapist if you notice:
- a lump or bulge in or outside the vagina
- persistent vaginal or pelvic heaviness, pressure or dragging
- difficulty starting urination
- a feeling that your bladder is not emptying properly
- difficulty emptying your bowel
- new urinary or faecal leakage
- recurrent urinary tract infections
- discomfort during sex
- symptoms that stop you exercising or doing the activities you want to do
If your bladder feels full but you cannot pass urine at all, seek urgent medical care.
Also seek urgent medical attention for severe pelvic or abdominal pain, heavy vaginal bleeding, fainting or symptoms that make you feel acutely unwell.
You do not need to work out whether you have a bladder prolapse, uterine prolapse, rectocele or another type before seeking help.
If talking about pelvic or vaginal symptoms feels difficult, our guide to talking to a doctor about intimate health concerns may help you prepare.
Frequently asked questions
What is a bladder prolapse?
A bladder prolapse, also called a cystocele or anterior vaginal wall prolapse, happens when the bladder bulges into the front wall of the vagina because the tissues supporting it have stretched or weakened. It can cause vaginal heaviness or a bulge, urinary leakage, difficulty passing urine or a feeling that the bladder has not emptied completely, although mild bladder prolapse may cause no symptoms.
Is a bladder prolapse the same as pelvic organ prolapse?
Bladder prolapse is one type of pelvic organ prolapse. Pelvic organ prolapse is the broader term covering prolapse of the bladder, uterus, rectum, small bowel or top of the vagina.
Can bladder prolapse cause urine leakage?
It can be associated with urinary leakage, urgency and problems emptying the bladder, but bladder prolapse does not explain every urinary symptom. Other types of urinary incontinence and bladder conditions can cause similar symptoms.
Can a bladder prolapse make it difficult to empty your bladder?
Yes. Some people with bladder prolapse experience difficulty starting urination, a stop-start stream or a feeling that urine remains in the bladder afterwards. If your bladder feels full and you cannot urinate at all, seek urgent medical care.
Is pelvic organ prolapse dangerous?
Pelvic organ prolapse is usually not life-threatening, but it can significantly affect quality of life. More advanced prolapse can sometimes interfere with bladder or bowel emptying, so symptoms are worth having assessed.
Can you have prolapse if you've never had a baby?
Yes. Pregnancy and vaginal birth are important risk factors, but prolapse can also occur in people who have never given birth. Age, connective tissue differences, chronic constipation, long-term coughing, pelvic surgery and other factors may contribute.
Can you exercise with a prolapse?
Usually, yes. Exercise remains important for overall health and prolapse does not mean you have to stop being active. Some people notice more pressure, heaviness or bulging with particular high-impact activities or heavy lifting. A pelvic health physiotherapist can help you adapt exercise according to your symptoms, fitness and goals.
Can pelvic floor exercises fix prolapse?
Pelvic floor muscle training can improve symptoms and pelvic floor function, particularly with mild to moderate prolapse, but it does not necessarily reverse the anatomical prolapse itself. A supervised program can help ensure the exercises are appropriate and performed correctly.
Can prolapse affect sex?
It can. Some people experience pressure, discomfort or changes in sensation during sex, while others notice no effect. Certain types of vaginal pessary can remain in place during intercourse. If prolapse is affecting your sex life, a pelvic health professional can discuss options with you.
Can prolapse get worse?
Prolapse can change over time. Some people notice little change, while others develop more noticeable symptoms. If heaviness, bulging, bladder or bowel symptoms are increasing, arrange another assessment.
Will prolapse come back after surgery?
It can. Surgery may significantly improve symptoms, but it cannot guarantee permanent correction. RCOG estimates that around 25 to 30 in 100 people who have prolapse surgery later develop another prolapse.
Is a prolapse sponge the same as a pessary?
No. A vaginal pessary is a medical support device fitted and monitored by an appropriately trained healthcare professional. Prolapse sponges are soft removable products marketed for temporary support. Evidence for prolapse sponges is limited, and they should not be considered equivalent to a clinically fitted pessary.
The bottom line
Pelvic organ prolapse is common and includes bladder prolapse, uterine prolapse, rectocele and other forms of vaginal prolapse.
A bladder prolapse or cystocele occurs when the bladder bulges into the front vaginal wall and may cause pressure, bulging, urinary leakage or difficulty emptying the bladder.
Not everyone with prolapse needs treatment. If symptoms are mild or not bothering you, watchful waiting may be reasonable. When treatment is needed, options can include pelvic floor physiotherapy, a vaginal pessary, management of menopause-related vaginal symptoms or surgery.
If you have persistent heaviness, bulging, bladder or bowel difficulties or other symptoms that concern you, a GP, gynaecologist or pelvic health physiotherapist can help confirm what is happening and discuss your options.
You can find a pelvic health physiotherapist in Australia through our directory.
Related reading
- Light Bladder Leakage: Causes, Types & What Can Help
- How to Do Kegel Exercises
- Overactive Pelvic Floor: Symptoms, Causes & Treatment
- Pelvic Floor Relaxation Techniques
- Painful Sex: Causes & What Can Help
- Menopause: A Comprehensive Guide
Sources
- Healthdirect Australia, Bladder prolapse (cystocele)
- Healthdirect Australia, Prolapsed uterus
- Continence Health Australia, Pelvic organ prolapse and pelvic floor support
- Australian Commission on Safety and Quality in Health Care, Treatment options for pelvic organ prolapse
- Royal College of Obstetricians and Gynaecologists, Pelvic organ prolapse
- National Institute for Health and Care Excellence, Urinary incontinence and pelvic organ prolapse in women: management
This article provides general information and is not a substitute for personalised medical advice. It cannot tell you which type or stage of prolapse you have or which treatment is right for you. Seek advice from a qualified healthcare professional about your own symptoms.