17597 Vaginal Prolapse

Overview

Vaginal prolapse happens when the tissues that hold the bladder, womb, or bowel in place become weak. This can make one of these organs drop into the vaginal space, often feeling like a bulge or a feeling that something is falling out.

Yes, vaginal prolapse is very common. It is especially frequent after childbirth and in people who have gone through menopause.

Vaginal prolapse affects people who have a vagina. It is most often seen in people who have had vaginal births, but it can also happen in people who have never given birth, especially as they get older.

Symptoms

Common symptoms

• A feeling of heaviness, pulling, or dragging in the pelvic area
• A visible or noticeable bulge that sticks out of the vagina
• A feeling like something is falling out of the vagina
• Discomfort or pain during sexual intercourse
• Difficulty emptying the bladder or a weak urine stream
• Leaking urine when coughing, sneezing, or exercising
• Constipation or needing to push to empty the bowel

Symptoms in children

• Vaginal prolapse is very rare in children. If a child complains of a bulge, pain, or trouble urinating, a parent or caregiver should talk to a qualified healthcare provider.

Symptoms in older adults

• Symptoms may become more noticeable with age as muscles naturally weaken.
• Lower estrogen levels after menopause can cause vaginal tissues to become thinner and drier, which may make the prolapse feel more uncomfortable.
• Older adults may experience new or worsening urinary leakage or constipation.

Causes

Main causes

• Weakening of the muscles and connective tissue that support pelvic organs
• Vaginal childbirth, especially with a large baby or a long labor
• Menopause – lower estrogen levels can make tissues thinner and less elastic
• Pressure on the pelvic floor from chronic coughing, heavy lifting, or constipation

Risk factors

• Multiple vaginal births
• Giving birth to a large baby
• Prolonged labor or assisted delivery with forceps
• Being overweight or obese
• Smoking, which can weaken connective tissue
• Chronic conditions like asthma, bronchitis, or chronic constipation
• A family history of prolapse

When to see a doctor

See a doctor urgently if:

• If you see a new bulge coming out of your vagina and it is painful or swollen
• If you cannot pass urine or empty your bowels
• If you have heavy bleeding from your vagina

Book a routine appointment if:

• If you feel a sensation of heaviness, fullness, or a dragging feeling in your pelvic area
• If you notice a bulge during daily activities like showering or wiping
• If you have urinary leakage, constipation, or discomfort during sex that bothers you

Diagnosis

A healthcare provider, usually a doctor or a nurse, can diagnose vaginal prolapse by asking about your symptoms and performing a pelvic examination. The examination is usually done while you are lying on your back, and sometimes it is also done while you are standing up.

Tests that may be done

• Pelvic examination – the doctor gently looks and feels inside the vagina
• You may be asked to cough or bear down to see how the prolapse moves
• Sometimes a urinary test or a bladder scan is done if you have urinary symptoms
• In rare cases, a specialized scan called MRI or ultrasound might be recommended

What to expect at your appointment

The examination is usually quick and should not be painful. During the exam, you may feel some pressure, but it is important to let the doctor know if you are in pain. The doctor will explain what they find and discuss your options with you in plain language.

Treatment

Treatment for vaginal prolapse depends on how much it bothers you. The goal is to relieve symptoms and improve quality of life. Many people can manage mild prolapse with lifestyle changes and exercises. There is no one-size-fits-all approach, and you can take your time to decide what feels right for you.

Self-care at home

• Do pelvic floor exercises (sometimes called Kegel exercises) – these help strengthen the muscles that support your pelvic organs
• Avoid heavy lifting, or learn to lift properly by bending your knees and tightening your pelvic floor
• Prevent constipation by drinking plenty of water and eating foods high in fibre
• Maintain a healthy weight – even modest weight loss can ease pressure on the pelvic floor
• If you smoke, consider asking your healthcare provider for support to stop smoking

Medical treatments

Your doctor may suggest pelvic floor physiotherapy, where a trained physiotherapist helps you exercise the right muscles. Another option is a pessary – a soft support device worn inside the vagina that can be fitted by a healthcare provider. Some people benefit from local hormone treatment, such as a vaginal cream or ring, which is only recommended after discussing the risks and benefits with a doctor. Always talk to your doctor or pharmacist before using any product inside the vagina.

When is surgery considered?

Surgery may be considered if your symptoms are severe, if other treatments have not helped, or if the prolapse affects your daily life. There are several surgical options, and a specialist can explain what would be best for you. Surgery is not urgent, and you should be given time to make your decision.

Living with this condition

Living with prolapse often means finding small ways to ease pressure on your pelvic floor. Taking breaks to rest, sitting rather than standing for long periods, and supporting your bottom with a cushion can help. A portable support device or pessary can also be used if your doctor thinks it is suitable.

Lifestyle tips

• Stay active with gentle exercises like walking, swimming, or prenatal/postnatal classes
• Avoid exercises that put heavy strain on the pelvic floor, such as high-impact running or jumping
• Avoid lifting heavy objects – ask for help when you need it
• Empty your bladder regularly and do not strain when using the toilet
• Wear supportive clothing if it makes you feel more comfortable

Diet and exercise

Eating a high-fibre diet with plenty of fruits, vegetables, and whole grains helps prevent constipation and reduces straining during bowel movements. Drinking enough water is also important. Gentle pelvic floor exercises done regularly can help support your pelvic organs. If you are unsure how to do them, ask for a referral to a pelvic floor physiotherapist.

Mental health and emotional wellbeing

Living with prolapse can affect how you feel about your body and your relationships. It is normal to feel embarrassed, anxious, or frustrated. These feelings are understandable, and you do not have to cope with them alone. Talking to a trusted friend, counsellor, or your healthcare provider can help. If you are feeling overwhelmed or sad for a long time, ask your doctor about mental health support as well.

Prevention

You cannot always prevent vaginal prolapse, especially if it is related to childbirth or age, but there are steps that may lower your risk or slow its progression. Keeping your pelvic floor muscles strong, maintaining a healthy weight, treating constipation early, and avoiding heavy lifting can all help protect the pelvic area.

Vaccines

A vaccine for prolapse is not available. Some infections that cause chronic coughing (like the flu or COVID-19) can be prevented with vaccination, which can indirectly reduce pressure on your pelvic floor. Ask your healthcare provider about recommended vaccinations for you.

Screening programmes

There is no routine national screening test for prolapse. However, you may be checked for prolapse during a regular pelvic exam or after childbirth if you have symptoms. If you have any concerns, you can request an assessment at any time.

Complications

If left untreated

• Symptoms may stay the same, or they may gradually become more noticeable over time
• Some people experience increasing discomfort or difficulty with urination or bowel movements
• Rarely, a prolapse can become severe enough that the organs press on the vagina all the time, making daily activities hard
• Untreated prolapse does not become cancer and is not a threat to life

Long-term outlook

For most people, vaginal prolapse can be managed well. Many people find great improvement with conservative treatments such as pelvic floor exercises and lifestyle changes. Even when surgery is needed, it can offer long-lasting relief. With the right support, most people continue to live full and comfortable lives.

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