Vaginal Prolapse

What is vaginal prolapse?

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.

Are there different types of prolapse?

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:

• Vaginal prolapse (apical prolapse): The top of your vagina (known as the “vaginal vault”) droops down into your vaginal canal. This usually occurs in people who have had a hysterectomy (removal of your uterus).
• Uterine prolapse: Your uterus bulges or slips into your vagina sometimes so far that it comes out of your vaginal opening. In severe cases, you’ll feel vaginal tissue rubbing against your clothes.
• Cystocele: Your bladder drops into your vagina.
• Urethrocele: Your urethra (the tube that carries pee from your bladder) bulges into your vagina.
• Rectocele: Your rectum bulges into your vagina.
• Enterocele: Your small intestine bulges against the back wall of your vagina.

How common is vaginal prolapse?

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.

How do I know if I have a prolapse?

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.

How does a prolapse affect other parts of my body?

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.

What are the symptoms of vaginal prolapse?

Symptoms of vaginal prolapse can include:

• A feeling of fullness, heaviness or pain in the pelvic area. This feeling often gets worse as the day goes on or after standing, lifting or coughing.
• Lower back pain.
• Bulging in your vagina.
• Feeling like something is slipping out of your vagina.
• Leaking pee (urinary incontinence).
• Repeat bladder infections.
• Difficulty pooping.
• Problems with sexual intercourse.
• Problems inserting tampons.

What does vaginal prolapse feel like?

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.

What causes vaginal prolapse?

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:

• Childbirth: Vaginal delivery raises the risk of prolapse more than a C-section. Your risk of prolapse may be higher if you’ve had many vaginal deliveries, prolonged labor or delivered a large baby (more than 9 pounds).
• Menopause: During menopause, your ovaries stop producing hormones that regulate your monthly menstrual cycle (period). The hormone estrogen is particularly important because it helps keep your pelvic muscles strong. When your body doesn’t make as much estrogen as before, your pelvic muscles can become weak and you may develop a prolapse.
• Surgery: People who have had a hysterectomy (surgery to remove your uterus) are more likely to have vaginal prolapse.
• Aging: As you grow older, you are at a higher risk of prolapse.
• Extreme physical activity or lifting of heavy objects: Strain from activity can also weaken your pelvic muscles and allow your organs to sag out of position.
• Genetic or hereditary factors: Your pelvic support system could naturally be weaker.

Activities or conditions that place extra pressure on your abdominal area can also cause a prolapse. These can include:

• Not maintaining a healthy body weight.
• Heavy lifting.
• Straining to poop.
• Having a chronic cough (common in people with asthma or respiratory problems).

How is vaginal prolapse diagnosed?

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.

At what age does a prolapse happen?

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.

How is vaginal prolapse treated?

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:

• Your general health and if you have any other serious medical conditions.
• Your age.
• The severity of your prolapse.
• If you want to have children in the future.
• If you want to have penetrative sex in the future.

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:

• Exercise: The muscles of your pelvis can be strengthened with exercises called Kegel exercises. To do these exercises, tighten your pelvic muscles as if you are trying to hold back pee. Hold the muscles tight for a few seconds and then release. Repeat this 10 times. You can do this up to four times a day and these exercises can be done anywhere.
• Vaginal pessary: Typically shaped like a small plastic or rubber doughnut, a pessary is a device that sits in your vagina. It acts as a support structure, helping to hold things in place. Your healthcare provider fits you for a pessary and inserts it. You’ll need to clean it frequently and remove it before having sex.

For more severe cases, surgery to correct vaginal prolapse can be an option. These options include:

• Vaginal vault suspension: This procedure involves attaching your vagina to the ligaments inside your pelvis that are used to hold it up.
• Sacrocolpopexy: This procedure involves attaching a piece of mesh to your vagina and securing the mesh to your tailbone to give the vagina a lift. This surgery is done through your abdomen, using small incisions and a minimally invasive surgery called laparoscopy.
• Colpocleisis: This procedure involves stitching your vagina shut. An advantage of this surgery is the outcome — your risk of getting another prolapse is low. However, once you have this procedure, you can’t have penetrative sex.

What happens if the prolapse is left untreated?

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.

Can you push a prolapse back up?

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.

Can vaginal prolapse be prevented?

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:

• Exercising regularly (performing Kegel exercises).
• Maintaining a healthy body weight and diet.
• Not smoking (smoking cigarettes can cause you to cough more).
• Using proper lifting techniques when carrying heavy objects.

What are proper lifting techniques and how do they help prevent a prolapse?

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.

• Don’t lift alone: When you have something that’s oddly shaped or very large, get help lifting it.
• Check your footing: Make sure you have a good footing before lifting something.
• Lift with your legs: When you pick something up that’s lower than the level of your waist, keep your back straight and bend at your knees and hips. Don’t bend forward at the waist with your knees straight.
• Use a wide stance: Keep your feet apart and firmly on the ground when you lift something.
• Don’t jerk or twist when you lift something: Make sure that you straighten your knees in a steady motion and don’t jerk the object up.
• Reposition objects before lifting: If you’re lifting an object from a table, slide it to the edge so that you can hold it close to your body.
• Hold packages close to your body: Keep your arms bent, your stomach muscles tight and hold the object closer to the core of your body.
• Lower objects in the same way you picked them up: Place your feet apart, tighten your stomach muscles and bend at your hips and knees to lower an object.

Can vaginal prolapse happen again?

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.

What’s the outlook for vaginal prolapse?

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.

When should I see my healthcare provider?

Contact your healthcare provider if you have symptoms of prolapse like:

• Feeling full in your vagina or like you’re sitting on a ball.
• Feeling a lump or bump coming out of your vagina.
• Pain in your lower back or pelvic region.
• Needing to pee more often than normal.
• Painful sex.
• Irregular vaginal bleeding.

A note from Cleveland Clinic

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.