Dr. Ryan Stewart, DO
Ryan Stewart, DO
Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed January 2016

Understanding Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) is a common condition in women where pelvic organs shift into spaces they wouldn’t normally occupy — essentially a hernia of the pelvic floor. Below, I’ll walk through the types of prolapse, what symptoms to look for, how we diagnose it, and what your treatment options are.

Types of Pelvic Organ Prolapse

POP is a general term that covers several specific types:

  1. Cystocele: Prolapse of the bladder
  2. Rectocele: Prolapse of the rectum
  3. Enterocele: Prolapse of the small intestine
  4. Urethrocele: Prolapse of the urethra
  5. Uterine Prolapse: Prolapse of the uterus
  6. Cervical Prolapse: Prolapse of the cervix
  7. Vaginal Vault Prolapse: Prolapse of the top of the vagina in women who have had a hysterectomy

Multiple Types of Prolapse Often Occur Together

It’s common for patients to experience more than one type of pelvic organ prolapse simultaneously. For instance:

  • About 70% of patients with a cystocele (bladder prolapse) also have ‘apical’ prolapse involving the uterus, cervix, or vaginal cuff.
  • Having more than one type of prolapse can change which symptoms you notice and which treatments make sense.
  • This is why a thorough evaluation matters — we need to know what’s going on in each compartment before recommending a plan.

Symptoms of Pelvic Organ Prolapse

POP isn’t dangerous, but it can be really bothersome. Common symptoms include:

  • Feelings of pelvic pressure, fullness, pulling, or tugging (especially with heavy lifting)
  • Sensation of sitting on an egg or ball
  • Visible or palpable bulge at the vaginal opening
  • Difficulty with vaginal intercourse
  • Urinary symptoms (frequency, urgency, or incontinence)
  • Spraying during urination
  • Difficulty with bowel movements
  • Abnormal vaginal bleeding (Note: Always consult a doctor for abnormal bleeding)

Diagnosis of Pelvic Organ Prolapse

We diagnose POP with a pelvic exam, which includes:

  1. Internal and external examination
  2. Use of a speculum
  3. Asking the patient to bear down, push, or cough to make the prolapse more pronounced

I use the POP-Q (Pelvic Organ Prolapse Quantification) system to stage prolapse on a scale from 0 to 4, where 0 is no prolapse and 4 is complete prolapse.

Treatment Options for Pelvic Organ Prolapse

There are several effective treatment options for POP, and the right approach depends on your symptoms, your goals, and what matters most to you. During your consultation, we’ll talk through all of the options so you can make an informed decision about your care. Not everyone needs surgery, and not everyone needs to start with conservative treatment first — it really depends on your situation.

Observation (Expectant Management)

If your prolapse isn’t causing bothersome symptoms, it’s perfectly reasonable to monitor it over time. Prolapse often remains stable, and not every prolapse requires treatment.

Home Exercises

Kegel exercises to strengthen pelvic floor muscles, often combined with core strengthening and postural changes, can help alleviate symptoms.

Pelvic Floor Physical Therapy

Working with a pelvic floor physical therapist gives you supervised, hands-on treatment that goes well beyond what you can do on your own at home. Studies show this can improve symptoms in women with mild to moderate prolapse.

Pessary

A pessary is a device worn inside the vagina to support the pelvic organs. It’s a non-surgical option that can be managed either by the patient at home or by a healthcare provider in the office. Up to 92% of women can be successfully fitted with a pessary, and many find it makes a real difference in their day-to-day comfort.

Surgical Options

For women with bothersome symptoms who want a more definitive solution, surgery can be very effective. The best surgical approach depends on the type and severity of prolapse, your overall health, and your goals. Options include:

  • Vaginal Repair Surgery performed entirely through the vagina, using the patient’s own tissues and sutures to restore normal vaginal support.

  • Robotic-Assisted Laparoscopic Sacrocolpopexy A minimally invasive approach using small abdominal incisions and robotic assistance to attach a lightweight mesh to the vagina and sacrum, providing durable support. Learn more about robotic sacrocolpopexy.

  • Colpocleisis (Obliterative Repair) An option for women who do not desire future vaginal intercourse. This procedure has high success rates and shorter recovery times.

Making a Decision About Treatment

The right treatment depends on several factors that are unique to you:

  • The severity and type of prolapse
  • How your symptoms affect your daily life
  • Your overall health and medical history
  • Your goals for treatment (e.g., preserving sexual function, avoiding surgery)
  • Your lifestyle and occupation

Decision Aids

One helpful tool is the “Should I Have Surgery?” decision aid, which walks through the condition, treatment options, and potential outcomes. It includes comparisons of surgical and non-surgical options, personal stories from other patients, and questions to help you think about what matters most to you.

Reviewing something like this before your consultation can help you come in with a clearer sense of your priorities, which makes our conversation more productive.

Next Steps

If you’re dealing with symptoms of pelvic organ prolapse, you don’t have to just live with it. There are real options — and the first step is getting a thorough evaluation so we can figure out what’s going on and what makes sense for you.

If you’d like to learn more, I encourage you to schedule an appointment for a thorough evaluation and personalized treatment plan.

References

  1. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783-1790. doi:10.1007/s00192-013-2169-9
  2. American College of Obstetricians and Gynecologists/American Urogynecologic Society. Pelvic Organ Prolapse. ACOG Practice Bulletin No. 214. Obstet Gynecol. 2019;134(5):e126-e142. Reaffirmed 2024. doi:10.1097/AOG.0000000000003519
  3. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;(12):CD003882. doi:10.1002/14651858.CD003882.pub4

Frequently Asked Questions

What is pelvic organ prolapse (POP)? Pelvic organ prolapse (POP) is a common condition in women where pelvic tissues and organs move into spaces they wouldn't normally occupy, essentially a type of hernia involving the pelvic organs.
What are the types of pelvic organ prolapse? There are several types of POP including cystocele (bladder prolapse), rectocele (rectum prolapse), enterocele (small intestine prolapse), urethrocele (urethra prolapse), uterine prolapse, cervical prolapse, and vaginal vault prolapse.
What are the common symptoms of pelvic organ prolapse? Common symptoms include feelings of pelvic pressure or fullness, sensation of sitting on an egg or ball, visible or palpable bulge at the vaginal opening, difficulty with vaginal intercourse, urinary symptoms, difficulty with bowel movements, and in some cases, abnormal vaginal bleeding.
How is pelvic organ prolapse diagnosed? POP is typically diagnosed through a comprehensive pelvic exam, which includes internal and external examination, use of a speculum, and asking the patient to bear down or cough. Doctors often use the POP-Q system to stage the prolapse on a scale from 0 to 4.
What are the treatment options for pelvic organ prolapse? Treatment options include observation, home exercises, pelvic floor physical therapy, pessary devices, and surgical options such as vaginal repair, robotic-assisted laparoscopic sacrocolpopexy, and colpocleisis. The right approach depends on your symptoms, goals, and overall health — we'll discuss all the options together so you can make the best decision for you.
Can pelvic organ prolapse be treated without surgery? Yes, non-surgical treatments such as pelvic floor exercises (Kegels), physical therapy, and the use of a pessary device can often be effective in managing symptoms.
What factors are considered when choosing a treatment for POP? Factors considered include the severity and type of prolapse, patient's symptoms and their impact on quality of life, overall health and medical history, patient's goals for treatment, and lifestyle and occupation.
Is it common to have multiple types of prolapse at once? Yes, it's common for patients to experience more than one type of pelvic organ prolapse simultaneously. For example, about 70% of patients with a cystocele also have 'apical' prolapse involving the uterus, cervix, or vaginal cuff.
How can I prepare for my initial consultation about pelvic organ prolapse? To prepare for your initial consultation, consider the following steps: 1) Keep a symptom diary noting when and how your symptoms affect you. 2) Write down any questions you have about your condition and treatment options. 3) Make a list of your current medications and any previous treatments you've tried. 4) If possible, gather any relevant medical records (such as past surgeries) or test results. 5) Consider bringing a family member or friend for support and to help remember information.

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The information provided is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for personalized medical guidance.

Page last modified: Mar 15 2026.