Can pelvic organ prolapse cause back pain?
Some women with pelvic organ prolapse notice low back pain or a dragging feeling, especially later in the day or after standing for a while. The international terminology for prolapse lists “POP-related low backache” as a recognized symptom.
Prolapse is not the most common cause of back pain. But the two can be connected, and I see it fairly often in clinic.
How prolapse can cause back pain
The uterosacral ligaments run from your cervix and upper vagina back to the sacrum, the flat bone at the base of your spine. They help hold the top of the vagina and the uterus up. When prolapse stretches these ligaments, you may feel a low, period-like ache centered over the sacrum. It gets worse with standing or activity.
Prolapse can also lead to back discomfort in other ways:
- Postural changes. You may shift how you stand or move without realizing it, which puts extra strain on your back.
- Pelvic floor and core connection. Your pelvic floor muscles work with your core, hips, and back. Problems in the hips, back, or pelvic joints can add to pelvic floor symptoms or feel like them.
Back pain from prolapse usually feels like a dull ache or dragging in the low back. It tends to get worse as the day goes on and better when you lie down or when the prolapse is pushed back up. Most prolapse symptoms follow that same pattern.
Back pain without any pelvic symptoms is more likely coming from your spine, muscles, or joints. If back pain comes with leg weakness, numbness between your legs, or new trouble controlling your bladder or bowels, get seen right away.
When to bring it up
If you have low back pain along with pelvic pressure, a vaginal bulge, or changes in bladder or bowel habits, tell your doctor. Those symptoms together suggest prolapse may be part of the picture.
I ask about pain when I evaluate prolapse. One way to test the connection is with a pessary, a removable device that supports the prolapsed organs from inside the vagina. If a pessary eases your back pain, the two are likely related.
Pelvic floor physical therapy can also help. A pelvic floor PT works on strength and coordination, plus your core, hips, and posture. In one large trial, women with prolapse who had one-on-one pelvic floor training reported less low-back heaviness at 6 months than women who didn’t. By 12 months the gap had narrowed. We have pelvic floor PTs in our office and can also refer to therapists in the community.
When we treat the prolapse, whether with a pessary, physical therapy, or surgery, many women tell me their back pain gets better too.
References
- Haylen BT, Maher CF, Barber MD, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP). Neurourology and Urodynamics. 2016. doi:10.1002/nau.22922
- Haylen BT, Vu D. Surgical anatomy of the vaginal vault. Neurourology and Urodynamics. 2022. doi:10.1002/nau.24963
- Hilton P, Dolan LM. Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG: an International Journal of Obstetrics and Gynaecology. 2004. doi:10.1111/j.1471-0528.2004.00505.x
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. American Urogynecologic Society Best Practice Statement: Evaluation and Counseling of Patients With Pelvic Organ Prolapse. Urogynecology. 2025. doi:10.1097/SPV.0000000000001641
- Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet. 2014. doi:10.1016/S0140-6736(13)61977-7
- Harm-Ernandes I, Boyle V, Hartmann D, et al. Assessment of the Pelvic Floor and Associated Musculoskeletal System: Guide for Medical Practitioners. Female Pelvic Medicine & Reconstructive Surgery. 2021. doi:10.1097/SPV.0000000000001121
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