Can your uterus prolapse?
Yes. The uterus can drop toward the vaginal opening when the muscles, ligaments, and connective tissue that hold it in place lose their support. That is uterine prolapse, and it is one form of pelvic organ prolapse.
It is common. On a careful pelvic exam, about 65% of postmenopausal women have some prolapse, and about 25% have tissue that reaches or passes the vaginal opening. But only a small share, roughly 3 to 6%, have a bulge that actually bothers them. So finding some descent on an exam is closer to normal than to alarming. What matters is whether it is causing symptoms.
How the uterus is normally held up
Your pelvic organs rest on a support system with a few layers:
- pelvic floor muscles that work like a hammock across the bottom of the pelvis
- ligaments at the top that suspend the cervix and upper vagina
- sheets of connective tissue, called fascia, along the vaginal walls
When the top-level ligaments give way, the uterus and the top of the vagina can descend. When the side supports weaken, the bladder or the rectum can bulge into the vagina as well.
Who is more likely to get it
The strongest risk factors are:
- vaginal childbirth, especially more than one delivery
- age
- menopause and the drop in estrogen that comes with it
- higher body weight
- anything that raises pressure in the belly for years, such as chronic constipation and straining, a chronic cough, or smoking
- inherited differences in connective tissue
Childbirth is the big one. In a study that examined women within a year of their first baby, about a third already had stage II support, meaning the leading edge of the prolapse had come down close to the vaginal opening. Most of them had no symptoms. A cesarean lowered the risk but did not erase it.
Having risk factors does not mean you will develop bothersome prolapse, and having some prolapse does not mean it will get worse.
What it feels like
The most telling symptom is a bulge, the feeling of something sitting low in the vagina, or something you can see or feel at the opening. Around that, women describe:
- pressure or heaviness that builds over the day
- a low backache
- bladder trouble, such as leaking, a weak stream, or a sense that you cannot empty all the way
- bowel trouble, such as constipation, or needing to press on the vaginal wall to finish
Symptoms and exam findings do not always line up. Some women with a significant amount of descent barely notice it, while others with mild prolapse are quite bothered. Most women start to feel a prolapse once the leading edge reaches about half a centimeter past the hymen. That gap between anatomy and symptoms is why treatment is driven by how you feel, not by a number on the exam.
How prolapse is measured
Instead of loose labels, urogynecologists use a system called the POP-Q. It measures how far the lowest part of the prolapse sits relative to the hymen, the vaginal opening, while you bear down. It sorts into stages:
- Stage 0: no prolapse
- Stage I: the lowest point stays more than 1 cm above the opening
- Stage II: the lowest point is within 1 cm above or below the opening
- Stage III: the lowest point is more than 1 cm past the opening
- Stage IV: nearly everything has come down and the vagina is turned close to inside out
Uterine prolapse also travels with its neighbors. It often comes with a bladder bulge (cystocele), a rectal bulge (rectocele), or a loop of small bowel pressing in from above (enterocele).
Will it get worse?
Not necessarily, and not quickly for most women. Among women with untreated symptomatic prolapse, about 78% had no change over roughly 16 months. Over a couple of years, only 10 to 20% see their stage go up, and prolapse can even improve on its own, in one group about 1 in 5 got better within a year without treatment.
Can you lower your risk?
You cannot undo childbirth or genetics, but you can take pressure off the support you have:
- keep a weight that is healthy for you
- treat constipation so you are not straining, and treat a lingering cough
- do not smoke, since both the cough and the effect on tissue work against you
- do pelvic floor muscle training
Treatment, if you want it
Mild prolapse with no symptoms does not need treatment. If it is bothering you, there is a range of options, and the choice is yours.
Pelvic floor physical therapy. Working with a therapist on the muscles that support the pelvis can reduce prolapse symptoms. In a large trial, women who did individualized training reported more improvement and were less likely to need further treatment than women who were given only a leaflet. We have pelvic floor physical therapists in the office.
A pessary. This is a soft support device that sits in the vagina and holds the prolapse up. Every woman with bothersome prolapse should be offered one. In a large registry, about 78% of women using a pessary said their prolapse was much or very much better at one year.
Surgery. Several operations can rebuild the support, or, for women who no longer want vaginal intercourse, close off the vaginal canal. About 1 in 8 women has prolapse surgery by age 80.
How I think about this
The question I care about is not whether you have prolapse. A lot of women do, and much of it never causes trouble. The question is whether it is getting in the way of your life. If it is not, watching it is a sound plan, and you can start treatment later if things change. If it is, we pick the option that fits what you want, not the one that looks most impressive on an exam. The number on the POP-Q helps me track things over time, but it does not decide anything by itself.
When to get checked
Consider an evaluation if you notice:
- a bulge you can feel or see at the vaginal opening
- pressure or heaviness that builds through the day
- new bladder or bowel trouble
- any bleeding after menopause, which always gets looked at on its own
References
- Committee on Practice Bulletins—Gynecology, American Urogynecologic Society. Pelvic Organ Prolapse. ACOG Practice Bulletin No. 214. Obstetrics & Gynecology. 2019.
- Barber MD. Pelvic organ prolapse. BMJ. 2016. doi:10.1136/bmj.i3853
- 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
- Handa VL, Nygaard I, Kenton K, et al. Pelvic organ support among primiparous women in the first year after childbirth. International Urogynecology Journal. 2009. doi:10.1007/s00192-009-0937-3
- Hilton P, Dolan LM. Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG. 2004. doi:10.1111/j.1471-0528.2004.00505.x
- 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
- Hooper GL, Moynihan L, Leegant A, et al. Vaginal Pessary Use and Management for Pelvic Organ Prolapse. Urogynecology. 2023. doi:10.1097/SPV.0000000000001293
- Andy UU, Meyn L, Brown HW, et al. Outcomes at 12, 24, and 36 Months in Women Treated for Pelvic Organ Prolapse With Pessary or Surgery: Results From the Multicenter Pelvic Floor Disorders Registry. Urogynecology. 2025. doi:10.1097/SPV.0000000000001669
- Chang OH, Carter Ramirez A, Edwards A, et al. The Role of Uterine Preservation at the Time of Pelvic Organ Prolapse Surgery. Urogynecology. 2025. doi:10.1097/SPV.0000000000001667