Does pelvic organ prolapse get worse over time?
Prolapse can change over time, but most of the time it stays about the same. In one study, 78% of women with untreated prolapse had no change after 16 months. In a large study of women past menopause, only 11% had the prolapse drop 2 centimeters or more over 3 years. Across studies, about 10% to 20% of women see their prolapse move up a stage over 2 years.
Prolapse can also get better on its own. In one group of women past menopause, about 1 in 5 who had prolapse no longer had it a year later.
Some women do notice slow worsening. I talk with my patients about what raises the odds of that so we can build a plan together.
What makes prolapse more likely
These are known risk factors for prolapse. Research hasn’t sorted out how much each one drives worsening once you already have it.
- Having children, especially vaginal births
- Getting older
- Menopause
- Extra body weight
- Chronic constipation and straining
- Connective tissue disorders that you’re born with
Weight and constipation are the two you can change, so those are where I focus.
What you can do
Pelvic floor physical therapy helps. In the largest trial of its kind (the POPPY trial), women who did individualized pelvic floor training had better symptom scores at one year than women who only got a lifestyle advice leaflet. 57% in the training group said their prolapse felt better, compared to 45% in the leaflet group. The prolapse itself didn’t change much on exam. The training mostly helped how women felt.
Therapy covers strength, relaxation, coordination, and how you breathe and brace when you lift. We have pelvic floor physical therapists in our office who work with you one-on-one. See pelvic floor physical therapy for prolapse for more.
Other things that help:
- Keeping a healthy weight to take pressure off your pelvic floor
- Treating constipation and chronic cough so you strain less
A pessary, a removable support device, holds the prolapse up and relieves symptoms. It might also help keep prolapse from getting worse, but there isn’t enough research yet to say.
When to talk about treatment
Not every prolapse needs treatment. If yours isn’t bothering you, watching it over time is a reasonable choice. The exception is prolapse that keeps your bladder from emptying. I check how well you empty before we decide to watch.
When symptoms do bother you, like pressure, a bulge, or trouble with your bladder, bowels, or sex, we talk through your options together. They include a pessary, pelvic floor therapy, and surgery. You don’t have to try them in order. We pick based on your symptoms and what matters most to you.
How I approach it
I measure your prolapse at the first visit so we have a baseline to compare against later. If you’re not bothered, we watch it. If you are, we pick the treatment that fits your goals. I don’t fix a prolapse that isn’t bothering you.
References
- Committee on Practice Bulletins—Gynecology, American Urogynecologic Society. Pelvic Organ Prolapse (ACOG Practice Bulletin No. 214). Obstetrics & Gynecology. 2019.
- 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
- Barber MD. Pelvic organ prolapse. BMJ. 2016. doi:10.1136/bmj.i3853
- 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
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019. doi:10.1097/GCO.0000000000000584
- Hooper GL, Moynihan L, Leegant A, et al. Vaginal Pessary Use and Management for Pelvic Organ Prolapse. Urogynecology. 2023. doi:10.1097/SPV.0000000000001293
← Learn more about Pelvic Organ Prolapse