How common is pelvic organ prolapse?
Prolapse is very common, but how common depends on what you count. If you ask women whether they feel a bulge, about 3 to 6% say yes. If you examine women instead, 41 to 50% have some degree of prolapse. Both numbers are correct. One counts symptoms, the other counts anatomy, and that is why the numbers you find online seem to disagree.
Why the numbers look so different
A pelvic exam finds any amount of descent, including amounts a woman would never feel. Most women do not notice prolapse until the leading edge reaches about half a centimeter past the opening of the vagina. Everything above that point shows up on an exam and causes no symptoms at all.
The Women’s Health Initiative examined a large group of postmenopausal women. 65% had prolapse at stage II or higher, but only 25% had prolapse that reached or passed the vaginal opening. In a separate study of nearly 2,000 women, about 3% reported a bulge they could feel.
So some loss of support is close to an expected finding as women get older. Prolapse that bothers you is a much smaller group.
The numbers worth knowing
- 3 to 6% of women report a bothersome vaginal bulge
- 41 to 50% have some prolapse on a pelvic exam, including about 40% of women over 50
- About 1 in 8 women has surgery for prolapse by age 80
- Around 300,000 prolapse surgeries are done in the US each year
- New cases peak between ages 70 and 79
- The number of women affected is expected to rise about 50% by 2050 as the population ages
It starts earlier than people expect
Prolapse is not only an older woman’s condition. In a study of first-time mothers examined 6 to 12 months after delivery, about 1 in 3 already had stage II support. Prolapse that reached or passed the vaginal opening was present in 14 to 15% of women after a vaginal birth, and 5% after a cesarean without labor. Almost none of these women had symptoms.
It does not only move in one direction, either. Among postmenopausal women followed over time, new prolapse showed up in 26% at one year and 40% at three years. But prolapse also resolved on its own in about 1 in 5 women at one year.
What makes it more likely
- Childbirth, especially vaginal delivery, and having more deliveries
- Getting older
- Higher body weight
- Menopause
- Chronic constipation or a chronic cough
- A prior hysterectomy
- Family history and connective tissue disorders
The front wall of the vagina, where the bladder sits, is the most common place for prolapse. It is found about twice as often as the back wall and three times as often as the top of the vagina.
Common does not mean you have to live with it
Common and normal are not the same thing. If you feel a bulge, pressure, or heaviness, or if prolapse is getting in the way of your bladder, your bowels, or sex, that is worth treating. I see women every week who waited years because they assumed this is just what happens after having kids or going through menopause.
But because so much prolapse causes no symptoms, finding it on an exam is not by itself a reason to do anything about it. Prolapse that does not bother you can reasonably be watched. When it does bother you, we talk through the options together, from a pessary to pelvic floor therapy to surgery.
References
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. AUGS Best Practice Statement: Evaluation and Counseling of Patients With Pelvic Organ Prolapse. Urogynecology. 2025. doi:10.1097/SPV.0000000000001641
- ACOG/AUGS Practice Bulletin No. 214: Pelvic Organ Prolapse. Obstetrics & Gynecology. 2019.
- Barber MD. Pelvic organ prolapse. BMJ. 2016. doi:10.1136/bmj.i3853
- Handa VL, Nygaard I, Kenton K, et al. Pelvic organ support among primiparous women in the first year after childbirth. International Urogynecology Journal and Pelvic Floor Dysfunction. 2009. doi:10.1007/s00192-009-0937-3
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