Understanding Uterine Prolapse
What is Uterine Prolapse?
Uterine prolapse happens when the structures that normally support the uterus, such as the pelvic floor muscles and ligaments, stretch and weaken. The uterus can then descend into or protrude out of the vagina. It’s a type of pelvic organ prolapse that primarily affects women who have given birth or those in their postmenopausal years.
It’s 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. Only about 3% report a bulge they notice. Some descent on an exam is common enough that I don’t treat it unless it’s causing symptoms.
Causes and Risk Factors
These raise your risk of uterine prolapse:
- Vaginal childbirth, especially multiple births
- Age and menopause
- Obesity
- Chronic coughing or constipation
- Heavy lifting over many years
- Family history of pelvic floor disorders
- Hysterectomy or other pelvic surgeries
Vaginal childbirth is the biggest risk factor. In a study that examined women 6 to 12 months after their first baby, about a third already had stage II support, meaning the prolapse had come down close to the vaginal opening. Even after a cesarean without labor, 5% had prolapse at or past the opening.
Key Point:
These factors raise risk, but uterine prolapse can happen to women of any age or background.
Symptoms
Symptoms range from mild to severe and may include:
- A feeling of heaviness or pulling in the pelvis
- A bulge or protrusion from the vagina
- Difficulty urinating or having a bowel movement
- Lower back pain
- Discomfort during sexual intercourse
- In advanced cases, the cervix or uterus may protrude outside the vagina
Some women have mild prolapse with no symptoms at all.
Symptoms and exam findings don’t always line up. Some women with a lot of descent barely notice it, while others with mild prolapse are quite bothered. Most women start to feel a prolapse once its leading edge is about half a centimeter past the hymen. That gap is why I base treatment on how you feel, not on a number from the exam.
Stages of Uterine Prolapse
Urogynecologists stage prolapse with a system called the POP-Q, which measures how far the lowest point of the prolapse sits from the hymen, the vaginal opening, while you bear down:
- Stage 0: no prolapse
- Stage 1: the lowest point stays more than 1 cm above the opening
- Stage 2: the lowest point is within 1 cm above or below the opening
- Stage 3: the lowest point is more than 1 cm past the opening
- Stage 4: the vagina is turned nearly inside out
Uterine prolapse often comes with a bladder bulge (cystocele), a rectal bulge (rectocele), or small bowel pressing down from above (enterocele).
Diagnosis
If you suspect you have uterine prolapse, consult a urogynecologist or pelvic floor specialist. Diagnosis typically involves:
- A detailed medical history
- A pelvic examination
- Imaging tests if necessary
Your doctor may also perform tests to assess your bladder and bowel function.
Will it get worse?
Not necessarily, and not quickly for most women. Among women with untreated prolapse, about 78% had no change over roughly 16 months. Prolapse can also improve on its own: in one group of postmenopausal women, about 1 in 5 got better within a year without treatment.
Treatment Options
Treatment for uterine prolapse depends on the severity of your condition and your personal preferences. Options include:
Conservative Treatments
- Pelvic floor muscle exercises (Kegels)
- Pelvic floor physical therapy
- Pessary devices
- Lifestyle changes (e.g., weight loss, avoiding heavy lifting)
Conservative options are typically tried first. A pessary (a removable support device fitted inside the vagina) can be offered to any woman with symptomatic prolapse, and supervised pelvic floor muscle training has been shown to reduce prolapse symptoms. In a large registry, about 78% of women still using a pessary at one year said their prolapse was much or very much better.
Surgical Options
For more severe cases, or when conservative treatments haven’t provided enough relief, surgery may be an option. Repairs for uterine prolapse generally include a step to resuspend the uterus or the top of the vagina, and they fall into two broad approaches:
- Uterine-preserving repair (hysteropexy): the uterus is kept in place and resuspended to a stronger ligament, sometimes with the help of mesh. This may be done through the vagina or through the abdomen (including laparoscopic or robotic approaches).
- Hysterectomy with prolapse repair: the uterus is removed and the top of the vagina is resuspended at the same time. Removing the uterus by itself, without this added support, is not enough to correct the prolapse.
Repairs of the front or back vaginal wall (colporrhaphy), or an abdominal mesh repair such as sacrocolpopexy, may also be part of the plan depending on which areas are affected.
Keeping the uterus is a reasonable choice for many women, and professional guidelines recommend that uterine preservation be offered when there is no sign of uterine or cervical disease. Whether to keep or remove the uterus is a personal decision to make with your surgeon, weighing your preferences, medical history, and plans for the future.
Important:
The best treatment plan for you will depend on factors such as your age, desire for future pregnancies, and overall health. Discuss all options thoroughly with your healthcare provider.
Living with Uterine Prolapse
Many women live well with uterine prolapse. Things that help:
- Perform pelvic floor exercises regularly
- Maintain a healthy weight
- Practice good bowel habits to avoid constipation
- Avoid heavy lifting when possible
- Follow up with your healthcare provider as recommended
Prevention Strategies
While not all cases of uterine prolapse can be prevented, you can reduce your risk by:
- Maintaining a healthy weight
- Practicing pelvic floor exercises throughout your life
- Treating and preventing constipation
- Avoiding heavy lifting or using proper lifting techniques
- Quitting smoking
When to Seek Help
See your healthcare provider if you:
- Feel a bulge in your vagina
- Experience persistent pelvic pressure or discomfort
- Have difficulty urinating or with bowel movements
Early intervention can often lead to better outcomes and may help you avoid more invasive treatments.
Uterine prolapse is common. With treatment, most women get relief from their symptoms and stay active. Your healthcare team can help you build a plan around your own needs and concerns.
References
- Committee on Practice Bulletins—Gynecology, American Urogynecologic Society, Tulikangas P. Pelvic organ prolapse. Practice Bulletin No. 214. Obstetrics & Gynecology. 2019.
- 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
- Nager CW, Visco AG, Richter HE, et al. Effect of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: 5-year results of a randomized clinical trial. American Journal of Obstetrics and Gynecology. 2021. doi:10.1016/j.ajog.2021.03.012
- Hooper GL, Moynihan L, Leegant A, et al. Vaginal pessary use and management for pelvic organ prolapse. Urogynecology. 2023. doi:10.1097/SPV.0000000000001293
- 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
- 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
- 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
- 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