Prolapse treatments
Pelvic organ prolapse means the bladder, uterus, top of the vagina, or rectum has dropped into the vaginal canal. It is common, especially after vaginal childbirth and menopause. Many women have some prolapse on exam and never notice it. Treatment is for prolapse that bothers you: a bulge you can see or feel, pressure, trouble emptying your bladder or bowels, or problems with sex.
Choosing among your options
There is no single right treatment for prolapse. Which option fits you depends on:
- Which part of the vagina has dropped, and how far
- Which symptoms bother you most, and how much
- Your overall health and past surgeries
- Your goals, including whether you want to stay sexually active and how much recovery time you can take
We decide together. You do not have to fail one treatment before you can choose another. A pessary and pelvic floor physical therapy are reasonable first choices for many women, and every woman with bothersome prolapse should be offered a pessary. If you would rather have surgery first, that is a reasonable choice too.
I group prolapse treatment into four tiers, from watching it over time up to surgery:
| Tier | Option | What it involves | Who it tends to suit |
|---|---|---|---|
| No treatment | Watch and wait | Periodic checkups, no treatment | Prolapse that isn’t bothering you |
| Conservative | Pelvic floor physical therapy | Supervised pelvic floor muscle training, sometimes with biofeedback | Mild to moderate prolapse; anyone who wants to try nonsurgical care |
| Conservative | Lifestyle changes | Weight management, careful lifting, treating chronic cough or constipation | Anyone with prolapse, alone or with other treatment |
| Office-based | Pessary | A removable vaginal support device, fitted in the office | Any woman with bothersome prolapse, especially one who wants to avoid or delay surgery |
| Surgery (reconstructive) | Vaginal prolapse repair | Repair through the vagina using your own tissue | Women who want the prolapse fixed and prefer no abdominal incisions |
| Surgery (reconstructive) | Robotic sacrocolpopexy | Small abdominal incisions; lightweight mesh attaches the top of the vagina to the sacrum | Women who want the strongest anatomic support at the top of the vagina |
| Surgery (obliterative) | Colpocleisis | Narrows or closes the vaginal canal | Women who don’t plan to have vaginal intercourse again |
Nonsurgical treatments
Pelvic floor physical therapy
- A pelvic floor physical therapist builds a training program around your muscles, often with biofeedback
- In a large randomized trial, women who did individualized pelvic floor training had fewer prolapse symptoms at a year than women who got a lifestyle advice leaflet
- Therapy tends to improve symptoms more than it changes how far the prolapse drops on exam, and it has not been shown to keep prolapse from getting worse
Pessaries
- A pessary is a removable silicone device that sits in the vagina and holds the prolapse up
- Pessaries come in many shapes and sizes, and most women can be fitted with one
- A pessary works for any type or stage of prolapse, and you can stop using it at any time
Lifestyle changes
- Losing weight if you carry extra, using good body mechanics when you lift, and treating a chronic cough or constipation all reduce the strain on your pelvic floor
- These changes help alongside other treatment. There is little evidence that they shrink a prolapse on their own
Surgical treatments
Reconstructive surgery
- Reconstructive surgery puts the vagina and the organs it supports back where they belong, so you keep a vagina for intercourse
- I can do it through the vagina using your own tissue, or through small abdominal incisions with robotic sacrocolpopexy
- Sacrocolpopexy uses a strip of lightweight mesh placed through the abdomen. In older studies it held the top of the vagina up better than vaginal repair, but it carries a small risk of mesh problems that a repair with your own tissue does not.
- The FDA removed mesh kits for transvaginal prolapse repair from the U.S. market in 2019. That order did not cover mesh placed through the abdomen for sacrocolpopexy
Obliterative surgery (colpocleisis)
- Colpocleisis narrows or closes the vaginal canal
- It is for women who are sure they will not want vaginal intercourse again
- It carries low operative risk, and prolapse rarely comes back after it
Making your decision
At your visit I examine you, measure the prolapse, and ask what bothers you most. Then we go through the options that fit, with the benefits and risks of each. Bring your questions and tell me what you want to get back to doing; your goals shape the choice as much as the exam does.
Did you know?
If your prolapse isn’t bothering you, you may not need any treatment. Prolapse doesn’t always get worse; in some women it stays the same or even improves over time.
Next steps
If you have symptoms of prolapse or concerns about your pelvic health:
- Schedule a consultation with a urogynecologist
- Write down your symptoms, what bothers you most, and your questions
- Consider bringing a trusted friend or family member to your appointment
References
- 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
- 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
- Ferrando CA, Bradley CS, Meyn LA, et al. Twelve Month Outcomes of Pelvic Organ Prolapse Surgery in Patients With Uterovaginal or Posthysterectomy Vaginal Prolapse Enrolled in the Multicenter Pelvic Floor Disorders Registry. Urogynecology. 2023. doi:10.1097/SPV.0000000000001410