Vaginal prolapse occurs when the muscles supporting your pelvic organs (such as the vagina, uterus, bladder, and bowels) become weak, causing the organs to move out of their normal positions. This may cause the top of the vagina (the “vaginal vault”) to drop into the vaginal canal. Symptoms can include pelvic pressure, a bulging feeling in the vagina, difficulty with bladder and bowel function, and pain during sex. Vaginal prolapse can be treated in a few different ways; your choice of treatment may depend on your symptoms, age, and other health problems.

Overview

What Is Vaginal Prolapse?

Vaginal prolapse, also known as “vaginal vault prolapse,” is a condition where the top of the vagina drops into the vaginal canal. This happens when the pelvic floor muscles and tissues that support the vagina and other pelvic organs become weak and stretched, causing those organs to sag and bulge into the vagina. Vaginal childbirths, menopause, and hysterectomy raise the risk of vaginal prolapse. The condition affects about one-third of women during their lifetime.

Types of Pelvic Organ Prolapse

Vaginal prolapse seldom involves just the vagina. Other pelvic organs can also fall out of their normal position. This condition may be referred to, collectively, as pelvic organ prolapse, and may include:

Uterine prolapse: When the uterus drops into or out of the vagina.
Bladder prolapse (cystocele): When the bladder drops into the front wall of the vagina.
Rectal prolapse (rectocele): When the rectum drops into the back wall of the vagina.
Small intestine prolapse (enterocele): When the small intestine drops down against the back wall of the vagina.

Each may come with similar symptoms to vaginal prolapse, but treatment may vary depending on the organs involved and severity of symptoms.

Signs and Symptoms of Vaginal Prolapse

Some women with vaginal prolapse may not experience symptoms at all. But in a small percentage of women, vaginal prolapse can cause the following symptoms:

Pelvic fullness, pressure, or pain
Bulging feeling in the vagina
Low back pain
Worsening symptoms after standing for long periods, lifting heavy objects, or coughing
Urinary issues, like incontinence or urinary tract infection
Difficulty having a bowel movement
New pain during sexual intercourse
Difficulty inserting tampons or menstrual cups

Causes and Risk Factors of Vaginal Prolapse

A prolapse happens when pelvic floor muscles that support your pelvic organs (the vagina, bladder, uterus, urethra, and rectum) weaken and stretch.

This can be due to the following factors.

Multiple Vaginal Deliveries The stretching that occurs during vaginal childbirth can weaken pelvic floor muscles. Multiple births can raise that risk.

Menopause The hormone estrogen helps keep your pelvic muscles strong, and as this hormone decreases during menopause, these muscles can become weaker.

Hysterectomy People who have their uterus removed (also called a hysterectomy) may have a higher risk of pelvic organ prolapse, especially if their uterus was removed through the vagina (versus a stomach incision).

Age Vaginal prolapse can happen at any age, but as women get older, their risk for prolapse increases.

Heavy Lifting Lifting heavy objects can put extra pressure on your pelvic muscles and push your vaginal vault into the vagina canal.

Overweight Extra body weight also increases the pressure on your pelvic muscles, putting you at higher risk for vaginal prolapse.

Pressure Any activity that increases the pressure to your pelvic region can boost your risk for vaginal prolapse: even straining to have a bowel movement or coughing frequently.

How Is Vaginal Prolapse Diagnosed?

To diagnose vaginal prolapse, your healthcare provider has several options.

Physical Exam Your provider may first perform a pelvic exam and attempt to locate the prolapse in your vagina with a gloved finger. They may ask you to cough or strain to check the extent of your prolapse.

Ultrasound If they need a better view of the surrounding organs, your provider may next try an ultrasound, which uses sound waves to get a rough image of your body’s organs.

MRI A magnetic resonance imaging (MRI) scan offers the best possible picture of your internal organs, and may be used if your provider needs more detail to recommend treatment.

Urodynamic Tests If you have difficulty urinating, your provider may use this test to check how well your bladder is working and determine whether your prolapse has affected it.

Treatment and Medication Options for Vaginal Prolapse

Vaginal prolapse often requires no treatment, but, depending on its severity, your provider may offer a few options.

You may be referred to a gynecologist, who specializes in the female reproductive system, or a urogynecologist, who specializes in pelvic floor disorders.

You might feel tempted to try to push your prolapse back into place, but experts warn this fix is only temporary, and your best option is to get medical treatment.

There is little evidence that estrogen therapy can treat pelvic organ prolapse.

But other treatments have had plenty of success.

Devices and Exercises

Vaginal Support For some vaginal prolapses, your provider may insert a vaginal pessary, which can help ease symptoms by keeping your vagina in place. This device is soft and flexible, comes in different shapes and sizes, and should stay in place when you bear down (like when you try to pee or poop). Your provider can teach you how to remove and reinsert your pessary for cleaning.
Pelvic Floor Exercises For people who experience few to no symptoms of vaginal prolapse, your provider may suggest exercises to strengthen your pelvic floor muscles. The most common of these are called Kegel exercises, which you can do by tightening and relaxing your pelvic floor muscles.
Pelvic Floor Muscle Training A structured pelvic floor muscle training program has been shown to help with the symptoms and severity of pelvic organ prolapse.
A physical therapist with special training in pelvic floor therapy can teach you the exercises and make sure you’re doing them right. Pelvic floor muscle training can also be very effective at improving urinary incontinence.

Surgery

For severe cases of vaginal prolapse, your provider may recommend one of these surgical options.

Vaginal vault suspension surgically connects the top of your vagina to ligaments inside your pelvis using your own tissue.
Sacrocolpopexy attaches your vagina to your tailbone using a surgical mesh, restoring your vagina’s natural position and relieving symptoms like a bulging feeling in the vagina.
Colpocleisis stitches the walls of your vagina together, either partially or fully, which has a high safety and success record, but you’re no longer able to have penetrative sex.

You can discuss each option with your health provider to determine the right option for you.

Prevention of Vaginal Prolapse

While you can’t always prevent vaginal prolapse, you can take steps to strengthen your pelvic floor muscles. Kegel exercises are a commonly prescribed pelvic floor exercise. To perform Kegels, try the following.

Locate the right muscles. To find your pelvic floor muscles, try to stop peeing midstream or imagine trying not to pass gas and notice which muscles you feel tightening. You can also insert a finger into your vagina and try to squeeze it with your pelvic muscles.
Hold the squeeze. Once you find the right muscles, tighten them for three seconds if you can (it’s okay to start with less time). Then release the tension and relax. Repeat this as many times as you can, several times per day.
Avoid tightening other muscles. Try not to tighten other muscles in your stomach or thighs, which can put pressure on your bladder.

Not sure if your pelvic muscles are weak? You can ask your provider to help you find them at your next checkup and give you guidance on strengthening them and avoiding excessive pelvic pressure.

Lifestyle Changes for Vaginal Prolapse

Decrease your risk of developing vaginal prolapse by making a few lifestyle changes.

Try to Maintain a Healthy Body Weight

Losing weight if you’re overweight can take pressure off your pelvic floor muscles.

Quit Smoking

Smoking cigarettes can cause a chronic cough, which adds to pelvic pressure. If you smoke, try to quit.

Use Good Lifting Techniques

To avoid pelvic pressure while lifting, lift with your back straight while bending at your knees and hips, use a wide stance, and don’t twist as you lift.

Complications of Vaginal Prolapse

If vaginal prolapse goes untreated, you could experience complications like increased pain, sores on your vaginal wall, and infection. Left too long, you can experience problems such as loss of control over your bladder or bowel.

Let your healthcare provider know if you experience these symptoms:

Sensation of sitting on a ball
A lump coming out of your vagina
Pain in your lower back or pelvis
More frequent urination
Painful sexual intercourse
Unusual bleeding from your vagina

The Takeaway

Vaginal prolapse is a type of pelvic organ prolapse, which occurs when the muscles and tissues that support your pelvic organs (such as the uterus, vagina, rectum, and bladder) become weak, causing one or more of these organs to move out of position. Vaginal prolapse is when the top of your vagina falls into your vaginal canal. Women usually don’t have symptoms, but those who do will often experience a bulging sensation, pelvic pain, or a feeling of fullness in the belly. For symptoms that are bothersome, your provider may recommend trying a pessary or doing Kegel exercises to strengthen your pelvic floor muscles. For more severe cases, you may benefit from surgery.

Common Questions & Answers

How common is vaginal prolapse?

About one half of women from age 50 to 79 are believed to experience some type of pelvic organ prolapse.

Can I push my prolapse back in?

Although you may be able to manually push your vaginal prolapse back in, experts recommend seeing a healthcare provider as soon as possible for a more permanent treatment solution.

What happens if I don’t treat my vaginal prolapse?

If left untreated, you could experience complications like increased pain, sores on your vaginal wall, and infection, as well as difficulty urinating and having a bowel movement.

What’s the best treatment for vaginal prolapse?

Treatment depends on the severity of your prolapse and can range from pelvic floor exercises to surgery.

Kara Smythe, MD

Medical Reviewer

Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.

She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.

Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.

When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.

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Abby McCoy, RN

Author

Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.

McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.