Pelvic Organ Prolapse: Everything You Didn't Know That You Need To Know
- sarah8648
- 9 hours ago
- 8 min read
By Sarah Bersey BSc (Hons) PGDip
Pelvic organ prolapse (POP) occurs when the muscles and connective tissues that support the pelvic organs (the hammock-like pelvic floor) are damaged (often by vaginal childbirth) or have become weakened, such as by ageing and/or hormone changes. (APOPS 2025) This can cause one or more organs, usually the uterus and bladder, to shift out of place and to shove into the vaginal space. Over time, the organ(s) move down in the vaginal canal and eventually the prolapsed organ(s) bulge outside of the vaginal opening.(APOPS 2025)
Medical practitioners have recorded instances of POP dating back to the Kahun Gynaecologic Papyrus (circa 1835 BC) (APOPS 2025), but it is not commonly discussed. It predominantly affects women and people with uteruses, from young teenagers to geriatrics. However, the frequency of cases increases with population age. (Johns Hopkins Medicine 2025). Overall estimates put the frequency of POP at:
However, it should be noted that although common, POP is not "just a normal consequence of childbirth or of ageing". (PhysicalTherapyMa (n.d.))
Types of POP:
Five categories of POP have been recognised and women often experience two or three types at the same time (APOPS 2025):
Types Of Prolapse
Each type of pelvic organ prolapse affects different organs. Organs that can prolapse can include the bladder, rectum, intestines, uterus, and vagina.
Risk factors for POP:
Childbirth & vaginal deliveries – especially multiple births, large‑baby or forceps deliveries (Johns Hopkins Medicine 2024)
Increasing age & post‑menopausal status – estrogen deficiency weakens pelvic connective tissue (Johns Hopkins Medicine 2024)
Obesity & chronic constipation – sustained intra‑abdominal pressure (straining) stresses the pelvic floor (Johns Hopkins Medicine 2024)
Connective‑tissue disorders (e.g., Ehlers‑Danlos) that impair ligament integrity
Prior pelvic surgery (hysterectomy, bladder or rectal surgery)
(Johns Hopkins Medicine 2024)
Smoking (Cleveland Clinic 2024)
A family history of POP (Cleveland Clinic 2024)
These factors predispose both uterine prolapse (descent of the uterus into the vagina) and bladder prolapse (cystocele, where the bladder bulges into the anterior vaginal wall).
Causes Of POP:
POP Treatment Options:
Both conservative and surgical management may be appropriate depending on the patient’s age, desire for future fertility and sexual function, symptom severity, and any other conditions in this area. (Medline Plus 2024) The degree of severity also influences treatment choice. (Johns Hopkins Medicine 2024)
Management goals include:
symptom relief
prevention of worsening of organ prolapse
preservation or improvement of sexual function
prevention of new support defects and incontinence
restoration of adequate pelvic support (Medline Plus (a) 2024)
Observation and close follow-up are appropriate for women with mild, asymptomatic cases. Most women do not experience symptoms until the bulge protrudes beyond the vaginal opening.
Actual treatment types may be of the following types:
Conservative / non‑surgical management
Pelvic‑floor muscle training (PFMT) (also known as Kegel exercises) | Strengthens levator ani and pubococcygeus muscles, improving support offered by the pelvic floor. Can be effective in improving stress, urge to strain and urinary incontinence. | Mild/moderate prolapse, motivated patients |
Lifestyle modification | Weight loss, high‑fiber diet, smoking cessation reduces intra‑abdominal pressure | All patients; especially those with obesity or constipation |
Topical estrogen (post‑menopausal) | Improves vaginal tissue quality, may enhance PFMT efficacy | Post‑menopausal women with atrophic changes |
Pessary fitting | Mechanical support of the uterus/bladder; reversible | Women who wish to avoid surgery or are poor surgical candidates |
Pelvic floor brace | Provides additional support under the pelvic floor | Women who wish to avoid surgery or are using pessaries |
(Cleveland Clinic 2024, Johns Hopkins Medicine 2024, Kuo et al 2025, BraceAbility 2025)
Evidence shows PFMT and pessaries can relieve symptoms and delay surgery, although long‑term success varies. (Cleveland Clinic (2024))
PFMT types:
Fast/quick contractions: These are used to help with urge suppression and to improve coordination, which is helpful for conditions like urinary urgency.
Slow/sustained contractions: These focus on building endurance in the pelvic floor muscles. They involve slowly contracting the muscles and holding for a period of time, gradually increasing the hold duration.
Biofeedback may be used as a method of positive reinforcement. Electrodes are placed on the abdomen and along the anal area. Some therapists place a sensor in the vagina in women to assess the contrctions .of pelvic floor muscles. (MedLine Plus (b) 2024)
A monitor will display a graph showing which muscles are contracting and which are at rest. This can help find the right muscles for performing pelvic floor muscle training exercises.(MedLine Plus (b) 2024)
PFMT/Kegels are pivotal for life-long pelvic floor health. Women who are waiting to make the decision whether or not to move forward with surgery should consider treatments & exercise routines to optimize their pelvic health. (APOPS 2025)
In addition, Kegel Breathing is a technique to incorporate breathing and pelvic floor contraction patterns to benefit pelvic floor muscle strength while engaging in normal daily routine activities. An activity that can be combined with nearly any daily ritual, this is a useful adjunct to specific exercise times and readily becomes a beneficial habit.(APOPS 2025)
Pessary types:
A vaginal pessary is a plastic or silicone device that sits inside the vagina and is usually supplied by healthcare providers. It helps support the walls of the vagina and should reduce the symptoms of the POP. The pessary is designed to be as comfortable as possible and the aim is to improve the patient's quality of life. Two thirds of women who use a vaginal pessary long term find it an acceptable option for management of their prolapse symptoms. (Cambridge University Hospitals 2025)
Types of NHS-supplied pessary (Cambridge University Hospitals 2025):
Specific situational use for POP pessaries:
In addition, Single-use and reusable silicone pessaries and sponges are also available to purchase in various shapes and materials (Kegel 8 2025, APOPS 2025). These can be worn with or without a support belt girdle (BraceAbility 2025). Girdles may also be used alone to provide support and are described by users as "supportive, effective, and comfortable".(BraceAbility 2025)
Vaginal pessaries available to buy:
A support belt girdle:
A pessary is typically replaced every four to six months, but in certain situations—such as limited access to in-person appointments during a pandemic—it may remain in place for up to 12 months. Research shows that leaving a pessary in for up to a year is safe, provided you do not experience side effects like vaginal bleeding, discomfort, or unusual discharge. If wearers notice any issues before their scheduled appointment, please contact the provider.
Finding the right pessary size and type often involves some trial and error. If a pessary falls out, don’t worry—this simply means the wearer may need to try a different one. It can sometimes take two or three visits to find the best fit.
A new pessary should be used if the current one shows signs of wear, such as cracks, splits, or an odor, or if it no longer effectively manages your prolapse symptoms, following the manufacturer’s guidelines.
At each visit, we will assess how well your symptoms are controlled and check the fit of your pessary. The pessary will be removed, and your vaginal walls and cervix (if present) will be examined with a speculum. If the pessary is still in good condition, it can be cleaned and reinserted. Otherwise, a new pessary—either the same type and size or a different one if needed—will be provided.(Cambridge University Hospitals 2025)
Surgical Options
Choice depends on prolapse stage, desire for uterine preservation, any concurrent medical problems, and patient preference. (Cleveland Clinic 2024, Johns Hopkins Medicine 2024)
1. Vaginal Mesh (Synthetic) Repair
How it works: A mesh patch is placed through the vagina to support the weakened tissue.
Pros
Strong, durable support; lower chance of recurrence.
Often done as a minimally invasive outpatient procedure.
Cons
Risk of mesh‑related complications (erosion, infection, pain).
Some patients require additional surgery to remove or adjust the mesh.
2. Native Tissue Vaginal Repair (e.g., Anterior/Posterior Colporrhaphy)
How it works: The surgeon folds and sutures the patient’s own vaginal tissue to tighten the wall.
Pros
No foreign material, eliminating mesh‑specific risks.
Generally well tolerated; quick recovery.
Cons
Higher chance of prolapse returning over time compared with mesh.
May be less effective for severe prolapse.
3. Sacrocolpopexy (Abdominal or Laparoscopic/Robotic)
How it works: A synthetic sling is attached to the top of the vagina and anchored to the sacrum (lower spine) via an abdominal incision or laparoscopic ports.
Pros
Very high long‑term success rates, especially for uterine or vault prolapse.
Can be performed robotically or laparoscopically, reducing incision size and postoperative pain.
Cons
Requires an abdominal approach—longer operative time and recovery than purely vaginal surgeries.
Potential for bowel or nerve injury near the sacrum.
4. Hysteropexy (Uterus‑Preserving)
How it works: The uterus is lifted and secured (often with mesh or sutures) without removal.
Pros
Preserves the uterus for women who wish to keep it for personal or hormonal reasons.
Similar success rates to sacrocolpopexy when done laparoscopically.
Cons
Still involves abdominal surgery and its associated recovery.
Not suitable if the uterus itself is diseased (e.g., fibroids).
5. Obliterative Procedures (Colpocleisis)
How it works: The vaginal canal is partially closed, essentially “closing off” the vagina.
Pros
Short operation, minimal anesthesia, rapid recovery.
Excellent anatomical support for women who no longer desire vaginal intercourse.
Cons
Irreversible—precludes future vaginal sexual activity and vaginal deliveries.
Not appropriate for younger or sexually active patients.
((Cambridge University Hospitals 2025, Cleveland Clinic 2024, Kuo et al 2025, Medline Plus (a) (2024))
Choosing the Right Option
Factor | Typical Preference |
Desire to retain uterus | Native tissue repair, hysteropexy, or sacrocolpopexy |
Concern about mesh | Native tissue repair, obliterative procedures |
Need for strong, lasting support | Sacrocolpopexy (laparoscopic/robotic) |
Sexual activity important | Avoid obliterative procedures; choose vaginal or abdominal repairs |
Overall health / surgical risk | Less invasive vaginal repairs preferred if medically feasible |
((Cambridge University Hospitals 2025, Cleveland Clinic 2024, Kuo et al 2025, Medline Plus (a) (2024))
Bottom line for surgery selection:
Vaginal approaches (native tissue or mesh) are less invasive but may have higher recurrence rates.
Abdominal/laparoscopic sacrocolpopexy offers the most durable results but involves a longer recovery.
Obliterative surgery is a simple, highly effective option for women who no longer need a functional vagina.
A thorough discussion with a specialist urogynecologist—covering symptom severity, lifestyle goals, and personal health is strongly advised and will help determine the safest and most satisfying choice. (Cleveland Clinic 2024, Johns Hopkins Medicine 2024, Kuo et al 2025)
Post‑operative care typically includes brief PFMT, activity modification, and follow‑up imaging or exams to monitor for recurrence.(Cleveland Clinic 2024, Johns Hopkins Medicine 2024)
Conclusion:
POP is a common problem that many women are uncomfortable seeking help about. However, as it is not a normal event, and negatively impacts daily life, they should feel empowered to find out about treatment options from their healthcare provider.
Women who have had multiple vaginal births, are older, obese, constipated, or post‑menopausal are at highest risk for uterine and bladder prolapse. Initial management emphasizes lifestyle change, PFMT, and pessary use. When symptoms are severe, persistent, or impact quality of life, surgical correction — preferably uterus‑preserving when feasible — is available, with options ranging from minimally invasive laparoscopic/robotic sacro‑hysteropexy to traditional vaginal repairs. Individualized counseling about risks (e.g., mesh complications) and expected outcomes is essential.
Sources and Useful References
APOPS (2025) Association For Pelvic Organ Prolapse Support Pelvic Organ Prolapse FAQ [online] https://www.pelvicorganprolapsesupport.org/pop-faqs
A comprehensive information source and support community for POP sufferers
Cambridge University Hospitals (2025)Vaginal pessaries for pelvic organ prolapse (POP) [online] https://www.cuh.nhs.uk/patient-information/vaginal-pessaries-for-pelvic-organ-prolapse-pop/
Cleveland Clinic (2024) – Uterine Prolapse: Stages, Symptoms, Treatment & Surgery (2024). [online] https://my.clevelandclinic.org/health/diseases/24046-pelvic-organ-prolapse
Discusses conservative measures: PFMT, lifestyle changes, pessary fitting, and topical estrogen.
Johns Hopkins Medicine (2024) – Uterine Prolapse. . [online] https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-prolapse
Notes additional risk contributors like prior hysterectomy and provides prevalence data
Kegel 8 [online] https://www.kegel8.co.uk
Suppliers of a range of re-usable pessaries
Information about pelvic floor strengthening exercises and devices
Kuo, C-H. , Martingano, D.J, Mikes, b.A. (2025) NCBI Bookshelf – Pelvic Organ Prolapse (StatPearls) [online] https://www.ncbi.nlm.nih.gov/books/NBK563229/
Details surgical options, including sacrohysteropexy, sacrospinous hysteropexy, mesh‑augmented repairs, and combined procedures.
Mayo Clinic (2021) Proceedings – Evaluation and Management of Pelvic Organ Prolapse [online] https://www.mayoclinicproceedings.org/article/S0025-6196(21)00699-6/fulltext
Highlights risk factors such as vaginal deliveries, age, post‑menopausal status, obesity, chronic constipation, and connective‑tissue disorders.
Medline Plus (a) (2024) Pelvic Floor Disorders [online] https://medlineplus.gov/pelvicfloordisorders.html
Medline Plus (b) (2024) Pelvic floor muscle training exercises [online] https://medlineplus.gov/ency/article/003975.htm
M2B Healing (2025) Kegels [online] https://pelvicfloorspecialist.com/kegels/#:~:text=TWO%20TYPES%20OF%20KEGELS:&text=In%20order%20to%20train%20both,seconds%20progressing%20to%2010%20seconds.
PhysicalTherapyMa (n.d.) Womens Physical Therapy [online] https://www.physicaltherapyma.com/blog/womenshealth
StressNoMore (2025) [online] https://www.stressnomore.co.uk/blogs/womens-health/pessary-use-in-pelvic-organ-prolapse-and-incontinence?srsltid=AfmBOootp3MZ5I70FP-51ArF2B8X4CkRfZooY877NGmCU6HRsXAeFHEQ
Good source of information about types of pessaries and their use
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