Vaginal Prolapse: Symptoms, Stages, Causes & More

Pelvic organ prolapse is a common yet under-discussed condition that affects millions of women worldwide. Understanding what happens when the pelvic floor's supportive structures weaken can help women recognise symptoms and seek appropriate care. This is also termed apical prolapse and is a condition in which the surrounding supportive pelvic muscles can weaken, allowing organs to sag and protrude into the vaginal canal. It’s a lot more common than you might think, with a global prevalence of nearly 25% — that’s one in four women. While this diagnosis can feel overwhelming, understanding your options and seeking appropriate care can help you manage the condition effectively. Many women with mild prolapse experience minimal symptoms and can manage their condition effectively with conservative treatments and lifestyle modifications.

What is prolapse and how does it affect the vagina?

Prolapse is the term used to describe a condition in which supportive structures — such as muscles and ligaments — weaken, allowing organs or tissue in the area to fall out of place. Pelvic organ prolapse is a common condition that occurs when the pelvic floor muscles weaken or become damaged, causing organs like the uterus or bladder to shift or sag into the vaginal canal. In the case of vaginal prolapse, these organs drop and descend into the vaginal canal. 

The term may also be used more specifically to describe a type of pelvic prolapse in which the vaginal vault (the uppermost part of the vagina) sags and descends, sometimes even causing the vagina to protrude from the body.

Vaginal prolapse is a condition where your vagina slips out of position. It happens when the tissues and muscles in your pelvis weaken and overstretch. It’s more common in women who have had multiple vaginal deliveries during childbirth and have gone through menopause.

Signs and symptoms of vaginal prolapse

In mild cases, there may be no early signs of vaginal prolapse but they can develop as the condition progresses. The most common vaginal prolapse symptom is a feeling of pressure in the vaginal region, which can be painful and may include a sensation of fullness such as if something were stuck inside. As the pelvic organs are located in the same region, a prolapse of any one affects the surrounding organs, so you may experience other symptoms including:

• Bowel symptoms such as difficulty with evacuation and constipation

• Changes in urination frequency, partial emptying of the bladder or urinary incontinence

• Pain and discomfort during penetrative sex

• Abnormal vaginal bleeding

• Pain or discomfort when trying to use tampons

What causes vaginal prolapse?

Vaginal prolapse occurs when the supportive structures of the pelvic floor are weakened or damaged, typically due to well-recognised risk factors. Some of these risk factors are :

• Multiple vaginal childbirths or difficulty during childbirth

• Obesity or excess body weight

• Ageing and menopause

• Certain gynaecological surgeries 

• Strenuous activity such as lifting heavy weights

Understanding the stages of vaginal prolapse

Based on the severity of the condition, there are four vaginal prolapse stages.

1. First-degree prolapse: The mildest stage of vaginal prolapse in which the affected organs have only descended slightly.

2. Second-degree prolapse: The affected organs have descended to reach the level of the vaginal opening. 

3. Third-degree prolapse: Sagging of the organs is so severe that as much as 1 cm of it bulges out from the vagina.

4. Fourth-degree prolapse: The bulge of organs from the vaginal opening extends beyond 1 cm.

The different types of pelvic organ prolapse can include:

• Vaginal prolapse (apical prolapse): The top of your vagina (known as the vaginal vault) droops down into your vaginal canal. This usually occurs in women who have had to remove their uterus.

• Uterine prolapse: Your uterus bulges or slips into your vagina sometimes so far that it comes out of your vaginal opening. In severe cases, you’ll feel vaginal tissue rubbing against your clothes.

• Cystocele: Your bladder drops into your vagina.

• Urethrocele: Your urethra (the tube that carries pee from your bladder) bulges into your vagina.

• Rectocele: Your rectum bulges into your vagina.

• Enterocele: Your small intestine bulges against the back wall of your vagina

How to fix vaginal prolapse: Treatment options

Treatment for vaginal prolapse can vary depending on the severity of the condition, as well as other factors such as your age and medical history. Doctors will also consider whether you plan to have more children in the future or not, before determining the appropriate treatment. While many women with mild prolapse can manage their symptoms effectively with conservative treatments, the condition typically requires ongoing management rather than spontaneous resolution. In mild cases, non-invasive treatments are adequate and can include:

• Pelvic floor muscle training (PFMT): This is the first line of treatment for mild prolapse.

• Lifestyle modifications: Weight loss, constipation treatment, and avoiding heavy lifting can help.

In some cases where non-invasive treatments are inadequate, surgery may be recommended.

How to prevent or manage vaginal prolapse

There is no proven method of prevention, but the risk of vaginal prolapse can be drastically reduced by following these simple tips.

• Adopt a regular practice of pelvic floor muscle strengthening exercises, such as Kegels.

• Maintain a healthy body weight and don’t ignore chronic constipation or coughing, as they increase pressure on the pelvic muscles.

• Only practise weight lifting under proper guidance and using the right technique.

• Discuss hormonal treatments with your doctor to lower postmenopausal risks.

• Get regular health checks, including routine gynaecological exams, to ensure early detection.

The last word

Vaginal prolapse may be a common condition, but it deserves attention and care. Left unmanaged, it can interfere with daily life, intimacy, and self-confidence. The good news is that with early diagnosis, many women find relief through non-surgical options like pelvic floor exercises, pessaries, and lifestyle changes. In more advanced cases, surgical treatment can offer long-term improvement. Regular gynaecological check-ups, staying informed, and taking proactive steps toward pelvic health can make a significant difference. Don’t ignore the signs,  empower yourself with knowledge and take charge of your well-being.

Frequently Asked Questions

1. What is vaginal prolapse?

Vaginal prolapse occurs when the pelvic floor muscles weaken, causing the vagina or surrounding organs to drop from their normal position. It’s common after childbirth or menopause.

2. What are the main symptoms of vaginal prolapse?

Symptoms include a heavy feeling in the pelvis, a bulge in or outside the vagina, discomfort during sex, and urinary issues.

3. What causes vaginal prolapse?

Common causes include childbirth, menopause, chronic coughing, heavy lifting, obesity, or ageing. These factors weaken the pelvic floor muscles over time.