What causes pelvic organ prolapse?

The pelvic floor muscles, ligaments, and connective tissues help hold the bladder, uterus, and bowel in position. Vaginal childbirth can stretch or injure this support. Ageing and the hormonal changes of menopause can reduce tissue resilience, while repeated constipation, straining, chronic coughing, heavy lifting, or higher body weight may add pressure. A prolapse may involve the front vaginal wall, the uterus, or the back vaginal wall. Symptoms can include heaviness, a bulge, urinary leakage or difficulty emptying the bladder, and bowel pressure.

A pelvic health clinician can assess the type and severity of prolapse. Pelvic floor exercises, physiotherapy, constipation care, and strategies to reduce repeated straining may improve support and symptoms. Some people use a vaginal pessary fitted by a clinician; others need monitoring or surgery depending on the findings and their goals. Avoid holding your breath during lifting, and seek advice before starting an intense exercise programme.

Arrange an assessment for a new vaginal bulge, persistent pelvic heaviness, urinary difficulty, leakage, or bowel symptoms. Seek urgent help if you cannot pass urine, have severe pain, heavy bleeding, fever, or a prolapsed tissue that becomes very swollen, dark, or intensely painful.

Which pelvic organ is affected, and how advanced is the prolapse? Would pelvic floor physiotherapy or a pessary suit me? How should I manage constipation and lifting? What changes mean I need an earlier review?