When should you see a doctor about vaginal bulge?

A vaginal bulge can happen when pelvic organs or supporting tissues move downwards. A cystocele involves the front vaginal wall and bladder; a rectocele involves the back wall and rectum; uterine prolapse involves the uterus. These are forms of pelvic organ prolapse, but an examination is needed to identify the affected area and severity.

Symptoms may include pelvic heaviness, a dragging sensation, incomplete bladder emptying, constipation, or discomfort during sex. A bulge can be more noticeable after standing, coughing, or straining. It is not possible to diagnose the cause by appearance alone.

Note when the bulge appears, whether it changes through the day, and any bladder, bowel, bleeding, pain, or sexual symptoms. Avoid straining where possible, treat constipation with advice from a clinician, and use careful lifting technique. Do not push a painful or bleeding bulge back repeatedly. Assessment may lead to pelvic floor physiotherapy or a discussion of vaginal pessary fitting.

Seek prompt medical help if the bulge becomes very painful, cannot be gently reduced, bleeds, changes colour, or is associated with inability to pass urine, fever, vomiting, or severe abdominal pain. Otherwise, arrange a routine pelvic health or gynaecology appointment when symptoms persist or interfere with comfort.

Which pelvic organ or vaginal wall is involved? Could pelvic floor physiotherapy help? Would a pessary suit my symptoms? What should I do about constipation, lifting, exercise, bladder emptying, and changes that should prompt earlier review?