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Pelvic Organ Prolapse (POP)

A weakened pelvic floor allows the bladder, uterus, rectum or vaginal vault to descend toward (or through) the vaginal opening. Up to half of women have some prolapse on examination, but only 3 to 6% of women of all ages have symptoms from it6, rising to about 1 in 10 over 50 10.

Hormonal & Women's Health Evidence-Based

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Definition

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse is the downward descent of one or more pelvic organs (bladder, uterus, rectum, small bowel or the vaginal vault) into or through the vagina, caused by weakening or injury of the pelvic floor muscles, fascia and connective tissue that normally hold these organs in place.1

POP is staged using the standardized Pelvic Organ Prolapse Quantification (POP-Q) system, ranging from Stage 0 (no prolapse) to Stage IV (complete eversion).

The condition is named by the organ involved. The four types are described below:

Pelvic organ prolapse, a side view of the pelvis with the uterus dropped down into the vagina, a dashed outline of its normal position, and the bladder, rectum and pelvic floor muscles
💡 Key Insight: NICE advises considering a program of supervised pelvic floor muscle training for at least 16 weeks as a first option for stage I or II prolapse with symptoms, and continuing it if it helps7. (Source: Based on NICE guideline NG123, Urinary incontinence and pelvic organ prolapse in women: management.)

Cystocele (Anterior Wall Prolapse)

The most common type: the bladder bulges down into the front wall of the vagina. Women describe a "ball" or pressure at the vaginal opening, dribbling, incomplete emptying or needing to splint (push back) to fully urinate. Frequently coexists with stress incontinence.

  • โ†’Hallmarks: Bladder bulge, urinary urgency, slow stream, splinting, recurrent urinary tract infections (UTIs) from urinary stasis
  • โ†’Primary lever: Pelvic floor physical therapy (PT)2, low-pressure (hypopressive) exercises, bladder retraining, weight optimization, vaginal estrogen if postmenopausal3

Rectocele (Posterior Wall Prolapse)

The rectum bulges forward into the back wall of the vagina, creating a pocket where stool collects. Women describe difficulty emptying the bowels, needing to "splint" the back vaginal wall to defecate, a sense of incomplete evacuation, and pressure or fullness after meals.

  • โ†’Hallmarks: Constipation, posterior splinting, stool trapping, bearing-down strain
  • โ†’Primary lever: Aggressive constipation prevention, fiber and hydration, squat-position toileting, pelvic PT

Uterine Prolapse (Apical Descent)

The uterus descends from its normal position into the vaginal canal as the uterosacral and cardinal ligaments stretch or tear. Stage III to IV ("procidentia") presents as a visible cervix or uterus protruding at or beyond the vaginal opening. Often coexists with cystocele and rectocele.

  • โ†’Hallmarks: Heaviness or "dragging" sensation worse by evening, low back pain, lump felt or seen at vaginal opening
  • โ†’Primary lever: Pelvic PT (Kegels, hypopressives, biofeedback) for Stage I to II; pessary for Stage II to III; vaginal estrogen postmenopause

Vaginal Vault Prolapse + Enterocele

After hysterectomy, the upper vagina can descend (vault prolapse), often dragging loops of small bowel into a hernia between the vagina and rectum (enterocele).

  • โ†’Hallmarks: Bulge after prior hysterectomy, sensation of "everything falling out," dyspareunia, bowel pressure
  • โ†’Primary lever: Pelvic PT plus pessary; surgical repair is often necessary at advanced stages
By the Numbers

Pelvic Organ Prolapse by the Numbers

3 to 6%
of women have prolapse when it is defined by symptoms, against up to 50% when it is defined by what an examination finds6
1 in 10
women over 50 have some symptoms of prolapse10
12.6%
lifetime risk of prolapse surgery by age 80, in US insurance data covering over 10 million women11
17%
greater chance of improving by a prolapse stage with pelvic floor muscle training than without it, pooled from two trials12
16 weeks
the minimum length of the supervised pelvic floor muscle training program NICE advises considering as a first option for stage I or II prolapse with symptoms7
6 months
the longest a pessary should stay in without being removed, to prevent serious complications7
Signs & Symptoms

Symptoms of Pelvic Organ Prolapse

Prolapse symptoms typically worsen across the day, with standing, lifting, exercise or straining, and improve overnight when the woman is recumbent.

SymptomWhat happens
Pelvic, Vaginal & Sexual Symptoms
Vaginal Bulge or "Something Falling Out"The defining symptom of prolapse. Many women describe feeling like they are "sitting on a ball," a softball-like lump at the vaginal opening, or seeing pink tissue when wiping. Worse with prolonged standing, by evening and after lifting. Improves lying down.
Pelvic Heaviness & "Dragging" SensationA constant pressure, fullness or pulling-down feeling in the pelvis or low vagina. Often the first symptom women notice.
Low Back Pain (Sacral Aching)A dull sacral or low back ache that worsens with standing and lifting and eases when lying down.
Painful Intercourse (Dyspareunia)Discomfort, pain or a sensation that "something is in the way" during intercourse. Atrophic vaginal tissue postmenopause amplifies this.
Sexual Avoidance & Body-Image DistressMany women silently avoid intimacy after noticing a bulge, often without ever raising it with a provider.
Vaginal Tissue Irritation, Bleeding or UlcerationWhen the prolapse protrudes beyond the vaginal opening, exposed mucosa can become dry, chafed and ulcerated against clothing. Spot bleeding, friction sores or chronic discharge are red flags requiring an exam, vaginal estrogen and a protective pessary or surgical referral.
Bladder, Bowel & Functional Symptoms
Stress Urinary Incontinence (Cough, Sneeze, Laugh)Involuntary urine loss with any rise in intra-abdominal pressure, coughing, sneezing, laughing, lifting, jumping or running. Frequently coexists with cystocele.
Urinary Urgency, Frequency & Incomplete EmptyingA bladder that has descended often cannot empty completely. Residual urine causes urgency, frequency, nocturia and recurrent UTIs. Many women learn to "splint" (manually elevate the front vaginal wall) to fully void.
Constipation & Stool Trapping (Posterior Splinting)A rectocele creates a pocket where stool accumulates. Many women describe pushing the back vaginal wall to evacuate, a sense of incomplete emptying or thin "ribbon" stools. Preventing constipation matters because straining worsens every type of prolapse.
Fecal & Flatal IncontinenceInability to control gas or stool, sometimes a single episode of urgency without time to reach the bathroom. Often linked to obstetric anal-sphincter injury from prior vaginal delivery.
Symptom Worsening With Standing, Lifting & ExerciseSymptoms reliably worsen with gravity and intra-abdominal pressure.
Anxiety, Avoidance & Quality-of-Life ImpactMany women restrict exercise, travel, intimacy and work activities because of POP.
โš ๏ธ Pattern to watch for: A vaginal bulge or heaviness that worsens by evening and improves overnight, plus urinary or bowel symptoms (incomplete emptying, splinting, recurrent UTIs, constipation), is worth raising with your doctor, who can examine you8.
Causes

Causes of Pelvic Organ Prolapse

Prolapse happens when the pelvic floor muscles weaken, and it becomes more common with age, particularly after menopause; usually more than one of the factors below is involved8.

CauseHow It Contributes to Pelvic Organ ProlapseWhat Helps
Pregnancy and childbirthThe NHS lists pregnancy and childbirth first among the causes of prolapse8Pelvic floor muscle training, supervised where possible, as the treatment section describes; see your doctor about any bulge or heaviness after birth
Age and menopauseProlapse is common in women over 50 and becomes more common with age, particularly after menopause8Vaginal estrogen, which NICE advises considering for the genitourinary symptoms of menopause; it eases symptoms but does not correct the prolapse7
Long-term constipation and strainingStraining repeatedly on the toilet is one of the listed causes8More fiber and water and regular gentle exercise to avoid constipation, as the diet section sets out; NICE advises preventing or treating constipation7
Being overweightBeing overweight is one of the listed causes8Losing weight, which NICE advises for women with prolapse whose BMI is over 30 7
Persistent cough and heavy liftingA persistent cough puts pressure on the pelvic floor, and activities that strain it, such as heavy lifting, are best avoided8Stopping smoking, treatment for the cause of a long-term cough and keeping heavy lifting to a minimum7
Pelvic surgery and connective tissue conditionsPelvic surgery such as a hysterectomy is a listed cause, and joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndromes make prolapse more likely8The same assessment and treatment options; before pelvic surgery, ask your surgeon how prolapse risk is managed
Diagnosis

How Pelvic Organ Prolapse Is Diagnosed

POP is primarily a clinical diagnosis based on examination using the standardized POP-Q system.

TestWhat it shows
At-Home Screening
These are not diagnostic but can identify patterns worth bringing to a pelvic-floor-trained physical therapist or urogynecologist:
Self-Inspection (Visual + Tactile)Standing with one foot on a low stool, gently bear down and use a mirror to inspect the vaginal opening. A visible bulge, descending tissue or a "pink ball" at or beyond the vaginal opening is highly suggestive of Stage II to III POP.
Symptom Diary & Diurnal PatternTrack symptoms morning vs evening, before vs after activity and across the menstrual cycle, for 2 to 4 weeks. Note any urinary or bowel splinting maneuvers.
At-Home Pelvic Floor Function CheckLying on your back with knees bent, gently insert one clean finger into the vagina and contract your pelvic floor as if stopping urine flow. You should feel an upward "lift" against your finger. If you cannot feel a lift, or feel a downward push instead, ask for supervised pelvic floor muscle training rather than exercising on your own.
Clinical & Imaging Tests
POP-Q ExaminationThe standardized Pelvic Organ Prolapse Quantification exam measures 9 anatomic points in centimeters relative to the hymen while you bear down as hard as you can (Valsalva). Stages run from 0 (no prolapse) through I (more than 1 cm above the hymen), II (within 1 cm of the hymen), III (more than 1 cm beyond) and IV (complete eversion).
Pelvic Floor Muscle Assessment (Modified Oxford Scale)A pelvic floor physical therapist or trained provider grades resting tone, voluntary contraction strength (0 to 5 on the Modified Oxford Scale), endurance, repetitions and coordination.
Urodynamic TestingMeasures bladder pressure, urinary flow, residual volume and detrusor activity.
Dynamic Pelvic MRI or DefecographyReserved for complex multicompartment prolapse, suspected enterocele or evaluation of obstructed defecation. NICE advises against routine imaging when prolapse is found on examination7.
Postvoid Residual (PVR) & Urine CultureUltrasound or in-and-out catheter measurement of urine left in the bladder after voiding. PVR greater than 150 mL is concerning for incomplete emptying and may explain recurrent UTIs. Urine culture rules out active infection that could be driving urgency or frequency independent of the prolapse.
Treatment Comparison

Conventional and Holistic Treatment for Pelvic Organ Prolapse

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Restore pelvic floor function, optimize intra-abdominal pressure, support connective tissue and remove the daily mechanical aggravators

Primary Treatment
Supervised pelvic floor PT (Kegels, biofeedback, hypopressives) + constipation prevention + collagen-supportive nutrition + lifting/​posture retraining + vaginal estrogen if postmenopausal
Duration
6 to 16 weeks of supervised PT for noticeable change; 6 to 12 months for sustained improvement
Effect on Underlying Disorder
First-line for Stages I to II; improves symptoms, and improves stage in a minority
Activity Outcome
Many women return to running and intimacy; ask your physical therapist before heavy lifting

Full Holistic Approach Includes

  • Supervised pelvic floor PT, 1 to 2x per week for at least 16 weeks, addressing both strength and overactive (hypertonic) tone
  • Daily Kegel program once technique is verified, 3 sets of 10 contractions, mixed quick and 10-⁠second holds
  • Hypopressive ("low-pressure") exercise, sometimes added to PT; its evidence is weaker than for pelvic floor muscle training
  • EMG biofeedback or perineometer to retrain accurate contraction and avoid bearing-down errors
  • Aggressive constipation prevention: 25 to 35 g fiber/day, about 8 to 13 cups (2 to 3 L) of water, magnesium glycinate, squat-position toileting (a footstool under the feet)
  • Lifting and posture retraining: exhale on exertion, hip-hinge mechanics, avoid holding your breath and bearing down (Valsalva), brace the core without down-bearing
  • Weight optimization to reduce intra-abdominal load; address chronic cough (asthma, GERD, smoking)
  • Vaginal estrogen postmenopausal (cream, tablet or ring) to thicken atrophic vaginal tissue and improve PT and pessary tolerance; in a randomized trial it did not reduce prolapse recurrence after surgery5
  • Pessary fitting trial (ring, Gellhorn or cube), removable if it does not suit; more than one fitting may be needed7
  • Collagen-supportive nutrition, vitamin C, glycine, zinc, copper, anti-inflammatory whole-food eating
โš ๏ธ Side effects: Transient muscle soreness in the first 2 to 3 weeks of PT; mild vaginal discharge or irritation during early pessary use; vaginal estrogen rarely causes spot bleeding (always evaluated). No surgical risks, and vaginal estrogen has low systemic absorption.
Supplement Protocol

Evidence-Based Supplements for Pelvic Organ Prolapse

Supplements support pelvic floor PT and nutrition; they do not replace either. No supplement treats prolapse: the non-surgical treatments NICE recommends are lifestyle advice, vaginal estrogen, pelvic floor muscle training and pessaries7.

Supplement What it is for Typical range Timing Notes & cautions
Vitamin C (with bioflavonoids)Essential cofactor for the hydroxylation step of collagen synthesis. Without adequate C, the body cannot build new collagen even with abundant amino acid substrate.500 to 1,000 mg per daySplit AM and PM with mealsChoose buffered or with bioflavonoids if sensitive stomach. Smoking and alcohol use raise requirements.
Magnesium Glycinate (or Citrate)An effective option for preventing constipation and straining. Magnesium also supports pelvic floor muscle relaxation in hypertonic patterns and improves sleep quality.300 to 500 mg elemental magnesium per day.Evening, 30 to 60 min before bedCitrate is more laxative; glycinate is calming and gentler. Increase slowly if stools become too loose. Reduce or avoid in reduced kidney function, where magnesium accumulates. In pregnancy, check the dose with your midwife or doctor. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common.
Psyllium Husk (Soluble Fiber)Forms a gel that bulks and softens stool simultaneously, one of the best-evidenced supplements for chronic constipation, and it reduces straining at toileting.5 to 10 g per day1 to 2x daily with at least 12 oz (350 mL) waterStart with 5 g and titrate up over 2 weeks. Always take it with water, and 2 hours apart from medications.
Vitamin D3 (with K2)Supports bone density and immune function. Not shown to help prolapse.D3: set the dose with your clinician; most adults need no blood test first; K2 (MK-⁠7): 100 to 200 mcg per dayWith a fat-containing meal, morning preferredIf you take warfarin, clear any vitamin K supplement with the clinician managing your anticoagulation before starting or stopping it: vitamin K antagonizes warfarin, and changing your intake destabilizes the INR. Consistency matters more than avoidance. This does not apply in the same way to direct oral anticoagulants such as apixaban or rivaroxaban, but tell your prescriber about any supplement you take.
Vaginal Estrogen (Topical, Postmenopausal; a prescription medicine, not a supplement)Restores vaginal mucosal thickness, improves lubrication, reduces UTIs and improves response to pelvic floor PT and pessary comfort. Local effect, minimal systemic absorption.Cream 0.5 to 1 g 2 to 3x/week, OR tablet 10 mcg 2x/week, OR ring every 90 daysBedtime, after voidingPrescription-required. Discuss with provider if history of estrogen-sensitive cancer. It improves comfort and pessary tolerance but does not correct prolapse.
Zinc (Picolinate or Bisglycinate)Cofactor for collagen-forming enzymes and tissue repair. Supports wound healing post-surgery and pelvic floor recovery postpartum.15 to 30 mg per dayWith meals (food prevents nausea)If using long-term (greater than 8 weeks at higher doses), add 1 to 2 mg copper to prevent imbalance.
Omega-⁠3 EPA/DHANot shown to help prolapse: there is no direct evidence it does, though it may lower some markers of inflammation.2 g combined EPA+DHA per dayWith mealsChoose a product with third-party purity testing. Ask your surgical team whether to pause it before surgery. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day14, so check this dose with your clinician first.
Iron (if Deficient)Iron deficiency is common in women who have periods. Treat only if blood tests confirm it.25 to 65 mg elemental iron every other day if ferritin less than 50 ng/mLMorning, empty stomach with vitamin CEvery-other-day dosing absorbs better than daily. Retest ferritin after 3 months. The top of this range sits above the 45 mg/day tolerable upper intake level for adults. That is appropriate only when correcting a confirmed deficiency under clinical supervision, not as general supplementation. Test ferritin first, and retest rather than staying on it indefinitely. Women who are pregnant or breastfeeding may need different amounts; ask your midwife or doctor9.
What to Expect

What to Expect Over Time

Treatment depends on which organs have prolapsed, how severely and how much the symptoms bother you; a prolapse that causes no problems may not need treatment8.

Treatment and supportive care, together
First Weeks

A doctor examines you to make the diagnosis, and refers you for bladder tests if needed8. Self-help starts at once: a healthy weight, fiber and water to avoid constipation, no heavy lifting, regular pelvic floor exercises and not smoking8.

Months 1 to 3

For stage I or II prolapse with symptoms, NICE advises considering supervised pelvic floor muscle training for at least 16 weeks as a first option. A pessary is an option alone or alongside training, and more than one fitting may be needed7.

Months 3 to 12

If training helps, NICE advises continuing it; in trials it improved symptoms and raised the chance of improving by a stage by 17%12. A pessary comes out at least every 6 months. Surgery is offered if symptoms have not improved with, or you have declined, non-surgical treatment7.

Long Term

No supplement treats prolapse. Prolapse can come back after surgery, and the long-term effects of all procedures, especially mesh, are uncertain, so ask about both before choosing7.

When to Seek Care

Go to an emergency department if your bladder feels full but you cannot pass urine at all; a prolapsed bladder or uterus is one cause13. See your doctor for any lump in or around the vagina, and report bleeding, discharge or trouble removing a pessary7.

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Next Steps

Pelvic Floor Self-Help Starts Now

Treatment depends on which organs have prolapsed, how severely and how much the symptoms bother you. Self-help starts at once: a healthy weight, fiber and water to avoid constipation, no heavy lifting, regular pelvic floor exercises and not smoking. No supplement treats prolapse.

Explore Menopause โ†’ Explore Chronic Constipation โ†’

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.4 Nutrition does not reverse anatomical prolapse. What it does influence is the two mechanical drivers that make prolapse worse day after day (intra-abdominal pressure and chronic straining), and those are genuinely modifiable. The treatment with the best evidence is supervised pelvic floor muscle training, which improves symptoms and prolapse stage for many women and is underused. Pessaries work well and are not offered often enough. Surgery is effective and has real recurrence rates. Prolapse is common, it is not dangerous in itself, and it is not something to be embarrassed about, though it is worth saying that new pelvic pressure with bleeding, or difficulty passing urine, needs assessment rather than a pelvic floor program.

  1. On what it is: descent of the anterior vaginal wall, posterior wall, uterus or vaginal vault through weakened support structures, staged by the POP-Q system. It is common, and mild descent found on examination in an asymptomatic woman does not require treatment. Symptoms rather than stage drive management. ↩
  2. On pelvic floor muscle training. Supervised training improves prolapse symptoms and can improve stage, with Cochrane reviews supporting its use as first-line conservative management. Supervision matters: a substantial proportion of women perform the contraction incorrectly when given only verbal instruction, and bearing down instead of lifting makes matters worse. ↩
  3. On vaginal estrogen after menopause: topical vaginal estrogen improves genitourinary atrophy and tissue quality and is commonly used alongside pessary management. Systemic absorption is low. It does not correct prolapse but it improves comfort and pessary tolerance, and it is a conversation worth having. ↩
  4. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  5. On vaginal estrogen and prolapse surgery: in 206 postmenopausal women having native tissue apical repair, vaginal estrogen before and for 12 months after surgery did not reduce prolapse repair failure compared with placebo, PubMed 37581673. ↩
  6. On how common prolapse is: a review for the Fifth International Consultation on Incontinence found a prevalence of 3 to 6% when prolapse is defined by symptoms and up to 50% when it is based on vaginal examination, so most prolapse found on examination causes no symptoms, PubMed 24142054. ↩
  7. On management: NICE guideline NG123 advises considering lifestyle advice (losing weight if BMI is over 30, minimizing heavy lifting, preventing or treating constipation), vaginal estrogen for genitourinary symptoms of menopause, a supervised pelvic floor muscle training program of at least 16 weeks as a first option for symptomatic stage I or II prolapse, continued if it helps, and a pessary alone or with training. Before a pessary it advises explaining that more than one fitting may be needed, that complications include discharge, bleeding and difficulty removing it, and that it should be removed at least every 6 months. It advises offering surgery when symptoms have not improved with, or a woman has declined, non-surgical treatment, after discussing the risk of recurrence and the uncertain long-term adverse effects of all procedures, particularly mesh, and advises against routine imaging when prolapse is found on examination, NICE NG123. ↩
  8. On symptoms, causes and self-help: NHS guidance describes prolapse as common in women over 50 and more common with age, particularly after menopause, and lists pregnancy and childbirth, being overweight, long-term constipation and straining, persistent coughing and pelvic surgery such as hysterectomy among the causes, with joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndromes making it more likely. It advises a healthy weight, more fiber and water and gentle exercise to avoid constipation, avoiding heavy lifting, regular pelvic floor exercises and not smoking, notes that a prolapse that is not bothering you may not need treatment, and advises seeing a doctor for a lump in or around the vagina, NHS, pelvic organ prolapse. ↩
  9. On iron in pregnancy: US National Library of Medicine guidance notes that women who are pregnant or producing breast milk may need different amounts of iron, and advises asking your health care provider what is right for you, MedlinePlus, iron in diet. ↩
  10. On symptoms after 50: the Royal College of Obstetricians and Gynaecologists states that 1 in 10 women over the age of 50 will have some symptoms of pelvic organ prolapse, and that exact numbers are hard to know because many women do not see a doctor about it, RCOG, pelvic organ prolapse. ↩
  11. On surgery: in US claims data for over 10 million women followed from 2007 to 2011, the lifetime risk of prolapse surgery by age 80 was 12.6%, and of surgery for either prolapse or stress incontinence 20.0%, PubMed 24807341. ↩
  12. On pelvic floor muscle training: a Cochrane review of six trials found greater improvement in prolapse symptoms with training than without it in all three trials that measured symptoms, and pooled data from two trials showed a 17% greater chance of improving by one prolapse stage; four of the trials were small, PubMed 22161382. ↩
  13. On being unable to pass urine: Australian government health guidance lists a prolapsed uterus or bladder among the causes of urinary retention, and advises seeing a doctor immediately or going to an emergency department if your bladder feels full but you cannot urinate at all, because acute urinary retention needs treatment right away, Healthdirect, urinary retention. ↩
  14. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩