Something feels different down there? What women need to know about pelvic prolapse

Meera, a 58‑year‑old retired schoolteacher from Kochi, had always been the dependable one — the woman who lifted heavy grocery bags, cared for grandchildren, and never said no when someone needed help. But over the past year, she began noticing a strange heaviness in her pelvis, a dragging sensation that worsened by evening. One afternoon, while bathing, she felt a soft bulge at the opening of her vagina. Panic followed. She worried it was cancer, or something “falling out.”

When she finally gathered the courage to see her doctor, she learned it was pelvic organ prolapse — a condition far more common, far more manageable, and far less frightening than she had imagined. Her relief was instant. Her journey to understanding her body had just begun.

Understanding Pelvic Organ Prolapse

Pelvic organ prolapse happens when the organs inside a woman’s pelvis — the uterus, bladder, or rectum — slip from their usual position and bulge into the vagina. These organs are normally held in place by a strong support system of muscles and ligaments called the pelvic floor. When these supports weaken, the organs can descend, sometimes enough to be felt or even seen at the vaginal opening.

Prolapse is not dangerous, but it can be uncomfortable and can affect daily life. Many women feel embarrassed to talk about it, but it is surprisingly common — especially after 50.

How common is it?

Prolapse often goes undiagnosed because women may ignore symptoms or assume they are part of ageing. But studies show that 1 in 10 women over 50 experience symptoms of pelvic organ prolapse. Many more have mild prolapse without any symptoms at all.

Why does prolapse happen?

The pelvic floor can weaken for several reasons, often a combination of:

• Pregnancy and childbirth, especially vaginal deliveries

• Ageing, particularly after menopause

• Being overweight, which increases pressure on pelvic organs

• Chronic constipation or persistent coughing

• Heavy lifting, including household chores

• Genetic tendency, where tissues are naturally more stretchy

Over time, these factors can stretch or strain the pelvic floor, making it less able to support the organs.

What does prolapse feel like?

Symptoms vary depending on which organ is bulging and how far it has descended. Some women have no symptoms at all, while others may notice:

• A bulge or lump in the vagina

• A dragging or heavy feeling in the pelvis

• Backache or discomfort that worsens after standing

• Difficulty or urgency in passing urine

• Leakage of urine when coughing or laughing

• Constipation or the need to press on the vagina to empty the bowel

• Discomfort or reduced sensation during sex

These symptoms can be frustrating, but they are not harmful. They simply indicate that the pelvic floor needs support.

Types of Prolapse

Different organs can cause different kinds of prolapse:

• Anterior wall prolapse — when the bladder or urethra bulges into the front vaginal wall (cystocele)

• Posterior wall prolapse — when the rectum or small bowel bulges into the back vaginal wall (rectocele or enterocele)

• Uterine prolapse — when the uterus drops into the vagina, sometimes even outside the body

• Vault prolapse — when the top of the vagina descends, usually after hysterectomy

It is common to have more than one type at the same time.

How is prolapse diagnosed?

A gynaecologist diagnoses prolapse through a simple internal examination. You may be examined lying down or standing. The prolapse is graded from Stage 1 to Stage 4, depending on how far it has descended.

Stage 1 prolapse is mild and often needs no treatment.

Sometimes, additional tests like a urine test, bladder scan, or urodynamics may be advised if bladder symptoms are present.

Do you need treatment?

Not always. Prolapse is not life‑threatening, and many women choose a “wait and watch” approach. Symptoms may stay the same, worsen slowly, or occasionally improve with lifestyle changes.

Treatment depends on:

• Your age

• Your symptoms

• Your general health

• Whether you are sexually active

• Whether you plan future pregnancies

Treatment Options

Lifestyle Changes

Small adjustments can significantly reduce symptoms:

• Losing weight if overweight

• Managing chronic cough

• Stopping smoking

• Avoiding constipation

• Avoiding heavy lifting

• Reducing high‑impact exercise like running or jumping

These changes reduce pressure on the pelvic floor.

Pelvic Floor Exercises

A physiotherapist can guide you through a structured programme (usually 3–6 months). These exercises strengthen the pelvic floor and often improve symptoms. Even if surgery is planned, pelvic floor training improves outcomes.

Vaginal Oestrogen

After menopause, vaginal tissues become thinner and drier. Oestrogen creams, tablets, or rings can reduce discomfort and improve tissue health.

Vaginal Pessary

A pessary is a soft silicone or plastic device placed inside the vagina to support the organs. It is a popular option for women who:

• Prefer to avoid surgery

• Plan future pregnancies

• Have medical conditions that make surgery risky

Pessaries come in many shapes and sizes. They are usually changed every 4–6 months. Some women remove and reinsert them themselves.

Surgery

Surgery is considered when symptoms significantly affect daily life and other options haven’t helped. It aims to repair and support the pelvic organs.

If you plan future pregnancies, surgery is usually delayed because childbirth can cause recurrence.

I will discuss the different types of prolapse surgery — including the role of mesh — in next week’s column.

Pelvic organ prolapse is common, manageable, and nothing to be ashamed of. Women like Meera often feel anxious until they understand what is happening. With the right information, lifestyle changes, and treatment options, most women find relief and regain confidence in their bodies. If you notice symptoms, speak to your gynaecologist. Early support can make a world of difference.

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.