Pelvic Organ Prolapse: Symptoms, Causes, and Treatment Options

By Dr. Courtney Buhrow, PT, DPT — Pelvic Floor Specialist at Revive PT & Wellness has spent 6 years helping women navigate pelvic floor symptoms, from postpartum recovery to prolapse, with a focus on getting to the root cause instead of just managing symptoms.

If it feels like something is falling out of your vagina, or like a tampon is slipping out even when you're not wearing one, you may be noticing the early signs of pelvic organ prolapse. It's a common condition where the pelvic organs shift downward due to weakened support in the pelvic floor. While the sensation can be alarming, it's both explainable and treatable.

This guide walks through what prolapse actually is, what it feels like, why it happens, and the full range of treatment options — because surgery is far from the only answer.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) happens when the muscles, ligaments, and connective tissue that normally support the bladder, uterus, or rectum become weakened or stretched. As a result, one or more of these organs descends toward or into the vaginal canal.

You may hear it described by which organ or wall is involved: a bulge from the bladder side is often called anterior vaginal wall prolapse (cystocele), while one from the rectum side is posterior vaginal wall prolapse (rectocele). Some women experience uterine prolapse, where the uterus itself descends.

Here's the reassurance worth hearing first before you start to panic: this is common. A recent clinical review found that some degree of prolapse is present in roughly 41–50% of adult women. You are not the only one dealing with this, even if it feels that way.

Prolapse tends to develop gradually, often after childbirth, but it can also show up later in life connected to menopause, chronic straining, or heavy lifting over time. Knowing what's actually happening in your body is usually the first step toward feeling less afraid of it.

Symptoms of Pelvic Organ Prolapse

Many women describe a sense that something is going to fall out of their vagina or there is a bulge at the opening. Other common symptoms or descriptions include:

• A feeling of heaviness or pressure in the vagina or rectum, especially by the end of the day

• A sensation that something is "falling out" or bulging at the vaginal opening

• A feeling like a tampon is slipping out, even without one in

• Low back or pelvic ache that builds with standing or activity

• Difficulty fully emptying the bladder or bowel

• Discomfort during exercise, intercourse, or lifting

  
  

Symptoms are often worse after standing for long periods, during exercise, or at the end of a busy day, and better after lying down. That pattern alone of symptoms that ease with rest, is a strong clue that pressure and support are involved, not just muscle soreness.

It's also worth knowing that not every one of these sensations means the organs have shifted. Sometimes what feels like prolapse is actually tight pelvic floor muscles or an irritated nerve, which a proper pelvic exam can clarify and which responds very differently to treatment.

What Causes Pelvic Organ Prolapse?

Prolapse happens when the pressure moving through the abdominal and pelvic cavity is more than what the pelvic floor can support. A few things commonly contribute:

• C-section or Vaginal childbirth, especially with a long pushing stage or an assisted delivery

• Pregnancy itself, due to the sustained weight and pressure on pelvic support tissue

• Chronic straining, from constipation or a persistent cough

• Heavy, repetitive lifting without adequate pressure management

• Menopause, as declining estrogen affects tissue elasticity

• Obesity, which increases sustained intra-abdominal pressure

• Connective tissue differences, which can run in families

  
  

Why So Many Women Wait to Get Help

This is the part that doesn't get talked about enough: the emotional weight of prolapse often outlasts the physical discomfort. Many women feel embarrassed to bring these symptoms up, even to a doctor, because it feels like it might be "in their head," or because they've never heard a friend mention anything like it. That silence can be isolating. It's easy to start wondering if you're the only one, or if something is fundamentally wrong with you compared to other women and moms around you.

When symptoms first appear, most people don't call a specialist. They Google it, scroll social media, or quietly mention it to their closest friend. And what often comes back is frightening: outdated stories about mesh complications, worst-case surgical outcomes, and the impression that surgery is the only path forward.

That fear can be paralyzing. We regularly see women who've stopped exercising, stopped lifting their kids the way they used to, or started declining plans with friends, all out of fear that something will "fall out" or get worse. Ironically, that avoidance often makes pressure management harder, not easier.

Here's what's important to know: surgical techniques have changed significantly, and outcomes today look very different than the stories circulating from years ago. But surgery is also just one option among several and for many women, it isn't the first or only step.

Treatment Options for Pelvic Organ Prolapse

There's no single right answer for every woman. The best plan depends on which organs are involved, symptom severity, and personal goals. Options include:

• Pelvic floor therapy — Involves a thorough physical exam and addresses the root cause: how pressure moves through the abdominal and pelvic cavity. Effective on its own for many women, and important alongside any other treatment.

• Pessaries — A removable device fitted and sized to your body, worn internally to support the pelvic organs and relieve symptoms without surgery.

• Lifestyle and activity modifications — Adjustments to lifting mechanics, breathing patterns, and bowel habits that reduce downward pressure. Reducing body stressors, muscle clenching, and holding your breath consistently

• Surgery — Reserved for cases where symptoms significantly affect quality of life or when organs need to be repositioned; techniques and outcomes have improved substantially in recent years, especially when paired with pelvic floor therapy

  
  

Why Pelvic Floor Therapy Matters, Regardless of Path

Even if surgery or a pessary is part of your plan, pelvic floor therapy is what addresses the underlying cause — poor pressure management through the pelvic floor and abdominal wall. Without that piece, symptoms tend to return over time, because the same pressure patterns that contributed to the prolapse are still at play.

Working with a specialist in pelvic floor therapy can also improve the success of surgery or a pessary, or prevent the need of surgery, and helps rebuild the strength, breathing mechanics, and confidence needed to return to exercise and daily life without fear.

When to See a Pelvic Floor Specialist

You don't need to wait until symptoms are severe to get an evaluation. It's worth reaching out if you notice:

• Heaviness, pressure, or bulging that doesn't go away or only after resting

• Symptoms that are changing how you move, exercise, or spend time with family and friends

• Difficulty fully emptying your bladder or bowel

• Pain or pressure during intercourse

• Ongoing worry or fear about your symptoms, even if you're unsure it's "bad enough" to ask about

  
  

A thorough evaluation looks at more than just the exam findings, it should include your history, movement patterns, breathing and pressure mechanics, and which vaginal wall is involved. That full picture is what helps determine the next right step, whether that's pelvic floor therapy, a referral to a urogynecologist, or both.

If you're local to the Des Moines area, our team at Revive works specifically with prolapse and can help you sort out what's actually going on before fear does the deciding for you.

Frequently Asked Questions

How long until I notice a difference with pelvic floor therapy? Many women can start noticing symptom relief within the first 1-2 visits, though this varies based on severity and how consistently you're able to practice the strategies between sessions. Real change and full progress often takes a few months.

Can pelvic organ prolapse get better without surgery? For many women, yes — symptoms can improve significantly with pelvic floor therapy, a pessary, or both, especially when prolapse is mild to moderate. Whether surgery is eventually needed depends on symptom severity and how organs respond to conservative treatment.

Is a pessary uncomfortable to wear? When properly fitted, most women don't feel a pessary once it's in place. It may take an adjustment period and a few fitting visits to find the right size and type for your body and activity level.

Is there a pelvic floor therapist near Des Moines who treats prolapse? Yes! Our team at Revive specializes in pelvic floor therapy for prolapse, including evaluation, pessary support, and pre- and post-surgical care, for women throughout the Des Moines Metro.

You Don't Have to Navigate This Alone

If you're dealing with the heaviness, the fear, or the questions you've been afraid to ask out loud — you're not imagining it, and you're not the only one going through it. Prolapse is common, and it responds well to the right care.

The first thing we tell every new patient is simple: you're not alone in this, and there are people who understand exactly what you're navigating. If you're ready to get real answers instead of what a search engine turns up at midnight, reach out to our team — we're here to help you figure out the next right step.