What is Pelvic Organ Prolapse (POP)? Symptoms

What is Pelvic Organ Prolapse?

Severity of Prolapse

  • Mild or 1st degree prolapse: When the prolapse is still within the vagina
  • Moderate or 2nd degree prolapse: When the prolapse is just outside the vagina
  • Severe or 3rd and 4th degree prolapse: When the prolapse is completely outside the vagina

Types of Prolapse

You may present with one or more types of prolapse.

  • Cystocoele: When the top of the vagina supporting the bladder prolapses downwards into and outwards outside the vagina.
  • Rectocoele / Enterocoele: When the bottom of the vagina supporting the rectum / small intestines respectively prolapses upwards into and outside the vagina.
  • Uterine prolapse: When the back of the vagina supporting the uterus prolapses into and outside the vagina.
  • Procidentia: When there is prolapse of the uterus and vagina including the bladder completely outside the vagina.
  • Vault prolapse: When the back of the vagina prolapse into and outside the vagina after a previous hysterectomy.

What are the causes?

The prolapse is due to the progressive weakening of the supporting tissues of the uterus and the vagina in situations such as pregnancy and childbirth, especially difficult and prolonged labour.

The supporting tissues become even weaker when you enter the menopause and as you grow older. If you are involve in strenuous physical work, or suffer from chronic cough and constipation, you have an increased tendency to develop pelvic organ prolapse.

Other causes include congenital weakness of the pelvic floor muscles, ligaments and fascia and collagen deficiency.


Some of the symptoms are included below; they are not listed in descending order of frequency of presentation but may be related to the severity/degree of your prolapse.:

  • A dragging sensation in the lower abdomen and pelvis
  • A swelling sensation in the vagina
  • Backache that progresses through the day
  • A lump outside the vagina
  • Vaginal bleeding and discharge
  • Difficulty in walking, sitting
  • Difficulty in passing urine and motion
  • Difficulty or inability to have sex
  • Anxiety, depression because of feeling less feminine secondary to the lump below and inability to have sex
  • Fear that lump below may be a growth or cancer
  • Therapeutic options

    You are advised to see your gynaecologist or urogynaecologist to receive a complete evaluation of your condition.

    A complete management programme may involve lifestyle changes, pelvic floor rehabilitation, use of topical (local) oestrogen cream and/or vaginal tablets to improve post-menopausal vaginal dryness and thinning, vaginal pessaries to support your prolapse and urodynamics investigations before surgical intervention.

    Surgery for POP

    Surgery for POP would depend on the severity and type of prolapse. The commonly performed vaginal operations include:

    Advantages of vaginal surgery

    The advantages of vaginal surgery are:

    *All the above advantages hold true for vaginal hysterectomy when compared to abdominal (open) and laparoscopic (key hole) hysterectomy.

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