A Weak Pelvic Floor Can Lead to Vaginal Wall Prolapse

Pelvic organ prolapse (POP) is a condition that occurs when the web of muscles that are at the base of a woman’s pelvis (known as the pelvic floor muscles) become weak.

Patient with vaginal wall prolapse lies in hospital bed

This causes the organ or organs that they are supporting — whether that’s the vagina, uterus, bladder, urethra, small bowel or rectum — to shift position and put pressure on the vagina. In some cases, these tissues can cause so much pressure that they protrude out of the vagina.

There are a variety of reasons pelvic floor muscles can become weak, making pelvic prolapse more likely. For instance, if a woman:

  • Has given birth vaginally, and the labor was long or the baby was very large
  • Has had a hysterectomy
  • Is post-menopausal; women who are post-menopause have lower levels of estrogen which causes the muscles and soft tissues of the pelvis to weaken
  • Is obese
  • Experiences chronic coughing
  • Strains almost every time she has a bowel movement

Vaginal Prolapse Symptoms

If you think you might have pelvic organ prolapse, one or some of these symptoms may be familiar to you:

  • Difficulty with bowel movements
  • Heaviness or pressure in the pelvic area
  • Lower back pain
  • Pain during intercourse
  • Tissue protruding from the vagina or a feeling that it could
  • Urinary problems from incontinence to chronic urge to urinate to urine retention

Pelvic organ prolapse can worsen over time, so it’s important to make an appointment to see a doctor if you are experiencing any of these symptoms.

Non-Surgical POP Treatment Options

If your prolapse is not causing pain or interfering with your daily life, your doctor may suggest no treatment, exercises or non-surgical treatment. One non-surgical option frequently used to treat POP is a pessary, which is a small device that fits inside the vagina and helps support the pelvic organs.

A pessary must be fitted to each woman, and there is no scientific method available to determine the perfect size a patient needs. For that reason, after the first fitting, a woman will need to return to the doctor several days later to have it checked. If the pessary is working well, the woman will likely not need to return for several months. A pessary can be used on an ongoing basis, and it’s estimated that about half of the women who have one continue to use it. However, they must be cared for and used correctly. Otherwise, problems can occur, such as bleeding or vaginal infections. 

Kegel exercises are another non-surgical care method that may be recommended by a doctor to help strengthen the pelvic floor. The National Institutes of Health offers instructions on how to perform Kegel exercises.

Pelvic Organ Prolapse Surgery

There are several surgical solutions for patients who have pelvic organ prolapse. The particular procedure depends on factors such as a woman’s unique anatomy and whether or not she wants to be sexually active. Here are some examples:

  • Anterior Vaginal Prolapse Repair: Lifts the front vaginal wall back into the body so the bladder has support
  • Apical Suspension: Repairs the top of the vagina and helps maintain sexual function
  • Posterior Vaginal Prolapse Repair: Repairs a bulge in the back wall of the vagina

A doctor may be able to perform these procedures laparoscopically, using small incisions in the vagina or abdomen. This can help shorten recovery time.

For More Information

For more details about pelvic organ prolapse and surgical procedures for POP, visit the American College of Obstetricians & Gynecologists (ACOG).