Breaking the Silence About Pelvic Prolapse

Though nearly half of women who’ve given birth and half of women over 50 experience pelvic organ prolapse, it’s rarely discussed outside a doctor’s office or a trusted friend’s ear.

Pelvic organ prolapse happens when the uterus, vagina, bladder or rectum slip downward, causing symptoms like pelvic pressure, aching or leaking urine or stool. It can feel awkward or even isolating — but it’s more common than you might think, and there’s help available. 

Blame It on Gravity

Gravity pulls everything down as we age — breasts, jawlines and even pelvic organs. Every woman experiences some degree of slippage, but certain factors increase the risk. 

Women who’ve had multiple pregnancies or a difficult delivery are more likely to have prolapse, as are those with chronic constipation, a persistent cough or jobs involving heavy lifting. “Anything that repeatedly puts pressure on the abdominal organs can strain the ligaments and connective tissue,” says Wes Hilger, M.D., a urogynecologist with Sutter. 

Signs to Watch For

Many women have mild prolapse without realizing it. Others feel pressure in the pelvic area, pain during bowel movements or difficulty fully emptying the rectum.

More advanced cases can cause a visible bulge from the vaginal opening or urine and stool leakage. Intimacy may also feel different, which can be emotionally distressing or embarrassing. But you’re not alone — and you shouldn’t feel ashamed to bring it up with your doctor. 

Treatment Options

Dr. Hilger says the first step is to stop blaming yourself. “You might think, ‘If only I’d done my Kegel exercises,’” he says. “Kegels do help strengthen pelvic floor muscles, but serious prolapse usually involves connective tissue that doesn’t respond to exercise.”

Once you understand what’s happening, you may find reassurance — and even relief — just knowing it’s not dangerous. Maintaining a healthy weight and avoiding heavy lifting can help ease symptoms. 

A nonsurgical option called a pessary can also help. This small device, placed in the vagina, supports the organs mechanically and can be removed for cleaning or intimacy. It’s a simple, effective choice for many active women.

If symptoms persist, surgery may be recommended to lift the organs and tighten connective tissue. Depending on your anatomy and the severity of prolapse, the procedure can be done laparoscopically, vaginally or through an abdominal incision. Surgeries generally have high success rates, though Dr. Hilger notes that “gravity doesn’t stop, and neither does aging.” Still, most women regain comfort and function. 

Other Possible Causes

Not all bladder or bowel issues stem from prolapse. Urgency — a sudden need to urinate — or stress incontinence — leaking when coughing, sneezing or laughing — can result from other causes. “Sometimes the urethra itself is weakened, and we can repair that with newer treatments,” says Dr. Hilger. 

The Bottom Line 

If you notice pelvic pressure, leaking or other symptoms, talk with your doctor. “Ask questions and don’t be embarrassed,” Dr. Hilger says. “This is a common, treatable condition — and that’s good news.”