Understanding pelvic organ prolapse: The hidden struggle many women face
A VCU Health urogynecologist and reconstructive pelvic surgeon says that nearly half of women have it, but very few talk about it.
September 15, 2025
Upwards of 50% of women will experience pelvic organ prolapse within their lifetime. (Getty Images)
By Leigh Farmer
If you are a female who has had a vaginal birth, been through menopause or experienced chronic constipation, there is a roughly 50% chance that the organs in your pelvic region are beginning to descend into or entirely come out of your vagina.
Got your attention?
Okay, don’t panic. Help is here.
Pelvic organ prolapse, often simply referred to as prolapse, happens way more than you might think. It occurs when the pelvic organs begin to fall into the vaginal canal. Anatomically for women, it makes a lot of sense, according to Julie Suyama, MD, Ph.D., a urogynecologist and pelvic reconstructive surgeon at VCU Health.
Julie Suyama, MD, Ph.D., is a urogynecologist and pelvic reconstructive surgeon at VCU Health. (Tom Kojcsich, Enterprise Marketing and Communications)"[Females] have a hole in the bottom of their pelvic floor which is the vagina. It is a potential herniation spot. So, prolapse can simply be thought of as hernia through the vagina,” she said.
Every week, Suyama treats women experiencing this.
“I have patients that come in and I’m the first person that they are ever telling about this, and they are crying and feel ashamed,” Suyama said. “What I love about urogynecology and what drew me to this field really is that I can tell them ‘You are not alone, and we can fix this.’”
After treatment, Suyama says, many grateful patients report that they have a new lease on life. They express relief because they can resume activities with their family and travel – memorable moments previously put on pause due to pelvic prolapse.
Helping women get the care they need so they can get back to living life without discomfort is what motivates the compassionate medical professionals at VCU Health, like Suyama. She spoke with us about the symptoms and treatments for this common female affliction.
What are the symptoms of pelvic organ prolapse?
Symptoms can vary a great deal; however, there are a few that are more common. If you experience any of these, you should make an appointment with one of our female pelvic health specialists to get it checked out:
- The feeling of vaginal heaviness or bulging, as if sitting on an egg: Patients with severe prolapse can feel or see a bulge beyond the vaginal opening.
- The urgency to pee all the time: This is often caused by hormonal changes related to menopause and/or the loss of support of the front wall of the vagina. If the front wall of the vagina is falling down, then the bladder gets dragged down with it and feels a constant sense of pressure that mimics needing to urinate.
- Difficult bowel movements that require pushing in or around the vagina to adequately empty: Some women have a prolapse of the back wall of the vagina that can lead to stool trapping. It can be caused by excessive straining in patients with chronic constipation, but it can also make constipation and bowel emptying worse.
Is it possible to mistake these symptoms for menopause symptoms?
Some menopausal symptoms share space with prolapse. In fact, nearly all menopausal women report some degree of increasing bladder urgency and frequency. Even if there is no prolapse, menopause alone can cause irritating bladder symptoms just because the bladder, vagina and urethra aren’t getting enough estrogen.
After menopause, the ovaries produce decreasing amounts of estrogen every year of a woman’s life. As estrogen levels go down, irritative bladder symptoms start to go up. If you already have prolapsed, menopause could make your symptoms more intense.
What is the treatment for pelvic organ prolapse?
There are both surgical and non-surgical options for managing prolapse. Women who are not done having babies or who want to avoid surgery often choose a vaginal support device called a pessary. This medical device goes inside of the vagina and exerts pressure on the vaginal sidewalls to hold the prolapse up. These are inserted manually, and fitting will be done by your doctor to ensure comfort. Once the pessary is in place with the correct fit, you will not notice or feel it at all. Instead, you should just experience resolution of the sensation of pelvic heaviness or urinary urgency
For surgery, there are two main approaches to prolapse correction: from below (vaginal) or from above (abdominal). The first involves correcting any and all areas of prolapse through the vagina. There are no incisions on the abdomen. The second approach is abdominal, which can be performed via minimally invasive robotic surgery. This limits incisions and scarring and makes recovery easier.
Determining which type of surgery is right for each patient is a very individualized decision based on that person’s priorities and goals. Whether surgery is vaginal or robotic, recovery tends to be quick, and the vast majority of patients go home the same day. You will be walking within hours after surgery, and you can shower and eat dinner in the comfort of your own home by that evening.
Is there anything I can do proactively to avoid getting pelvic organ prolapse?
Maintaining a healthy weight, avoiding chronic constipation and exercising regularly are the best ways to avoid developing pelvic organ prolapse. Targeted pelvic floor muscle strengthening and stretching, particularly with the guidance of an excellent pelvic floor physical therapist, can also help prevent the progression of prolapse.
Vaginal estrogen is another treatment that can be beneficial to every single peri- and postmenopausal person with a vagina. Starting it proactively in the years leading up to menopause can strengthen vaginal walls and improve or prevent bladder urgency and frequency, urinary incontinence, pain with sex and vaginal dryness.
Are vaginal hormones safe?
Yes, vaginal hormones are safe treatment options for women. There’s a lot of misinformation out there based on outdated research that has led some to believe that vaginal hormones can lead to cancer or stroke. So many women live with these symptoms because they are afraid of getting sick. However, vaginal estrogen is a local therapy that is not absorbed systemically and therefore does not increase these risks. Vaginal estrogen is safe even in women with personal or family history of breast cancer.
This year, the American Urogynecology Society, the American Urologic Association, and the Society for Urology and Female Urodynamics came together to publish a statement about the safety and efficacy of vaginal estrogen in all women. The triple-endorsement has been a game changer and empowered women to take the steps the need to remain healthy and pain free.
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