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Vaginal Prolapse

Vaginal Prolapse After Childbirth: Common, treatable, not something to live with

Pelvic organ prolapse is when one or more of the pelvic organs (bladder, womb, or bowel) drops down into or against the wall of the vagina. It is common after childbirth, particularly after vaginal delivery, and it is one of the conditions women are most reluctant to ask about, despite being one of the most treatable.

This page explains what prolapse is, why it happens, and the wide range of options that exist to manage it well. If you have any of the symptoms below, please tell your midwife, GP or physiotherapist. There is a great deal that can be done.

What prolapse is, and why it happens

Your pelvic organs (bladder at the front, womb in the middle, bowel at the back) are supported by the pelvic floor muscles and the connective tissue around them. Pregnancy and birth stretch and strain these supports. When the supports are weakened, one or more of the organs may move down a little into the wall of the vagina. This is prolapse.

You may notice:

  • A feeling of heaviness or dragging in the vagina, particularly towards the end of the day, or after standing for a long time.
  • A feeling that something is “coming down” or “falling out” of the vagina.
  • A lump or bulge that you can feel in the vagina, or sometimes see at the entrance.
  • Difficulty emptying the bladder or bowel.
  • Lower backache that is worse standing.
  • Discomfort during sex or reduced sensation.

Symptoms are typically worse at the end of the day and better in the morning, and worse after physical effort or constipation.

Types of Prolapse

Cystocele (bladder prolapse)

The bladder drops into the front wall of the vagina.

What you might notice: Difficulty emptying the bladder fully, repeated UTIs, urinary urgency, leaking, or a soft bulge at the front of the vagina.

Uterine prolapse

The womb (uterus) drops downwards into the vagina.

What you might notice: A feeling of pressure or fullness in the vagina, a sensation that something is coming down, possible lower backache.

Rectocele (bowel prolapse)

The bowel pushes into the back wall of the vagina.

What you might notice: Difficulty emptying the bowel, feeling of incomplete emptying, needing to “splint” (press on the back wall of the vagina) to empty.

Sometimes more than one type is present at the same time.

What helps

The great majority of postnatal prolapse improves substantially with the right management. Options include:

  • Pelvic floor exercises, structured and consistent. Often the most important single step.
  • A postnatal physiotherapy assessment, particularly if symptoms are bothering you. Your physiotherapist can tailor a programme and check your technique.
  • Lifestyle measures: avoiding constipation, avoiding heavy lifting, managing weight, supporting your pelvic floor when you cough or sneeze (“squeeze before you sneeze”).
  • A pessary, a small medical-grade silicone device fitted inside the vagina to support the organs. Effective for many women, well-tolerated, reversible.
  • Topical oestrogen cream, if you are post-menopausal or have low oestrogen (less common postnatally).
  • Surgery, considered in some cases of significant or persistent symptoms, usually only after non-surgical options have been tried and family is complete.

Speak to your GP or physiotherapist if

Prolapse symptoms are very common, very treatable, and not something to be embarrassed about.

  • You feel a lump or bulge in the vagina, or a sensation of “something coming down.”
  • You have persistent heaviness, dragging or pressure in the vagina.
  • You have difficulty emptying your bladder or bowel.
  • You have leaks that are not improving with regular pelvic floor exercises.
  • Sex is uncomfortable or you have lost sensation.
  • Symptoms are affecting your daily life, exercise, or mood.

Your GP can refer you to the gynaecology or postnatal physiotherapy service. Many women find that even one physiotherapy session changes their outlook.

Frequently asked questions

Will prolapse always get worse?

No. With pelvic floor work and good management, many women see their symptoms improve significantly, or resolve. Things can change at life stages (further pregnancies, menopause), so management may need to be revisited at those times.

No, but the type matters. Low-impact exercise (walking, swimming, cycling, Pilates, yoga) is encouraged. High-impact exercise (running, jumping, heavy lifting) should be approached carefully and ideally after a physio assessment. Returning to running specifically has its own page.

Most pessaries can stay in for daily activities. Some can stay in for sex, others are removed. Your gynaecologist or physio will explain. Pessaries are completely removable

No. Surgery is one option, considered in selected cases after non-surgical options. Most women never need surgery.

Pregnancy can put further strain on the pelvic floor. Speak to your team early in a future pregnancy so that careful pelvic floor work can be part of your antenatal care.

No. Prolapse is the result of pregnancy and birth (the biggest single risk factor), plus genetic, hormonal, and lifestyle factors. It is common, not a failing.