Vaginal prolapse develops when the structures supporting the pelvic organs lose their strength over time. It rarely has a single cause and usually results from a combination of factors.

Vaginal childbirth is the most common trigger, particularly after prolonged labour, instrumental delivery using forceps or vacuum, or multiple pregnancies. Declining oestrogen after menopause causes connective tissue to lose elasticity, which speeds up the process. Chronic straining from constipation, a persistent cough, or years of heavy lifting adds repeated downward pressure on the pelvic floor. Excess body weight increases this pressure further. Hysterectomy changes the internal support structure and raises the risk of vaginal vault prolapse in some women. A genetic predisposition to weaker connective tissue makes prolapse more likely regardless of obstetric history. Age-related muscle weakening is a factor for most women over 50.

Untreated prolapse tends to worsen. The descent of the organ progresses over time, and symptoms become harder to manage. A bladder prolapse that is not treated leads to worsening urinary leakage, recurrent urinary tract infections, and in severe cases, urinary retention where the bladder cannot empty at all. A rectal prolapse causes progressive difficulty passing stools, bowel urgency, and discomfort that affects eating habits and daily routine. Untreated uterine prolapse can advance to a stage where the uterus descends partially or fully outside the vaginal opening, causing pain with any physical activity, skin ulceration from constant friction, and complete disruption to bladder and bowel function. Psychologically, untreated prolapse leads many women to restrict physical activity, avoid intimacy, and withdraw from social situations. The longer it is left, the more difficult surgical repair becomes and the higher the risk of complications.

Prolapse is named by which organ has descended. A cystocele is a bladder prolapse into the front vaginal wall and is the most common type. A rectocele is a rectal bulge into the back vaginal wall. Uterine prolapse involves the uterus descending into or beyond the vaginal canal. Vaginal vault prolapse occurs after hysterectomy when the top of the vagina loses support. An enterocele is a herniation of the small bowel into the upper vaginal wall. A urethrocele involves the urethra sagging into the vaginal wall.

Prolapse is also graded by severity. Grade 1 means the organ has dropped slightly but remains well inside the vagina. Grade 2 means it has reached the vaginal opening. Grade 3 means it protrudes beyond the opening. Grade 4 means the organ has fully descended outside the vagina.

Treatment depends on the type and grade of prolapse, the specific symptoms, the patient's age and health, and whether she plans to have more children. Not all prolapse needs surgery.

Pelvic floor physiotherapy is the first-line treatment for mild to moderate prolapse. A structured programme of pelvic floor muscle exercises, guided by a women's health physiotherapist, builds muscle strength and can reduce symptoms and slow progression.

Lifestyle modifications work alongside physiotherapy. Weight reduction, treating constipation, avoiding heavy lifting, and stopping smoking to reduce chronic cough all lower the load on the pelvic floor and slow further descent.

A vaginal pessary is a removable silicone device fitted inside the vagina to mechanically support the prolapsed organ. It is an option for women who cannot or do not want surgery, or as a bridge while waiting for an operation. It requires regular monitoring and replacement by a specialist.

Topical oestrogen in the form of vaginal cream or pessary improves tissue quality and elasticity in post-menopausal women. It is used alongside other treatments rather than independently.

Anterior repair, also called colporrhaphy, reinforces the front vaginal wall to return the bladder to its correct position. Posterior repair tightens the back vaginal wall to restore bowel function and correct a rectocele. Both are performed vaginally with no external incisions.

Sacrocolpopexy is a laparoscopic or robotic procedure that uses mesh to support the vaginal vault or uterus by attaching it to the sacrum. It offers reliable long-term results for vault prolapse and uterine prolapse.

Uterus-preserving repair is available for women who want to keep their uterus. Sacrohysteropexy and Manchester repair both correct uterine prolapse without hysterectomy and are performed laparoscopically at our centre.

Vaginal hysterectomy with pelvic floor reconstruction removes the uterus and repairs the pelvic floor in one procedure, for women with uterine prolapse who do not want to retain the uterus.

Robotic-assisted pelvic floor reconstruction is offered for complex or recurrent prolapse. It provides greater precision than conventional laparoscopy, with smaller incisions, reduced blood loss, and faster recovery.

Vaginal prolapse cannot always be prevented, but the following steps reduce the risk and slow progression in women who already have a mild prolapse.

Do pelvic floor exercises regularly, not just during pregnancy. Start them during pregnancy and continue after delivery. Avoid heavy lifting and if lifting is unavoidable, brace the pelvic floor before and during the effort. Treat constipation early and maintain a high-fibre diet to avoid chronic straining. Maintain a healthy weight. Treat a chronic cough rather than managing around it. Attend postnatal physiotherapy after vaginal delivery, particularly after a difficult or instrumental birth. In post-menopausal women, discuss topical oestrogen with a gynaecologist as it supports tissue health and reduces the rate of prolapse progression.

Diagnosis begins with a detailed consultation covering symptoms, obstetric history, bowel and bladder function, and medical background. A physical pelvic examination performed lying down and standing allows the specialist to identify the type and grade of prolapse.

Where the picture is unclear or surgery is being considered, further tests are used. Urodynamic testing evaluates bladder function and the extent of urinary leakage, and helps identify whether stress incontinence is present alongside the prolapse. Pelvic or transperineal ultrasound visualises organ position and movement. MRI of the pelvis provides detailed anatomy for complex or multi-compartment prolapse where more than one organ has descended. Cystoscopy examines the bladder and urethra in cases with prominent urinary symptoms. Defecography is used to assess bowel function specifically in cases of rectocele.

Before starting treatment, stop any activities that increase downward pressure on the pelvic floor, including heavy lifting and high-impact exercise, until the specialist has assessed you and given specific guidance. Provide a full medical history at the consultation, including all pregnancies and deliveries, any previous pelvic or abdominal surgery, current bladder and bowel symptoms, and any medications that affect bleeding or healing.

If surgery is planned, your specialist will advise on stopping blood thinners, arranging for a period of bowel preparation, and fasting before the procedure. Arrange for someone to take you home after the procedure and to stay with you for the first 24 hours. Avoid sexual intercourse in the week before surgery. Inform your doctor if you smoke, as stopping at least 6 weeks before surgery reduces the risk of wound healing problems and respiratory complications.

Before starting treatment, stop any activities that increase downward pressure on the pelvic floor, including heavy lifting and high-impact exercise, until the specialist has assessed you and given specific guidance. Provide a full medical history at the consultation, including all pregnancies and deliveries, any previous pelvic or abdominal surgery, current bladder and bowel symptoms, and any medications that affect bleeding or healing.

If surgery is planned, your specialist will advise on stopping blood thinners, arranging for a period of bowel preparation, and fasting before the procedure. Arrange for someone to take you home after the procedure and to stay with you for the first 24 hours. Avoid sexual intercourse in the week before surgery. Inform your doctor if you smoke, as stopping at least 6 weeks before surgery reduces the risk of wound healing problems and respiratory complications.

Most patients return to light activity within 2 to 4 weeks after laparoscopic or vaginal repair. Full recovery, including return to sexual activity and strenuous exercise, is typically cleared at 6 to 8 weeks at the post-operative review.

For the first 6 weeks, avoid any activity that creates downward pressure on the pelvic floor. Walking is encouraged from the first day, starting with short distances and building gradually. Do not return to gym sessions, running, or heavy work until the specialist has cleared this explicitly at follow-up.

Pelvic floor physiotherapy after surgery is strongly recommended. The repair creates the correct anatomy; physiotherapy strengthens the muscles that hold it in place. Women who continue pelvic floor exercises long-term after repair have lower rates of recurrence.

Some women notice temporary bladder symptoms after surgery, including urgency or difficulty initiating urination. These usually resolve within 4 to 6 weeks. If they persist beyond this, inform the specialist at the follow-up appointment.