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Uterine prolapse occurs when the uterus and cervix descend lower into the vagina because the structures that normally support the uterus and upper vagina are no longer providing their usual level of support.

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Pelvic organ support is complex and depends on the interaction of the pelvic floor muscles, ligaments, fascia, connective tissues and vaginal walls. Uterine prolapse is therefore not simply a consequence of weak pelvic floor muscles. A combination of anatomical, connective tissue, muscular and other factors can contribute to changes in pelvic organ support.

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Uterine prolapse is one form of pelvic organ prolapse (POP). More than one area of support may be affected at the same time, so uterine prolapse can occur alongside prolapse of the bladder, posterior vaginal wall or other pelvic structures. Urinary, bowel, sexual and pelvic symptoms should therefore be considered as part of the overall clinical assessment.

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What does uterine prolapse feel like?

The experience of uterine prolapse varies considerably. Some women have uterine descent without significant symptoms, and prolapse may be identified during a pelvic examination despite the woman having little or no awareness of it.

 

When symptoms occur, they may include:

• Pelvic pressure, heaviness or a dragging sensation

• A feeling of fullness or something coming down

• A bulge or lump within the vagina or at the vaginal opening

• A sensation of a ball or pressure within the vagina

• Difficulty retaining a tampon

• Discomfort or changes in sexual function

• Urinary symptoms, including difficulty emptying the bladder or urinary leakage

• Bowel symptoms, particularly where prolapse also affects the posterior vaginal wall

 

The extent of prolapse seen during examination does not necessarily correspond to the severity of symptoms or their impact on quality of life. Assessment should therefore consider both the anatomical findings and the woman's symptoms, functional difficulties and individual concerns.

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How is uterine prolapse diagnosed?

Diagnosis is primarily based on the woman's symptoms and a clinical pelvic examination.

The examination assesses the position of the uterus and cervix and may also evaluate the anterior and posterior vaginal walls to determine whether other areas of pelvic support are affected. Urinary, bowel, sexual and pelvic pain symptoms may form part of the wider assessment.

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The extent of prolapse can be documented using the POP-Q (Pelvic Organ Prolapse Quantification) system, a standardised method for describing the position of the pelvic organs.

The POP-Q system and staging are explained on the main Pelvic Organ Prolapse page.

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Importantly, POP-Q stage describes the anatomical position of the prolapse. It does not, on its own, determine whether treatment is required. Management should also take into account symptoms, functional impact, quality of life and the woman's preferences.

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Does uterine prolapse always require treatment?

Treatment is not automatically required simply because uterine prolapse is present. If prolapse is not causing troublesome symptoms, observation and monitoring may be appropriate.

Where symptoms affect everyday activities, exercise, bladder or bowel function, sexual function or quality of life, treatment options can be considered according to the individual's circumstances and preferences.

 

Management may include:

• Pelvic floor muscle training

• Vaginal pessary support

• Lifestyle and self-management measures where appropriate

• Management of associated bladder or bowel symptoms

• Vaginal oestrogen where appropriate for menopausal genitourinary symptoms

• Surgery where symptoms are significant and conservative treatment is unsuitable, unsuccessful or not preferred.

• Pelvic floor muscle training

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Pelvic floor muscle training is an important component of conservative management for symptomatic pelvic organ prolapse.

For women with symptomatic POP-Q stage 1 or stage 2 prolapse, NICE recommends considering a programme of supervised pelvic floor muscle training for at least 16 weeks. Where the programme is beneficial, continuing the exercises afterwards is recommended.

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Effective pelvic floor rehabilitation involves more than repeatedly contracting the pelvic floor muscles. Assessment and training may also consider the ability of the muscles to contract and relax appropriately and their coordination with breathing, movement and changes in abdominal pressure.

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Vaginal pessary support

A vaginal pessary is a medical device placed inside the vagina to provide mechanical support to prolapsing pelvic organs.

Pessaries are an established non-surgical treatment option for symptomatic pelvic organ prolapse. The choice of pessary and fitting approach depends on factors including the type and extent of prolapse, vaginal anatomy, comfort, symptoms and the woman's ability and preference to manage the device.

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NICE recommends considering a vaginal pessary for women with symptomatic pelvic organ prolapse, either alone or alongside supervised pelvic floor muscle training.

A pessary provides support while it is being worn; it does not repair or permanently strengthen the underlying supporting tissues.

Finding the most appropriate pessary may require more than one fitting. It is also important to consider whether the pessary affects sexual intercourse, physical activity, bladder or bowel function, and whether the woman can safely remove and replace it herself.

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Pessary safety and ongoing care

A pessary should not be considered a “fit and forget” device.

Some women can safely remove, clean and replace their pessary themselves, while others require ongoing care from a suitably trained healthcare professional. The appropriate follow-up and maintenance arrangements depend on the type of pessary, the woman's circumstances and her ability to manage the device safely.

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Current international guidance emphasises appropriate pessary fitting, education, maintenance and follow-up to reduce complications and support safe long-term use.

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What if the pessary shifts position?

It’s completely normal for a pessary to shift a little during the day as your body moves, your posture changes, and your pelvic floor responds to load. A pessary isn’t fixed in one position, it adapts to you.

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A good rule of thumb is this:
If the pessary still supports you and feels comfortable, it’s doing its job.

Some women notice that a ring pessary may tilt, rotate, or even sit more vertically at times. This can look surprising, but if it’s giving you support and not causing discomfort, then that position is simply your body’s natural way of holding it.

You might also find that the pessary feels different at the end of the day compared to when you first insert it, sometimes more comfortable, sometimes a little less.

This can change with activity, hormones, bowel patterns, and pelvic floor tension.

Before deciding a pessary has “failed,” give it a little time to settle and adjust to your body. Many pessaries need a short period of movement before they find their natural resting place.

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If you ever feel pain, pressure that doesn’t ease, or the pessary repeatedly falls out, speak with your clinician for guidance.

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Seek professional advice if you experience:

• New or significantly increased vaginal discharge, particularly if it is yellow, green, thick or foul-smelling

• Vaginal irritation or inflammation

• Unexpected vaginal bleeding

• Persistent discomfort or pain

• Difficulty removing the pessary

• Repeated slipping or expulsion of the pessary

• Vaginal ulceration or erosion

• New or worsening bladder or bowel symptoms

 

A clear or increased vaginal discharge can occur with pessary use and is not necessarily a sign of infection. However, a change in colour, consistency or odour should be assessed, particularly where it is accompanied by irritation, pain or bleeding.

 

NICE recommends that women using a ring pessary are advised that it should be removed at least every six months to reduce the risk of serious complications. Earlier review is appropriate if the pessary becomes painful, repeatedly falls out, causes unexpected bleeding or significant irritation or discharge, interferes with bladder or bowel function, or cannot be removed as expected.

Important: The manufacturer's instructions for the specific pessary should always be followed. If the manufacturer recommends removal or review at a shorter interval, for example, every three months, this should take precedence over the general six-month recommendation.

 

Vaginal oestrogen

For women with pelvic organ prolapse who have genitourinary symptoms or signs associated with menopause, NICE recommends considering vaginal oestrogen.

Vaginal oestrogen does not mechanically correct the prolapse. It may, however, improve menopausal genitourinary symptoms and may be considered as part of an individual's overall vaginal and pessary care where appropriate.

 

Does uterine prolapse mean I need a hysterectomy?

Not necessarily.

The presence of uterine prolapse does not automatically mean that the uterus needs to be removed.

If symptoms are significant and conservative treatment does not provide sufficient relief, surgery may be considered. Depending on the individual's circumstances, surgical options may include procedures that preserve the uterus as well as procedures involving hysterectomy.

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The choice of treatment depends on factors including symptoms, anatomy, previous surgery, reproductive plans, general health and personal preferences. The potential benefits, limitations and risks of available procedures should be discussed with an appropriately experienced clinician as part of shared decision-making.

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When should you seek professional advice?

• Professional assessment is advisable if you notice:

• A new vaginal bulge or lump

• A sensation of something coming down

• Persistent pelvic pressure, heaviness or dragging

• Difficulty emptying your bladder

• New or worsening bowel symptoms

• Pain or discomfort associated with the prolapse

• Vaginal bleeding or tissue that is becoming sore

• Symptoms affecting exercise, work, everyday activities or sexual function.

Understanding your treatment options

Uterine prolapse does not automatically mean that surgery is necessary. An appropriate clinical assessment can establish which areas of pelvic support are affected, identify associated symptoms and help you understand the range of available management options.

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Treatment should be guided by the whole clinical picture—not simply what can be seen during an examination. Your symptoms, quality of life, functional needs and personal preferences are all important when deciding whether treatment is appropriate and, if so, which approach is right for you.

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Clinical Evidence & References

• National Institute for Health and Care Excellence (NICE). Urinary incontinence and pelvic organ prolapse in women: management (NG123). Recommendations relating to assessment, pelvic floor muscle training, pessary treatment, vaginal oestrogen, conservative management and surgery.

• National Institute for Health and Care Excellence (NICE). Evidence review H: Lifestyle and conservative management options for pelvic organ prolapse. Evidence underpinning NICE recommendations for conservative management, including pelvic floor muscle training and pessary use.

• International Urogynecological Association (IUGA) – International Urogynecological Consultation (IUC). Chapter 2: Evaluation of the Patient with Pelvic Organ Prolapse. International Urogynecology Journal, 2023. Evidence review covering clinical assessment, physical examination and associated urinary, gastrointestinal and pelvic floor dysfunction.

• Rantell A, Abdool Z, Fullerton ME, et al. International Urogynecology Consultation Chapter 3 Committee 1 – Pessary Management. International Urogynecology Journal. Published online January 2025. Contemporary international review of pessary effectiveness, fitting, maintenance, patient education and complications.

• International Urogynecological Association (IUGA). International Urogynecological Consultation – Chapter 3: Conservative Treatment of the Patient with Pelvic Organ Prolapse. International evidence reviews addressing conservative management, including pessary treatment and pelvic floor muscle training.

• Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. International Urogynecology Journal. 2017;28:191–213.

• Clinical review: This page should be reviewed periodically against updated NICE recommendations and emerging international urogynecological evidence and consensus.

 

Page reviewed and updated August 2026