That "Something Coming Down" Feeling: Early Pelvic Organ Prolapse

Medically reviewed by Dr Manjushree Boob — MD, DNB, FICMCH, FICOG, Infertility & IVF Consultant and lead for cosmetic, aesthetic and functional gynaecology, Shubham Hi-Tech Hospital, Amravati.

She usually starts the sentence the same way: “This may sound silly, but…” Then comes the description. A heaviness low in the pelvis by evening. A feeling that something is about to fall out when she stands up from the toilet. A soft lump she noticed while bathing and has been too worried to mention to anyone.

It does not sound silly to me. It sounds like pelvic organ prolapse, a very common condition, and when it is caught early there is a lot we can do.

What prolapse actually is

Your bladder, uterus and rectum are held in place by a sling of muscles and ligaments, the pelvic floor. When that support loosens, one of those organs can sag down and press into the front or back wall of the vagina, or the uterus can slip lower than it should. Doctors name it by the organ that is sagging, such as a bladder (cystocele), rectum (rectocele) or uterine prolapse, and grade it from mild to advanced.

It is not a tear, and it is not dangerous in the way people fear. It is a loss of support, and the degree matters far more than the label.

Why it happens

• Pregnancy and vaginal childbirth, especially several deliveries, large babies or a long second stage
• The drop in oestrogen after menopause, which thins and weakens the tissues
• Years of straining with constipation
• A long-standing cough
• Repeated heavy lifting, including at work or while carrying children
• Being overweight
• Naturally looser connective tissue, which runs in some families

Having these risks does not mean you will develop prolapse, and having prolapse does not mean you did anything wrong.

A quick self-check

Tick any that sound like you:

• A heaviness or dragging feeling in the pelvis, worse by evening
• A feeling of sitting on a ball
• A bulge you can feel or see at the vaginal opening
• Needing to press on the vagina or perineum to pass urine or stool
• A feeling the bladder or bowel does not fully empty
• Backache that eases when you lie down
• Discomfort or a sense of looseness during intimacy

One or two ticks are reason enough to mention it at your next visit. None of these is an emergency by itself.

“I had my second baby three years ago. Why is this only showing up now?”

Often the support copes for a long time and then gives way when something adds to the load: a stubborn cough, constipation, a heavy job, or the oestrogen drop at menopause. So the delivery lays the groundwork, and later strains reveal it. It does not mean something new went wrong.

What helps, usually in this order

Pelvic floor exercises. Imagine stopping wind and the flow of urine together, and lifting inwards and upwards. Hold briefly, release fully, repeat, and keep your thighs, buttocks and abdomen relaxed. A pelvic floor physiotherapist can confirm you are using the right muscles. Exercises will not reverse a large prolapse, but they often ease symptoms and may help stop mild ones from progressing. Give them a few months.

Take the pressure off. Treat constipation with fibre, fluids and a footstool for your feet, so you do not strain. Look after a chronic cough. Aim for a comfortable weight. Lift with a breath out and your pelvic floor tightened.

Local oestrogen after menopause. Low-dose vaginal oestrogen, prescribed after a short check, can improve the thin, dry tissue, and it also helps comfort and bladder symptoms. I covered that side in our post on vaginal dryness after menopause.

A pessary. This is a soft, removable support placed in the vagina. Many women use one comfortably for years, and it suits those who want to avoid or delay surgery, or who are not fit for it.

Surgery, when needed. If symptoms still trouble you after the above, or the prolapse is advanced, surgery can restore support. Which operation is right depends on which organ has dropped, your age, whether you want to keep your uterus, whether you are sexually active and whether you plan more pregnancies. Some women are advised hysterectomy, and some can keep the uterus; you can read about the laparoscopic route to hysterectomy. No one should feel hurried into an operation.

“Is it bad to keep lifting my grandchildren and doing housework?”

Normal daily activity is fine and walking is good for you. The things to limit are repeated heavy lifting and straining. Breathe out, tighten the pelvic floor as you lift, and share the heavy jobs where you can.

Myth versus fact

Myth: Prolapse means the uterus will fall out completely.

Fact: Most prolapse is mild or moderate and stays that way, especially with treatment. Advanced cases are the minority.

Myth: Surgery is the only answer.

Fact: Exercises, lifestyle changes, oestrogen and pessaries help many women, and some need nothing more.

Myth: It is the price of having children, so nothing can be done.

Fact: It is common, but it is treatable, and there is no need to put up with it silently.

What to expect at your appointment

We begin by talking: your symptoms, deliveries, bladder and bowel habits, periods or menopause, and what you want from treatment. The examination is gentle and done lying down, often with a cough or bearing-down test, and sometimes standing, to see how much support has been lost. A urine test and, if needed, an ultrasound may follow. You will be told what each test is for, and the grade of your prolapse in plain words.

When to come in sooner

Please see a doctor promptly if you have:

• Difficulty passing urine, or being unable to pass urine at all
• Blood, an open sore or discharge from tissue at the vaginal opening
• Blood in the urine, or repeated urine infections
• Constant pain, or fever with a bulge
• A bulge that cannot be gently pushed back

You do not have to wait until it is advanced. If you would like to talk it through, the gynaecology team at Shubham Hi-Tech Hospital in Amravati will listen without judgement. Call +91-8668954915, reach us through our contact page, or read about our cosmetic, aesthetic and functional gynaecology care. If leaking urine is also part of the picture, see our post on stress urinary incontinence.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.