What Are the Different Types of Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) can affect different parts of the vagina and pelvic organs. The main types include anterior vaginal wall prolapse (often called cystocele or bladder prolapse), posterior vaginal wall prolapse (often associated with rectocele), uterine prolapse, and vaginal vault or apical prolapse. Some patients have more than one type at the same time, so a pelvic examination is important for identifying which structures have lost support.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles, connective tissues, and ligaments supporting the pelvic organs weaken.

This may allow structures such as the:

• Bladder
• Uterus
• Rectum
• Vaginal walls
• Vaginal apex

to descend toward the vaginal opening.

The type of prolapse is classified according to the structures involved.

What Are the Main Types of Pelvic Organ Prolapse?

The major categories include:

Anterior vaginal wall prolapse → bladder/front vaginal wall

Posterior vaginal wall prolapse → rectum/back vaginal wall

Uterine prolapse → uterus and cervix

Apical or vaginal vault prolapse → top of the vagina

More than one compartment may be affected simultaneously.

What Is Anterior Vaginal Wall Prolapse?

Anterior vaginal wall prolapse occurs when support between the bladder and front vaginal wall weakens.

The front wall of the vagina then descends.

This is one of the most common forms of pelvic organ prolapse.

What Is a Cystocele?

The term cystocele is commonly used to describe bladder prolapse toward the anterior vaginal wall.

Possible symptoms include:

• Vaginal bulging
• Pelvic pressure
• Frequent urination
• Urinary leakage
• Difficulty starting urination
• Feeling that the bladder does not empty completely

Some patients have anatomical prolapse without significant urinary symptoms.

What Does Bladder Prolapse Feel Like?

Patients may describe:

• Pressure inside the vagina
• A soft vaginal bulge
• Something “coming down”
• Difficulty completely emptying the bladder
• Symptoms becoming worse after standing

The severity of symptoms does not always match the anatomical degree of prolapse.

What Is Posterior Vaginal Wall Prolapse?

Posterior vaginal wall prolapse occurs when support between the vagina and rectum weakens.

The posterior vaginal wall may then bulge forward.

A rectocele may be associated with this type of prolapse.

What Is a Rectocele?

A rectocele occurs when the rectum bulges toward the back wall of the vagina.

Possible symptoms include:

• Vaginal pressure
• Posterior vaginal bulging
• Constipation
• Difficulty passing stool
• Incomplete bowel movements
• Excessive straining

Some patients feel the need to press around the vaginal or perineal area to help complete a bowel movement.

Is Rectocele the Same as Rectal Prolapse?

No.

These are different conditions.

Rectocele → rectum bulges toward the vaginal wall

Rectal prolapse → rectal tissue descends through the anus

They require different evaluations and potentially different treatments.

What Is Uterine Prolapse?

Uterine prolapse occurs when the supporting structures of the uterus weaken and the uterus descends toward the vagina.

The cervix may move progressively closer to the vaginal opening.

Possible symptoms include:

• Pelvic heaviness
• Vaginal pressure
• Feeling something descending
• Vaginal bulging
• Urinary symptoms
• Sexual discomfort

More advanced prolapse may extend outside the vaginal opening.

What Is Apical Prolapse?

Apical prolapse involves loss of support at the top of the vagina.

It can occur with uterine prolapse or after hysterectomy.

Maintaining adequate apical support is an important part of pelvic-floor anatomy.

What Is Vaginal Vault Prolapse?

Vaginal vault prolapse can occur after hysterectomy.

After the uterus is removed, the top of the vagina may lose support and descend downward.

Symptoms may include:

• Vaginal pressure
• Pelvic heaviness
• Vaginal bulging
• Difficulty with intercourse
• Urinary or bowel symptoms

Treatment depends on severity and patient goals.

Can Prolapse Happen After Hysterectomy?

Yes.

Removing the uterus does not eliminate the possibility of future pelvic organ prolapse.

Some patients may develop vaginal vault or other compartment prolapse after hysterectomy.

Previous pelvic surgery should therefore be discussed during evaluation.

Can You Have Multiple Types of Prolapse?

Yes.

This is very common.

For example, a patient may simultaneously have:

• Anterior wall prolapse
• Uterine or apical prolapse
• Posterior wall prolapse

Treating only one compartment without evaluating the others may not fully address the patient's symptoms.

What Is Complete Uterine Prolapse?

In advanced uterine prolapse, the uterus may descend substantially through the vaginal opening.

This is sometimes described as complete uterine prolapse or procidentia.

Patients may experience:

• Visible tissue outside the vagina
• Significant pressure
• Difficulty walking comfortably
• Urinary problems
• Tissue irritation

Advanced prolapse requires medical evaluation.

What Is Enterocele?

An enterocele refers to descent involving the upper posterior vaginal area where small bowel may push downward toward the vagina.

It may occur together with other forms of prolapse and can be associated with loss of apical support.

Diagnosis requires appropriate pelvic examination.

What Type of Prolapse Causes a Vaginal Bulge?

Several types can.

A vaginal bulge may result from:

• Cystocele/anterior prolapse
• Rectocele/posterior prolapse
• Uterine prolapse
• Vaginal vault prolapse

The location and appearance of the bulge alone may not reliably identify the type.

Which Prolapse Causes Bladder Problems?

Anterior vaginal wall prolapse is commonly associated with bladder symptoms.

However, urinary problems can occur with several pelvic-floor disorders.

Symptoms may include:

• Leakage
• Urgency
• Frequent urination
• Incomplete emptying
• Difficulty urinating

A pelvic examination helps determine whether prolapse is contributing.

Which Prolapse Causes Constipation?

Posterior vaginal wall prolapse and rectocele may contribute to bowel-emptying difficulties.

However, chronic constipation can also worsen pelvic organ prolapse through repeated straining.

The relationship can therefore work in both directions.

Which Prolapse Causes Pelvic Pressure?

Almost any type of prolapse can produce pelvic heaviness or pressure.

Symptoms may become more noticeable after:

• Prolonged standing
• Exercise
• Heavy lifting
• Coughing
• Straining

They may improve when lying down.

Which Type of Prolapse Happens After Childbirth?

Pregnancy and vaginal childbirth can contribute to several types of pelvic support problems.

Postpartum patients may develop:

• Anterior prolapse
• Posterior prolapse
• Uterine prolapse
• Pelvic-floor weakness
• Perineal changes

The exact condition should be diagnosed rather than assuming all postpartum vaginal looseness is the same problem.

Can Menopause Cause Different Types of Prolapse?

Aging and menopause can contribute to weakening pelvic support.

Symptoms may therefore become noticeable years after childbirth.

Other contributing factors can include:

• Obesity
• Chronic coughing
• Constipation
• Heavy lifting
• Previous pelvic surgery
• Connective-tissue weakness

Usually more than one factor is involved.

How Are Different Types of Prolapse Diagnosed?

Diagnosis typically involves:

medical history → symptom assessment → pelvic examination → evaluation while bearing down when appropriate

The doctor assesses:

• Anterior vaginal wall
• Posterior vaginal wall
• Uterine or apical support
• Vaginal opening
• Pelvic-floor function

This helps identify whether one or multiple compartments are involved.

What Are the Stages of Pelvic Organ Prolapse?

Doctors may use the POP-Q system to describe the anatomical extent of prolapse.

The degree of descent can range from relatively minor changes to tissue extending substantially beyond the vaginal opening.

Treatment is not determined by stage alone.

Symptoms and quality of life are also important.

Does Mild Prolapse Need Treatment?

Not necessarily.

If mild prolapse causes little or no discomfort, observation may be appropriate.

Treatment becomes more relevant when symptoms interfere with:

• Exercise
• Urination
• Bowel movements
• Sexual activity
• Daily life

The goal is generally symptom improvement.

Can Pelvic Floor Therapy Treat Prolapse?

Pelvic-floor muscle training may help selected patients manage symptoms, particularly with mild or moderate prolapse.

Treatment may focus on:

• Muscle strength
• Coordination
• Pressure management
• Bowel habits
• Exercise technique

A trained pelvic-floor physiotherapist can provide individualized guidance.

What Is a Pessary?

A pessary is a removable vaginal device designed to support prolapsed structures.

It may be appropriate for patients who:

• Prefer nonsurgical management
• Want to delay surgery
• Are planning future pregnancy
• Cannot undergo surgery
• Want symptom relief

Different shapes and sizes are available.

Which Types of Prolapse Need Surgery?

Surgery may be considered for bothersome prolapse that significantly affects quality of life.

The operation depends on:

• Prolapsed compartment
• Severity
• Uterine status
• Previous surgery
• Age
• Health
• Future pregnancy plans
• Patient preference

There is no single operation for every type of prolapse.

Is Vaginoplasty a Prolapse Treatment?

Not necessarily.

Vaginoplasty and pelvic organ prolapse repair should not automatically be considered the same surgery.

A patient reporting vaginal looseness may actually have:

• Vaginal laxity
• Perineal widening
• Pelvic-floor weakness
• Cystocele
• Rectocele
• Uterine prolapse
• Multiple conditions

Diagnosis should determine treatment.

How Somssi Women’s Clinic Evaluates Different Types of Prolapse

At Somssi Women’s Clinic in Seoul, pelvic-floor evaluation should identify which structures are contributing to symptoms.

Assessment may include:

• Anterior vaginal wall
• Bladder support
• Posterior vaginal wall
• Rectal support
• Uterine support
• Vaginal apex
• Perineum
• Pelvic-floor symptoms
• Urinary symptoms
• Bowel symptoms

Treatment can then be individualized according to the actual type and severity of prolapse.

Frequently Asked Questions

What are the main types of pelvic organ prolapse?

The main types are anterior vaginal wall prolapse, posterior vaginal wall prolapse, uterine prolapse, and apical or vaginal vault prolapse.

What is a cystocele?

It refers to bladder prolapse toward the anterior vaginal wall.

What is a rectocele?

It involves the rectum bulging toward the posterior vaginal wall.

Is rectocele the same as rectal prolapse?

No.

What is uterine prolapse?

It occurs when the uterus descends toward or through the vagina.

What is vaginal vault prolapse?

It occurs when the top of the vagina loses support, particularly after hysterectomy.

What is apical prolapse?

It is loss of support involving the upper vagina or uterus.

What is enterocele?

It involves descent of tissue containing small bowel toward the upper vagina.

Can I have more than one type of prolapse?

Yes. Multiple compartments can be affected simultaneously.

Which type causes urinary problems?

Anterior vaginal wall prolapse is commonly associated with bladder symptoms.

Which type causes constipation?

Posterior prolapse or rectocele may contribute to bowel-emptying difficulties.

Which type causes a vaginal bulge?

Any major type of prolapse can potentially create a vaginal bulge.

Can prolapse happen after childbirth?

Yes. Pregnancy and childbirth are important risk factors.

Can prolapse happen after hysterectomy?

Yes. Vaginal vault prolapse can occur after hysterectomy.

Can menopause contribute to prolapse?

Aging and postmenopausal changes may contribute to weakening pelvic support.

How do doctors determine which type I have?

A pelvic examination is used to assess the different vaginal compartments and pelvic structures.

Can ultrasound identify prolapse?

Additional imaging may sometimes be useful, but physical examination is central to diagnosis.

Does every prolapse need treatment?

No.

Can pelvic-floor exercises help?

They may improve symptoms in selected patients.

Can a pessary help different types of prolapse?

Yes. Pessaries can provide support for many patients with symptomatic prolapse.

Is vaginoplasty the same as prolapse repair?

No. They address different anatomical problems, although some patients may have both vaginal laxity and prolapse.

Which Type of Pelvic Organ Prolapse Do I Have?

A simple way to understand the main categories is:

front vaginal wall → anterior prolapse / cystocele

back vaginal wall → posterior prolapse / rectocele

uterus descending → uterine prolapse

top of vagina descending → apical or vaginal vault prolapse

multiple areas → multicompartment prolapse

Symptoms can overlap significantly, so it is difficult to determine the exact type based on symptoms alone.

At Somssi Women’s Clinic in Seoul, the first step should be identifying which pelvic structures have lost support, how severe the prolapse is, and whether it is actually responsible for the patient's symptoms.

Treatment can then range from observation and pelvic-floor rehabilitation to pessary management or surgery when appropriate.