Pelvic Organ Prolapse · Patient guide

What Causes Uterine Prolapse? Risk Factors Explained

Uterine prolapse is caused by stretching of the ligaments, fascia and pelvic floor muscles that hold the uterus in place. Vaginal childbirth is the biggest cause, followed by the loss of estrogen at menopause, chronic straining from constipation, coughing or heavy lifting, excess body weight and inherited connective-tissue weakness. Somssi Women's Clinic in Gangnam, Seoul sees these causes combine most often in women who gave birth years earlier and notice symptoms after menopause.

Medically reviewed by Dr. Yoon Ho-joo, MD, PhD, OB/GYN specialist, Somssi Women's Clinic · Last updated October 2026

At a glance

Key facts

The essentials, based on how Somssi Women's Clinic performs this procedure or answers this question. Your plan is confirmed at consultation.

• Main cause: stretched or torn pelvic supports (uterosacral and cardinal ligaments, pelvic floor muscles, vaginal wall)
• Biggest risk factor: vaginal childbirth, especially large babies, long pushing, forceps or significant tears; several births add up
• Other contributors: menopause and estrogen loss, chronic constipation or cough, heavy lifting or standing work, obesity, genetics, previous pelvic surgery
• Typical timing: symptoms often appear 10 to 20 years after childbirth, around or after menopause
• Measurement: a normal vagina is about 8 to 9 cm long; a cervix within about 5 cm of the opening indicates descent
• What helps: pelvic floor training early; native-tissue hysteropexy and posterior repair when support has failed

Uterine prolapse is caused by weakening of the supports that hold the uterus up, most often from childbirth, aging and menopause, and years of pressure from straining, lifting or excess weight. Usually several of these act together over decades, which is why the uterus can begin to drop long after the event that first damaged its support.

How the uterus is normally held in place

The uterus is suspended at the top of the vagina by the uterosacral and cardinal ligaments, which act like guy-ropes to the pelvic sidewalls and sacrum. Beneath it, the levator ani muscles form a floor that closes the pelvic outlet, and the vaginal walls, with their fascial layers, form a tube that rests on that floor. When all three work, a normal vagina is about 8 to 9 centimeters long and the cervix sits near its top. When they fail, the uterus slides down the canal, and when the cervix comes within about 5 centimeters of the opening, prolapse is established.

Somssi Women's Clinic is a surgical gynecology clinic in Gangnam, Seoul, founded in 2000 and led by Dr. Yoon Ho-joo, MD, PhD, who has presented research on uterine prolapse and sexual function at international meetings including WAS 2007 and ESSM 2006.

The main causes

Vaginal childbirth

Pregnancy and birth are the leading cause. The baby's head stretches the levator muscles and ligaments far beyond their normal range, and in some women the muscle tears away from the pubic bone. A large baby (over about 4 kilograms), a long second stage, forceps or vacuum delivery, and significant perineal tears raise the risk, and each additional birth adds to it. Cesarean birth lowers but does not remove the risk, because pregnancy itself loads the pelvic floor for nine months. The damage may cause no symptoms for years, which is why many women do not connect their prolapse with births that happened decades earlier.

Aging and menopause

Collagen in ligaments and fascia weakens with age, and the drop in estrogen at menopause thins the vaginal wall and reduces tissue elasticity. In the clinic's experience, the lower vaginal wall that should be a thick muscular layer can thin to 2 to 3 millimeters in a lax vagina, leaving little to hold the uterus. This is why prolapse that was mild in a woman's 40s often becomes obvious in her 50s and 60s.

Chronic pressure from above

Anything that repeatedly raises pressure in the abdomen pushes the uterus down against weakened supports: chronic constipation with straining, a long-standing cough from smoking, asthma or reflux, heavy lifting at work or in the gym, and prolonged standing. Occupations that involve standing all day and sports built around heavy lower-body loading are frequent contributors in the women we see.

Body weight

Excess abdominal weight acts like constant downward pressure on the pelvic floor and is an independent risk factor for prolapse and for recurrence after surgery.

Genetics and connective tissue

Some women inherit weaker collagen. A mother or sister with prolapse, joint hypermobility or hernias, and conditions such as Ehlers-Danlos syndrome raise the risk, and prolapse can occasionally occur in women who have never given birth.

Previous pelvic surgery

Hysterectomy removes the uterus but can also disrupt the ligaments that supported the vaginal top, leading to vault prolapse later. Earlier prolapse or tightening surgery that shortened the vagina or treated only one compartment can also predispose to further descent.

How the causes add up

Why the vaginal wall matters as much as the uterus

Many women are told their uterus has "fallen" as if the uterus itself were at fault. In fact the uterus is simply the heaviest passenger in a tube that has lost its shape. Dr. Yoon's view, reflected in the clinic's approach, is that uterine prolapse usually begins with vaginal laxity: the posterior wall and pelvic floor give way first, the vagina widens and shortens, and the uterus follows. That is why treatment at Somssi restores uterine position with a hysteropexy and then rebuilds the posterior wall and pelvic floor with your own tissue, rather than removing the uterus and leaving the wall as it was. See Uterine Prolapse Surgery.

Can prolapse be prevented?

• Learn and practice pelvic floor exercises after every birth and continue them for life; early, mild weakness responds well, and an EMS device can help if you cannot feel the contraction.
• Avoid constipation with fiber, fluids and, if needed, a stool softener; never strain.
• Treat chronic cough and stop smoking.
• Lift with the legs, exhale on effort and avoid repeated heavy loads.
• Maintain a healthy weight.
• After menopause, ask about vaginal estrogen if the tissue is thin or dry.

None of these can reverse an established prolapse, but they slow progression and protect any repair. Our guide Can Uterine Prolapse Be Treated Without Surgery? explains the non-surgical path.

When to see a doctor

Heaviness or dragging in the pelvis, a bulge at the opening, needing to press on the vagina or perineum to empty, urinary frequency or incomplete emptying, low back ache that eases when lying down, or a change in how intercourse feels all deserve an examination. Prolapse is staged from 0 to 4, and the earlier it is assessed, the more options remain. Read How Do I Know If I Have Uterine Prolapse? for the signs.

Bottom line

Uterine prolapse is the result of damaged or weakened supports, with childbirth, menopause and chronic straining the usual culprits, often acting together over many years. Some causes cannot be undone, but pressure from above can be reduced, tissue quality can be improved, and when support has failed it can be rebuilt with your own tissue while keeping the uterus. If you recognize your own history here, an assessment at Somssi Women's Clinic will tell you where you stand.

Questions patients ask

Frequently asked questions

Short, honest answers. For anything personal, a consultation is the right place to ask.

See the full FAQ →

Can uterine prolapse happen if I have never had children?

Yes, though it is much less common. Inherited connective-tissue weakness, chronic constipation or cough, heavy lifting, obesity and aging can all cause prolapse without childbirth. Women in this group are often younger and may be surprised by the diagnosis, which is why any persistent heaviness or bulge should be examined.

Does a cesarean section prevent prolapse?

It lowers the risk compared with vaginal birth, particularly an instrumental delivery, but does not eliminate it. Pregnancy itself stretches the pelvic floor and ligaments for months, and we regularly see prolapse in women who only had cesarean births. Pelvic floor care matters after any delivery.

Why did my prolapse appear years after my last birth?

Damage from childbirth often stays silent while estrogen keeps tissue thick and muscles compensate. At menopause the tissue thins, collagen weakens and the hidden defect becomes a visible prolapse. A typical interval between the last birth and symptoms is 10 to 20 years.

Can heavy exercise cause uterine prolapse?

Exercise is good for the pelvic floor overall, but repeated heavy lifting with breath-holding, high-impact training on a weak pelvic floor and standing work for long hours all add downward pressure. If you already have weakness, we suggest adapting technique, exhaling on effort and building pelvic floor strength alongside.

Is uterine prolapse hereditary?

Partly. Women whose mother or sister had prolapse are at higher risk, and conditions affecting collagen increase it further. Genetics sets the baseline; childbirth, menopause and lifestyle decide how far it progresses.

Can Kegel exercises fix the cause?

Kegels strengthen the levator muscles, which helps when the muscle is still reasonably thick and the prolapse is mild. They cannot repair torn ligaments or rebuild a wall that has thinned to a few millimeters. In those cases exercise maintains what remains, and surgical reconstruction restores the support.

Keep reading

Related treatments and guides

• Uterine Prolapse Surgery — how failed support is rebuilt while keeping the uterus
• How Do I Know If I Have Uterine Prolapse? — recognizing the symptoms
• What Are the Stages of Uterine Prolapse? — how severity is measured
• Can Uterine Prolapse Be Treated Without Surgery? — exercises, pessaries and lifestyle
• Can Uterine Prolapse Come Back After Surgery? — the same causes and recurrence
• Vaginoplasty After Childbirth: Can Surgery Repair Vaginal Laxity? — the laxity that often precedes prolapse

Sources and medical review

• American College of Obstetricians and Gynecologists (ACOG) — patient and practice guidance on pelvic organ prolapse and its risk factors.
• International Urogynecological Association (IUGA) — patient information on pelvic organ prolapse.
• Te Linde's Operative Gynecology (textbook) — anatomy of pelvic support and pathophysiology of prolapse.

Next step

A consultation first. A decision only when you are ready.

Tell us what you are experiencing and what you hope to change. Dr. Yoon examines, measures and explains the options, including when no surgery is the right answer. International patients can start with an online consultation before travelling to Seoul.