What are the different pelvic organ prolapse stages?

Pelvic organ prolapse is something that affects thousands of women every year and is a common side-effect of pregnancy and childbirth. Fortunately, if you’re at all concerned that you may be experiencing one of the various stages of prolapse, there are several warning signs that you can look out for to prevent your prolapse from getting worse.

What is a pelvic organ prolapse?

A pelvic organ prolapse is the term used to describe the action of an organ drooping, or sagging, or and slipping out of its natural place within your pelvic region. In women, this includes the uterus, vagina, small bowel, rectum, bladder, and urethra, and it often requires surgery to lift and support the organ back into place.

However, not all pelvic organ prolapses are the same, and a variety of different grades of prolapse are used to define how serious a prolapse may be, and therefore what actions are required to fix it.

Are there different grades of prolapse?

Generally speaking, there are four main stages of pelvic organ prolapse, all graded using the Pelvic Organ Prolapse Quantification System (POP-Q). These start from a minor movement of the organ to a complete prolapse where the organ is permanently protruding from the body.

In essence, this means that the POP-Q levels for uterine prolapse stages and bladder prolapse stages are much the same, though the physical effects of the prolapses may differ due to organ location, size, and shape.

Unfortunately, any pelvic organ can be subject to prolapse, usually into the vagina. Whereas if the vagina prolapses in on itself, it's usually a result of another organ prolapsing first and taking the vagina with it.

This is why a pelvic organ prolapse is often also referred to as a vaginal prolapse. You can read more about each type of possible pelvic organ prolapse on our Types of Prolapse page.

Breaking down the Pelvic Organ Prolapse Quantification System (POP-Q)

As we’ve already mentioned, there are four different prolapse stages or grades of prolapse that doctors use to describe prolapse severity, all qualified using the Pelvic Organ Prolapse Quantification System (POP-Q).

Naturally, stage one, or first first-degree prolapse, is considered to be the being the most mild, while and a stage four, or fourth fourth-degree prolapse is considered to be the being the most severe. Thus, doctors use quantitative measurements from a physical examinations to categorise your prolapse grades.

Below is a description of how this may be experienced in a patient:

• Stage 1: Mild or Slight – Here, the organ in question has shifted slightly out of position but may not yet be pushing on other organs. If your prolapse is at this stage, there is actually a chance that you may present no symptoms. You might not even know that you have a prolapse until it is picked up as part of a routine medical examination, such as a smear test. At this stage of prolapse, the pelvic organs are still well supported.
• Stage 2: Moderate – If your prolapse has reached this stage, you may experience symptoms such as a heaviness or full feeling in the general pelvic area, or a potentially even a dragging sensation. You may also experience pain or discomfort during sex as the prolapsing organ is still inside the body but has fallen away from its normal position.
• Stage 3: Severe – At stage three you are more than likely to experience a number of symptoms at a greater frequency and with more severity. Sometimes, you may feel a lump or a bulge inside the vagina, and occasionally, for example, if you cough, sneeze or laugh, the organ may actually protrude slightly and temporarily outside of the vagina.
Stage 4: Complete – The final stage, this grade of prolapse is sometimes referred to as a complete prolapse. You’ll experience severe symptoms, possibly most or all of the above, and you’ll feel extremely uncomfortable. In almost all cases, you will notice a fleshy protrusion from the outside of your vagina, which is the prolapsed organ.

How do I reduce the chance of a pelvic organ prolapse?

Although a prolapse is shocking and upsetting for any woman to experience, the good news is that there is plenty you can do to strengthen your pelvic floor and reduce the likelihood that you will experience any of the pelvic organ prolapse stages we’ve mentioned above.

In our opinion, the best way to look after your pelvic floor muscles is to make sure you perform pelvic floor/Kegel exercises daily. These exercises are simple to carry out and can be done on the way to work, at your desk or when relaxing on the sofa. And the beauty is, no one will know you’re doing them!

Of course, you can make them even more targeted by using an electric pelvic toner too. This simple machine has a fantastic prolapse programme to help with any vaginal prolapse symptoms and prevent them from becoming worse.

Done regularly, these sorts of exercises will help to strengthen the pelvic floor muscles and keep them doing their job, so if you do experience any uterine prolapse stages or vaginal prolapse stages, what stage of prolapse you experience will be kept to a minimum.

Why are pelvic floor exercises important?

Remember, it’s important to look after your pelvic floor muscles at whatever stage of life you’re at. It doesn’t matter if you’re young and having children hasn’t even crossed your mind yet, or you’re already looking after a growing family, strengthening your pelvic floor is crucial.

Sadly, it’s estimated that half of all women who have had children will experience some degree of pelvic organ prolapse in their lifetime. And if you do experience one form of vaginal prolapse, then you’ll be more likely to experience further prolapse of other pelvic organs.

That’s why preventing a prolapse from occurring in the first place is so important through regular Kegel exercises, helping to prepare your body for the stress and effort that comes with childbirth.