How Severe is your Prolapse? What your Prolapse Diagnosis Means

How severe is your prolapse diagnosis? Prolapse diagnosis

Are you worried you may need prolapse surgery?

Is your prolapse beyond repair without surgery? It‘s often confusing to understand your prolapse severity – especially if you’re feeling nervous and disappointed when receiving your diagnosis.

You can’t really see the full extent of your prolapse and it’s a little socially awkward to compare it to someone else’s.

The following Pelvic Floor Physiotherapist information is designed to help you understand your prolapse diagnosis:

  • How severe is your prolapse?
  • What is mild, moderate or severe prolapse diagnosis?
  • How does your doctor measure your prolapse?
  • What does your stage of prolapse mean?
  • What is a first, second or third degree uterine prolapse?
  • Is your prolapse beyond repair with exercises?

How Severe is your Prolapse?

Your prolapse symptoms may feel awful but this doesn’t necessarily mean your prolapse is severe! Typical prolapse symptoms such as pelvic heaviness or lower back pain don’t correspond with prolapse severity.1

Some women are quite surprised to learn they have a prolapse during their regular pap smear. Others report quite bothersome symptoms with relatively minor prolapse severity.

Some prolapse symptoms tend to worsen in women with more severe prolapse. Vaginal bulging and being able to see your prolapse at the entrance of your vagina are prolapse symptoms that often worsen with more advanced prolapse. In other words you may or may not necessarily experience some of the established troublesome bowel, bladder or prolapse symptoms with different degrees of prolapse severity.

There is however a trend for some specific and bothersome prolapse symptoms to worsen in women with more advanced or severe prolapse.

What is a Mild, Moderate or Severe Prolapse?

Your doctor may have given you a prolapse diagnosis of mild, moderate or severe prolapse.

This is a very simple and general diagnosis of prolapse severity usually based on how troublesome your prolapse symptoms are and the amount of downward movement of your prolapse within your vagina evident during your examination. A big problem with this type of general assessment is that it’s not scientifically accurate or exact.

An accurate prolapse diagnosis must fully reproduce the full extent of the downward movement of your prolapse during your internal examination. This is why your doctor or physiotherapist will ask you to cough and strain downwards during your examination.

Some women need to be examined standing upright to fully reproduce the full extent of prolapse and provide them with an accurate prolapse diagnosis.

What does your Stage of Prolapse (POP-Q) Mean?

The POP-Q3 or Pelvic Organ Quantification is the internationally recommended prolapse classification system that was introduced to improve the accuracy of measuring prolapse severity. This system allows your health practitioner to provide a more accurate prolapse diagnosis than a general assessment.

If your gynaecologist uses POP-Q he or she will measure how far your prolapse moves downward within and/or out of your vagina by looking at the leading edge or the lowest part of your prolapse and measuring how far this moves downwards with coughing and bearing down or straining. Using this system your gynaecologist may have told you that your prolapse is somewhere on the range of Stage 0 to 4.

Understanding your POP-Q Prolapse Severity Diagnosis

If your gynaecologist has uses POP-Q, he or she will classify your prolapse as follows:

Stage 0 – no prolapse is demonstrated during your examination

Stage 1 – the lowest part of your prolapse is more than 1 cm above your *hymenal ring

Stage 2 – the lowest part of your prolapse is within 1 cm either side of your hymenal ring

Stage 3 – the lowest part of the prolapse is more than 1 cm below the hymen but the vagina has not completely prolapsed

Stage 4 – the vagina is completely prolapsed outwards.

*Where is the hymenal ring?

Prolapse severity is measured using the hymenal ring as a fixed reference point in POP-Q assessment. The hymenal ring sits approximately 1cm within the external entrance or opening to the vagina. When the hymen (thin tissue across the entrance to the vagina) is broken by penetrative intercourse or using tampons the hymenal ring is the level where the hymen was previously positioned.

What is First, Second or Third Degree Uterine Prolapse?

Some gynaecologists still diagnose a uterine prolapse as first, second or third degree in severity.

This system was used in the past to grade uterine prolapse by assessing how far the cervix had moved downwards in the vagina. The cervix is the muscular ring (feels like a nose tip) that sits at the very top of your vagina at the entrance of your uterus.

Understanding your Uterine Prolapse Diagnosis

  • First degree uterine prolapse – the cervix moves down inside the vagina
  • Second degree uterine prolapse – the cervix moves though the opening of the vagina with straining
  • Third degree uterine prolapse – the uterus moves out of the vagina

Is your Prolapse Beyond Repair with Pelvic Floor Exercises?

Recent research2 has shown that some women with mild to moderate prolapse (i.e. Stages 1- 2 as measured by POP-Q method), supervised pelvic floor muscle training including home pelvic floor exercises decreased prolapse severity and reduced specific prolapse symptoms.

This means that for women with mild to moderate prolapse (i.e. prolapse above the hymen) it may be possible to reduce prolapse symptoms and even avoid prolapse surgery with pelvic floor muscle training.

A lack of research means that it is currently unknown whether women with more severe prolapse diagnosis can reverse prolapse symptoms and severity with exercises.

Some women with more advanced or severe prolapse will require prolapse surgery or long-term support pessary management. The most appropriate time for you to proceed with prolapse surgery is a matter for you and your gynaecologist to discuss and determine based upon your prolapse diagnosis and other relevant factors.

Key Points about your Prolapse Diagnosis

Understanding your prolapse diagnosis helps you make better informed decision about your future prolapse management.

The evidence suggests that for women with mild to moderate (Stage 1- 2) prolapse diagnosis, pelvic floor muscle training may be an effective method of reversing prolapse and reducing prolapse symptoms. If you can alleviate your prolapse symptoms, you may even feel less likely to need prolapse surgery!

prolapse exercises

ABOUT THE AUTHOR, Michelle Kenway Michelle Kenway is a Pelvic Floor Physiotherapist and author of Prolapse Exercises Inside Out.

Prolapse Exercises is a complete exercise guide for women with prolapse and after prolapse surgery seeking to exercise safely and protect their pelvic floor.

1. Barber MD, Walters MD and Bump R (2003) Association of the magnitude of pelvic organ prolapse and presence of severity of symptoms (abstract #3 103). In International Continence Society, Florence.

2.  Brækken, I. H., Majida, M., Engh, M. E., & Bø, K. (2010). Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American journal of obstetrics and gynecology, 203(2), 170-e1. 3. Bump R Mattiason A Bo K, Brubaker L DeLancey J Klarskov P Shull B Smith A (1996) The standardisation of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics & Gynecology, 175:13.


  1. I only have prolapse during ovulation. What is that?

    • Michelle Kenway says:

      Hi Nico
      This may be due to the fact that hormonal changes around this time that impact upon your pelvic floor function.

  2. Hi Michelle
    Thank you for the article I found it very helpful.
    I understand POP much better.

  3. Elizabeth says:

    Hello Michelle,

    Excellent article, very clear and helpful. I have a question: do you know of any pelvic floor physiotherapists in London, UK? I ask, because apart from a tiny handful of top gynaecologists who refer women to obstetric physiotherapists (a rare breed!), there appears to be widespread ignorance. I have searched hard but only found a couple of physios who run classes for women who have recently given birth and have pelvic floor weakness/damage and associated incontinence but nothing for old (ha ha) women like me who got a uterine prolapse as an extra menopause gift!

    Kindest regards,


    • Michelle Kenway says:

      Hi Elizabeth

      Thank you for raising this issue – I can only go on what I am told from women but this seems to be a huge area of need in the UK. It seems that many women have great difficulty accessing basic pelvic floor rehabilitation in the UK let alone information to help them exercise with prolapse and after hysterectomy/prolapse surgery.

      If any of our readers have access to this information I would love to hear from them to assist other women in the UK to access Pelvic Floor Physio services. Meanwhile I will try to access this information from other contacts too and will post for you if I can find out.

      Many thanks for raising this issue Elizabeth

  4. Dear Michele,
    I have second degree prolapse. Am just starting your pelvic floor exercises with much hope of avoiding surgery. Last year I really slacked on my Pilates stupidly, but I think I still have some abdominal muscle with memory. I started Keegals rather late but can do them. I’m carrying about 15 lbs over my IBW mostly in the abdominal area.Therefore, I feel that supporting this extra abdominal fat is helpful while I loose those lbs. Do you think that it is ok to use a supporting Cotton belt when going out or walking for some light exercise? I feel it helps my prolapse symptoms and it gives me support while I strengthen the pelvic floor muscles that are very weak..However I can feel my pelvic floor muscles even so when doing your exercises. I just bought your audio. The other question is: Is it normal to feel some tenderness in the pelvic area after doing these exercises for the first days like one does with abdominals after abandoning them for a while? I am in Guatemala, far from Australia. (Was in Melborne when very young for 2 years). I don’t think there are physiotherapists with your specialization down here. Your web site has been extremely helpful thank you.

    • Michelle Kenway Physiotherapist says:

      Hi Dominique

      Thanks for your comment & qns. Yes Guatemala is a long way from Australia and possibly challenging to find a Pelvic Floor Physiotherapist there, it must be very challenging for many of the ladies there to manage their difficult pelvic floor problems, especially the very young women who sustain fistula in childbirth.

      1. Some ladies do say that support briefs help with prolapse symptoms, especially those carrying extra abdominal weight. I’m not sure what type of cotton belt you’re describing, just make sure it doesn’t cinch your waist inwards like a tight belt would as this will not help.
      2. Pelvic floor exercises shouldn’t be painful during or afterwards. If you’re feeling discomfort it’s important to make sure that you are in fact relaxing your pelvic floor completely between each exercise and take sufficient time to rest and recover. I would also be inclined to reduce the number of pelvic floor exercises so that they are free of any discomfort. Progress the number of repetitions as comfortable before attempting to increase the strength later on.

      Let me know if you need anything else
      Kindest regards

      • Thankyou Michele for your prompt reply. Your written material and video is so clear and has been extremely helpful. It would help so much if the doctors here were better informed to recommend these exercises in time. I will pass your website info ion to those I know.
        I guess I was trying to progress too fast….

        The cotton wrap around support belt I am talking about is used commonly by midwives here. It is wrapped at the hip/ pelvic level not a the waist. But maybe to tight is not good. I will look at others.
        Thanks so much

        • Michelle Kenway Physiotherapist says:

          Hi Dominique
          The low slung belt should not be a problem for prolapse – it sounds like a pelvic support belt often used in pregnancy to stabilise the pelvic joints. If you think it helps then I don’t see an issue. A tight belt around the belly/middle would be better avoided though.

  5. Hi Michelle, I recently found out I have a cystocele. I have since been seeing a pelvic floor physiotherapist for the past 3 weeks. She’s started me on some pelvic floor exercises and I’m struggling with them as my muscles are so fatigued from keeping the pelvic organs up throughout the day. Main symptoms are heaviness, dragging and feel like it’s pushing agains the back wall. I am confused as to whether I need to keep them contracted (fully/partial?) while Im standing & walking around. And if I do, they end up so fatigued towards the end of the day that I can hardly hold my wee in.
    Do I keep them relaxed n have that heavy feeling as I am going about my day and focus on the 3 sets of exercises or do I keep going with trying to hold the pelvic organs up until it ‘strengthens’ but endure the fatigue at the end of the day and start over the next day? I haven’t felt any sort of improvement since starting 3weeks ago and it seems to be fatigued all the time. Please advice and if I could email you personally, that would be greatly appreciated as I am really struggling with this emotionally as well. I would love to have a consult with you but I’m in Victoria unfortunately. Still awaiting my urogynae appointment in a week’s time for a full internal examination.

    • Michelle Kenway Physiotherapist says:

      Hi Winn
      Yes this can be emotionally taxing indeed – please know that you’re not alone in dealing with this.

      Pelvic floor exercises are designed to strengthen the pelvic floor for support. As your muscles get stronger they should be able to support your prolapse better. This takes time and this is the sort of thing your physiotherapist will supervise and progress. Sometimes it can help to have a pessary at the same time as pelvic floor rehab is underway as this can provide support and this is something you may wish to discuss with your physiotherapist and your urogynaecologist. They will probably liaise with each other regarding your progress. You really need to speak with your physio about the problems you are having as she has assessed your condition. She may be able to modify your program to assist with fatigue.

      Kind regards