Types of Vaginal Prolapse
Professor Swati Jha
At a glance: Types of Vaginal Prolapse
I explain the different types of vaginal prolapse, including anterior wall prolapse, posterior wall prolapse, uterine prolapse, vaginal vault prolapse and combined prolapse. The type of prolapse matters because bladder, bowel and vaginal symptoms can overlap, and treatment should be based on a careful pelvic examination rather than symptoms alone. In Sheffield, I assess prolapse by identifying which part of the vaginal support has weakened, how advanced the prolapse is, and how it affects bladder, bowel, sexual function and daily life.
Types of Vaginal Prolapse
Understanding the types of vaginal prolapse matters because the compartment that has weakened determines the right diagnosis, the right investigation and the right treatment plan. Two women can both describe a vaginal bulge or pelvic heaviness and yet have very different findings on examination. Treating one prolapse type without recognising another that is contributing to the problem is one of the most common reasons for recurrence after surgery.
I assess the type and degree of vaginal prolapse through a careful pelvic examination. I look at the front wall, the back wall, the uterus or vaginal vault, and the relationship between them. The aim is not simply to name what is there — it is to understand how each compartment is contributing to your symptoms and what a sensible, durable treatment plan looks like for you.
Prolapse affects the front wall of the vagina, the back wall, the uterus, the top of the vagina after hysterectomy, or more than one area at the same time. This page explains each type, what can cause pelvic support to weaken, and how the type of prolapse shapes the options I will discuss with you. You can read more about the broader picture on the prolapse overview page or about individual vaginal prolapse symptoms if you are unsure what you are experiencing.
Understanding the Types of Vaginal Prolapse
The table below summarises the main types of vaginal prolapse, the common names you may have heard, and which structure is involved. A full assessment goes beyond naming the type — I also look at how far the prolapse descends and how it is affecting bladder, bowel, sexual function and quality of life.
| Type of prolapse | Also called | What has weakened or descended |
|---|---|---|
| Anterior vaginal wall prolapse | Cystocele, bladder prolapse | Front wall of the vagina; the bladder may bulge into the vaginal wall |
| Posterior vaginal wall prolapse | Rectocele, bowel prolapse | Back wall of the vagina; the rectum may bulge forward into the vagina |
| Enterocele | Small bowel prolapse | Small bowel bulging into the upper back vaginal wall, often at the apex |
| Uterine prolapse | Womb prolapse, uterovaginal prolapse | Uterus and cervix descending into the vagina |
| Vaginal vault prolapse | Apical prolapse, vault descent | Top of the vagina dropping after hysterectomy |
| Combined or multi-compartment prolapse | Multi-compartment prolapse | More than one compartment — front, back, uterus or vault — affected together |
I use a standardised grading system to record how far each prolapse descends relative to the vaginal opening. This allows objective comparison over time, guides treatment decisions, and helps explain whether a prolapse is mild and manageable with conservative measures or more advanced and likely to benefit from surgery.
What Weakens Pelvic Support?
Prolapse occurs when the ligaments, fascia and muscles supporting the pelvic organs stretch or tear beyond their ability to recover. This is rarely caused by a single event — most prolapse develops over time as a combination of structural, hormonal and lifestyle factors accumulate. Understanding what has contributed to your prolapse can help inform both the treatment approach and decisions about preventing recurrence.
Vaginal childbirth
The most significant risk factor for pelvic organ prolapse. Levator ani injury, fascial tears and nerve damage during delivery — particularly after prolonged labour, instrumental delivery, or large birthweight — reduce long-term pelvic support.
Menopause and oestrogen loss
Oestrogen helps maintain collagen and tissue elasticity in the vagina and supporting structures. After menopause, falling oestrogen levels reduce tissue quality and resilience, making prolapse more likely to develop or worsen.
Raised intra-abdominal pressure
Chronic constipation, a persistent cough, heavy lifting and high-impact exercise all generate repeated downward pressure on the pelvic floor. Over years, this can overcome even healthy pelvic support structures.
Body weight
Higher body weight increases the load on the pelvic floor. Even modest weight reduction can reduce prolapse symptoms and improve outcomes from both conservative and surgical treatment.
Connective tissue and genetic factors
Women with connective tissue disorders — including joint hypermobility syndrome, Ehlers-Danlos syndrome and Marfan syndrome — are at higher risk of prolapse, often presenting at a younger age and with greater severity.
Previous pelvic surgery
Prior hysterectomy or prolapse repair alters the anatomy and load-bearing relationships of the pelvic floor, increasing the risk of prolapse developing in adjacent compartments or of recurrence after repair.
A note on symptoms and risk
Not all women with these risk factors will develop a prolapse, and not all prolapse causes symptoms. Conversely, significant prolapse can be present with minimal subjective discomfort. Risk factor review is one part of the assessment — it does not replace a pelvic examination. Find out more on the prolapse overview page.
Why the Type of Prolapse Matters
I do not treat prolapse as a single condition with a single treatment. Which compartment is involved, how far the prolapse descends, and how it interacts with bladder, bowel, sexual function and pelvic floor dynamics all shape the management plan. Getting this right at the start is the most reliable way to avoid treatment failure and recurrence.
Bladder symptoms are not always anterior prolapse
Urinary urgency, frequency and incomplete emptying can arise from the bladder itself, from apical prolapse reducing the bladder outlet angle, or from overactive bladder independently of prolapse. Treating the front wall alone may not resolve symptoms.
Bowel symptoms have multiple causes
Constipation and difficulty emptying the bowel can reflect posterior wall prolapse, pelvic floor dysfunction, slow transit, or all three simultaneously. Assessment needs to go beyond the vaginal wall anatomy.
A visible bulge may come from more than one compartment
The most prominent compartment may not be the only one that needs treatment. Unrecognised vault or apical weakness alongside anterior repair is a leading cause of recurrence after surgery.
Treatment must match anatomy and priorities
The right option — whether pessary, pelvic floor physiotherapy or surgery — depends on the type of prolapse, its severity, your symptoms, tissue quality, previous surgery and what matters most to you.
The Main Types of Vaginal Prolapse Explained
Each type below reflects which compartment of vaginal support has weakened. I examine each compartment individually before forming a diagnosis and discussing treatment. Many women have more than one type involved, which is why a full pelvic examination matters more than any single symptom.
Anterior Vaginal Wall Prolapse
An anterior vaginal wall prolapse occurs when the front wall of the vagina loses support. Because the bladder sits behind this wall, this is often called a cystocele or bladder prolapse. It is one of the most common types I see.
You may notice:
- A vaginal bulge or dragging sensation
- Pelvic pressure that worsens through the day
- Difficulty emptying the bladder fully
- Urinary frequency, urgency or leakage
- Needing to change position to empty the bladder
An anterior prolapse should not be assessed in isolation. I also check support at the top of the vagina, because untreated apical weakness is a common contributor to recurrence after front wall repair.
How I diagnose prolapse →Posterior Vaginal Wall Prolapse
A posterior vaginal wall prolapse occurs when the back wall of the vagina loses support. When the rectum bulges forward into the vagina, this is called a rectocele. It is a common cause of bowel-related symptoms in women with prolapse.
You may notice:
- A bulge at the back of the vagina
- A feeling of incomplete bowel emptying
- Constipation or difficulty passing stool
- Needing to press on the vagina or perineum to open the bowel
- Discomfort with intercourse or pelvic heaviness
Bowel symptoms require careful interpretation. Constipation, pelvic floor dysfunction and rectocele frequently overlap. I assess the prolapse, bowel function and pelvic floor together before advising treatment.
Enterocele
An enterocele occurs when small bowel bulges down into the upper part of the back vaginal wall, typically at or near the vaginal apex. It can occur alongside apical prolapse and is more common after previous pelvic surgery, including hysterectomy.
Symptoms can include:
- Deep vaginal pressure or a high vaginal bulge
- Dragging discomfort
- A sensation of something dropping internally
Enterocele is not always obvious from symptoms alone. It is usually identified during a careful pelvic examination when assessing apical or vault support. It can be missed if only the most visible or symptomatic compartment is examined.
Uterine Prolapse
Uterine prolapse occurs when the uterus and cervix descend into the vagina. Some women notice the cervix coming lower, while others feel heaviness, pressure, or a visible bulge at the vaginal opening.
Uterine prolapse does not automatically mean the uterus must be removed. In selected women, uterine-preserving surgery is appropriate. In others, vaginal hysterectomy with prolapse repair may be the better option. I discuss both in detail before any decision is made.
What I consider:
- Uterine health and any bleeding or cervical screening history
- Future treatment preferences and sexual function
- Likelihood of recurrence and suitability for uterine preservation
- Whether anterior, posterior or vault support also needs addressing
Vaginal Vault Prolapse
Vaginal vault prolapse occurs after hysterectomy. The "vault" is the top of the vagina. If the supporting structures weaken, it can drop down towards or through the vaginal opening. This is an important type of prolapse because effective treatment must restore apical support — repairing only the front or back wall will not address the root cause.
You may notice:
- A central vaginal bulge or recurrent prolapse after previous surgery
- Heaviness, dragging or difficulty with intercourse
- Bladder or bowel symptoms depending on adjacent compartment involvement
Vault prolapse often requires specialist surgical planning. Options may include vaginal or laparoscopic approaches, depending on anatomy, previous surgery, symptoms and individual priorities.
Vaginal vault prolapse in Sheffield →Combined or Multi-Compartment Prolapse
Many women do not have a single isolated prolapse. It is common to have more than one compartment involved — for example, anterior and uterine prolapse, or vault prolapse with front and back wall weakness. Treating only the most visible compartment without recognising what else is contributing may not produce a lasting result.
In combined prolapse, I assess:
- Front and back wall support independently
- Uterine or vault apical support
- Bladder emptying and bowel function
- Vaginal tissue quality, previous surgery and sexual function
- Whether pessary, physiotherapy or planned surgical repair is most appropriate
Combined prolapse does not always mean major surgery. Many women do well with pessary treatment, pelvic floor physiotherapy and vaginal oestrogen. Others need a planned repair of more than one compartment.
Symptoms Do Not Always Identify the Type of Prolapse
Symptoms can guide the assessment, but they do not reliably identify the exact compartment involved. Urinary urgency can occur with anterior prolapse — but it can also be a feature of overactive bladder, independent of prolapse entirely. Constipation may reflect a rectocele, but it can equally be caused by pelvic floor dysfunction, bowel habit or medication. A visible bulge may be anterior, posterior, apical or a combination of all three.
This is why I do not rely on symptoms alone. I combine a detailed history with a pelvic examination and, where needed, bladder or bowel-focused assessment. The examination is performed at rest and while bearing down, because some prolapse is only visible under strain. This approach gives the most accurate picture of what is contributing to your symptoms and what is not.
Read more about vaginal prolapse symptoms and how prolapse is diagnosed.
Common symptom–type mismatches
- Urgency without a large cystocele — may be overactive bladder
- Constipation without posterior wall prolapse — may be pelvic floor incoordination
- Visible bulge from vault collapse — easily mistaken for anterior or posterior wall
- Enterocele without obvious bowel symptoms — found on careful apical examination
- Bladder emptying difficulty with uterine prolapse obstructing the urethra
- Recurrence after anterior repair — unrecognised apical weakness not addressed
When to consider additional tests
In selected cases — particularly when urinary symptoms are significant or when surgery is being planned — I may recommend further investigations such as urodynamics, bladder scan or pelvic floor assessment. These tests help clarify what is driving the symptoms and reduce the risk of an unsatisfactory outcome.
How I Diagnose the Type of Prolapse
During your consultation I take a detailed history, perform a pelvic examination and discuss what the findings mean for your specific situation. I examine each compartment separately and ask about the full range of bladder, bowel, sexual and quality-of-life effects.
History and symptom review
I ask about vaginal bulge and pressure, bladder emptying and leakage, urinary urgency and frequency, bowel emptying and constipation, sexual discomfort, previous hysterectomy or prolapse surgery, childbirth history, and menopause.
Pelvic examination
I examine the front wall, back wall, cervix or vault, and perineum. I examine at rest and under strain, because some prolapse is only apparent when intra-abdominal pressure is raised. I use a standardised grading system to record the degree of descent.
Bladder and bowel assessment
Where urinary symptoms are significant, I may check bladder emptying by post-void residual measurement. Where surgery is being considered, urodynamics may be recommended to assess bladder function before planning the procedure.
Discussion of options
Once I have a clear diagnosis, I explain what the findings mean, what is causing your symptoms, and what the realistic options are. Treatment decisions are made together, taking into account your symptoms, priorities and preferences — not just the examination findings alone.
Treatment Depends on the Type of Prolapse
The best approach depends on which compartment is affected, how far the prolapse descends, how it is affecting your daily life and function, vaginal tissue quality, previous surgery, and what matters most to you. There is no single right answer — and the fact that you have a prolapse does not automatically mean you need surgery.
Observation and lifestyle measures
If the prolapse is mild and not causing significant symptoms, treatment may not be needed immediately. Avoiding constipation, managing weight, reducing heavy straining and protecting the pelvic floor from unnecessary load can all slow progression and reduce discomfort.
Pelvic floor physiotherapy
A structured programme of pelvic floor muscle training with a specialist physiotherapist can improve symptoms and delay or avoid surgical intervention, particularly in mild to moderate prolapse. I can refer directly for assessment and treatment.
Vaginal oestrogen
After menopause, vaginal oestrogen improves tissue quality, reduces dryness and soreness, and makes pessary use more comfortable. It is commonly used alongside other treatments and is safe for most women, including those with a history of breast cancer in many circumstances.
Vaginal pessary
A pessary supports the prolapse without surgery. Different designs suit different prolapse types — ring pessaries, Gellhorn pessaries and shelf pessaries are used for anterior, uterine, vault and combined prolapse depending on fit, anatomy and comfort. I run a dedicated pessary clinic in Sheffield.
Sheffield pessary clinic →Prolapse surgery
Surgery may be appropriate when symptoms are significant, conservative measures are insufficient, or the prolapse is affecting bladder, bowel, sexual function or quality of life. The procedure is chosen based on the type and degree of prolapse, tissue quality, uterine preference and surgical history.
Prolapse surgery in Sheffield →Uterine-preserving surgery
In selected women with uterine prolapse who wish to avoid hysterectomy, uterine-preserving procedures such as sacrospinous hysteropexy or sacrohysteropexy may be suitable. The right approach depends on uterine health, prolapse severity, and individual circumstances.
Uterine preservation surgery →When to Seek a Specialist Assessment
A careful diagnosis is the right starting point. Once I know the type of prolapse, the degree of descent and how it is affecting you, I can explain the realistic options and help you decide what makes sense for your circumstances. You do not need to be certain about what type of prolapse you have before coming to see me — that is what the assessment is for.
You should seek specialist advice if you have any of the following:
- A vaginal bulge or heaviness that is affecting daily life
- Difficulty emptying your bladder or recurrent urinary infections
- Difficulty emptying your bowel or needing to support the vagina
- Discomfort or avoidance of intercourse due to prolapse
- Worsening symptoms after previous prolapse surgery
- Prolapse developing after hysterectomy
- Uncertainty about whether a pessary or surgery is more appropriate
- A previous diagnosis of prolapse and you would like a second opinion
Pelvic organ prolapse types Sheffield — specialist assessment at Spire Claremont and Thornbury Hospital
Further reading
Frequently Asked Questions
Answers to common questions about the types of vaginal prolapse, how they are diagnosed, and what treatment involves.
The main types of vaginal prolapse are anterior vaginal wall prolapse, posterior vaginal wall prolapse, uterine prolapse, vaginal vault prolapse and combined or multi-compartment prolapse. A specific type called enterocele — where small bowel bulges into the upper back vaginal wall — is also recognised separately. Each type reflects which part of the pelvic support has weakened. Treatment depends on which type is present, how far the prolapse descends, and how it is affecting your symptoms and quality of life.
The terms are often used interchangeably, but they describe the same finding from different perspectives. An anterior vaginal wall prolapse refers to the structural finding — weakness of the front wall of the vagina. Bladder prolapse or cystocele refers to the same finding in terms of what has fallen — the bladder bulging into the front vaginal wall. Both terms describe weakness of the same compartment. The distinction matters clinically because treating the front wall without addressing apical support can contribute to recurrence.
A rectocele is the most common form of posterior vaginal wall prolapse. It occurs when the rectum bulges forward into the back wall of the vagina, causing difficulty with bowel emptying or a sensation of incomplete evacuation. However, posterior wall prolapse can also involve the small bowel — this is called an enterocele and involves a different compartment at the top of the back wall. Both can be present together and are distinguishable on examination.
Yes — this is common. Many women have combined or multi-compartment prolapse, where the front wall, back wall, uterus or vaginal vault are affected in more than one area simultaneously. Combined prolapse is one of the reasons a full pelvic examination of all compartments is important before deciding on treatment. Addressing only the most visible or symptomatic compartment without recognising what else is contributing is a leading cause of unsatisfactory outcomes and recurrence.
After hysterectomy, some women develop vaginal vault prolapse — also called apical prolapse. The top of the vagina, which was previously supported by attachments to the uterus and its ligaments, can drop downwards if those supporting structures weaken over time. Vault prolapse is an important type of prolapse to recognise because effective treatment must restore support at the vaginal apex, not just repair the front or back wall. Options include sacrospinous fixation and laparoscopic sacrocolpopexy, depending on the degree of prolapse and individual circumstances. Read more about vaginal vault prolapse in Sheffield.
No. Uterine prolapse does not automatically mean the uterus must be removed. In selected women, uterine-preserving prolapse surgery is possible — procedures such as sacrospinous hysteropexy or laparoscopic sacrohysteropexy can support the uterus in position without removing it. Whether uterine preservation is appropriate depends on the degree of prolapse, uterine health, cervical screening history, sexual function, personal preference and the likelihood of long-term success. I discuss both options in detail at consultation so you can make an informed decision. Read more about uterine preservation surgery.
Yes. A vaginal pessary can provide effective support for many types of prolapse, including anterior, uterine, vaginal vault and combined prolapse. The choice of pessary — ring, Gellhorn, shelf or other designs — depends on the type and degree of prolapse, vaginal tissue quality and individual comfort. A pessary is a non-surgical option that works well for many women, particularly those who are not yet ready for surgery, who have medical conditions making surgery higher risk, or who prefer to avoid an operation. I review pessary fit and usage at follow-up to ensure continued comfort and effectiveness. Read about the pessary clinic in Sheffield.
The type of prolapse is confirmed by a pelvic examination. Symptoms can raise suspicion of prolapse, but they do not reliably identify the exact compartment or compartments involved — and they can be misleading. For example, bladder symptoms may reflect an anterior prolapse, an overactive bladder, or both. A bulge that feels posterior may in fact originate from the vaginal vault. A careful examination at rest and under strain, performed by a specialist, is the only reliable way to identify the type, degree and combination of prolapse present. Read about how I assess and diagnose prolapse.
Posterior vaginal wall prolapse — particularly a rectocele — is the most common type associated with bowel symptoms. Women may notice difficulty emptying the bowel, a feeling of incomplete evacuation, or needing to press on the vagina or perineum to pass stool. However, constipation and bowel symptoms can also arise from pelvic floor incoordination, slow bowel transit, medication effects, or a combination of causes that exist independently of prolapse. A bowel symptom in a woman with prolapse does not always mean the posterior wall is the sole cause, which is why I assess bowel function as part of the full picture rather than in isolation.
Anterior vaginal wall prolapse is most commonly associated with bladder symptoms, including difficulty emptying the bladder, urinary frequency, urgency and leakage. However, urinary symptoms are not specific to prolapse type. Overactive bladder, stress urinary incontinence and voiding dysfunction can all occur alongside or independently of prolapse. Uterine prolapse can occasionally obstruct the urethra and impair bladder emptying. Where urinary symptoms are significant, particularly if surgery is being considered, further bladder assessment such as urodynamics may be recommended to clarify what is driving the symptoms before deciding on treatment. Read about non-surgical treatment options.