Uterovaginal Prolapse Explained: Differences from Urethrocele & Rectocele + Management:
The affected structures Uterus and cervix Urethra (anterior vaginal wall) Rectum (posterior vaginal wall)
Medically Reviewed by:
Dr. Humaira Latif, MBBS
Gynaecology & Obstetrics Specialist | Ultrasound Specialist | 14+ Years of Clinical Experience.
Last Updated: July 2026.
There are various forms of pelvic organ prolapse. Uterovaginal prolapse occurs when the uterus and upper vagina bulge out. Urethrocele is characterized by an anterior vaginal wall bulge caused by the urethra collapsing downwards. Rectocele is a posterior vaginal wall bulge caused by rectal pressure on the vagina. You may have any one or a combination of them, which means that getting the terminology right is essential to find the right treatment.
If you have had "prolapse" mentioned to you and do not know what it means, know that it is quite common. These terms are commonly used interchangeably by patients and casually by professionals leading to a lack of understanding of what is going on in one’s body and how to get treatment. The objective of this guide is to explain these conditions, compare them and describe stages, causes, and treatment methods.
Table of Contents:
- What Is Pelvic Organ Prolapse?
- What Is Uterovaginal Prolapse?
- What Is Urethrocele?
- What Is Rectocele?
- Comparison Table: Uterovaginal Prolapse vs Urethrocele vs Rectocele
- Causes and Risk Factors
- Stages of Prolapse (POP-Q System)
- Symptoms by Type
- How Prolapse Is Diagnosed
- Non-Surgical Treatment
- Surgical Treatment Options
- Recovery and Prevention
- What Most Guides Don't Tell You
- When to See a Doctor
- FAQs
- Summary
- Related Articles
- References
- FREE Pelvic Organ Prolapse Self-Care Guide (PDF)
- Medical Disclaimer
- Author
1. What Is Pelvic Organ Prolapse?
Pelvic organ prolapse (POP) refers to a condition where one or more pelvic organs—namely the uterus, bladder, urethra, rectum, or the top of vagina after a hysterectomy—descend from their normal place and push against or through the vaginal walls. This occurs when the support structure of these organs considered to be normal—muscles, ligaments, and connective tissue—becomes crimped, weakened or torn.
Prolapse is quite common: according to studies, a considerable number of women, who have undergone vaginal delivery, are expected to have some degree of prolapse during their lives; however, many do not experience sufficient symptoms to seek treatment. It is the knowledge of what exactly went wrong—whether the uterus, urethra or rectum has dropped—that enables a doctor to come up with the appropriate treatment plan, which is the reason why the following differences are so important.
2. Definition of Uterovaginal Prolapse:
Uterovaginal prolapse occurs when the uterus and cervix fall from their normal position inside the pelvis because the ligaments (uterus and cardinal ligaments) that support the uterus lose their strength and stability. In serious cases, the cervix can be a visible part of the vaginal opening. In the worst cases, prolapse or uterine prolapse may occur.
This is the typical case of prolapse when people say that "the uterus has fallen," which in many cases usually goes together with other types of vaginal prolapses, such as prolapse of the vaginal wall.
3. Definition of Urethrocele:
Urethrocele is when the urethra (the transportation tube for the urine out of the body) falls through the front vaginal wall. Weakness of the tissue causing strains and pressure on the vagina happen when urethral tissue descends into the vagina. Urethrocele usually occurs with cystocele (bladder prolapse) because the two have quite a lot in common as far as the supporting system is pertained to.
4. What is Rectocele?
Rectocele is a bulging of the anterior wall of the rectum into the posterior wall of the vagina. This occurs when the rectovaginal septum, which is the membrane that separates the rectum from the vagina, either weakens or gets eroded, due to vaginal deliveries, chronic bowel movements or chronic constipation. As a result of this condition, stool remains stuck in the bulge, hence, making bowel movements look like they are incomplete, when in fact they are not, which is a condition that many women do not know is caused by prolapse.
5. Comparison Between Uterovaginal Prolapse and Urethrocele and Rectocele.
The affected structures Uterus and cervix Urethra (anterior vaginal wall) Rectum (posterior vaginal wall)
The part of the vagina that is involved UPPER vagina (APEX) Anterior wall Posterior wall
Symptoms Feeling of something coming down (heavy feeling in the vagina) Leakage of urine, feeling of incomplete emptying of the bladder, urgency Difficulties passing stools; the need to push on the vagina in order to defecate.
Additional conditions that usually occur along with these conditions Cystocele or Rectocele Cystocele Uterovaginal prolapse.
The treatments that are often first suggested Surgical procedures Hysterectomy or uterine suspension.
6. Causes and Risk Factors:
Because they affect a similar network of pelvic support tissue, the causes of all three problems are somewhat similar:
1.Delivery through the vagina :
particularly the type whereby the labour process is prolonged, involves delivery of large babies, or through vacuum or forceps-assisted labor, which can also cause pelvic floor muscles and nerves to be torn or stretched
2.Producing multiple children :
This is an accumulation of causes whereby the more deliveries one undergoes through the vagina, the greater is the risk that has already been accumulated.
3.Menopause:
has effects on the pelvic structure since, due to reduction in the secretion of estrogen, there is the thinning of connective tissue and vagina over a period of time.
4. Coughing often:
leads to prolonged cases of constipation (smokers and asthmatic people are mainly affected) or repetitive
actions such as lifting of heavy loads.
5. Overweight problem:
The excessive weight of the individual contributes to increased pressure on the pelvic area.
6. Conditions and diseases involving connective tissues:
Several diseases are inherited whereby connective tissues are affected due to other reasons.
7. Previous surgeries of the pelvis area:
Includes surgeries such as total hysterectomy, which causes further complications due to being one of the natural support points.
7. Stages of Prolapse using the POP-Q System:
In the field of medicine, doctors utilize a standardized measurement system known as POP-Q (Pelvic Organ Prolapse Quantification) for determining how much each organ has descended from its original position. While most articles directed towards the patients discuss prolapse without any indication of this scientific measurement, knowledge of this system allows you to better understand your examination reports.
8. Symptoms Associated with Different Types:
In uterovaginal prolapse, patients typically feel heaviness or dragging in the pelvic region and might notice a bulge at the vaginal opening that is more notable by the end of the day and after standing for a prolonged period. With further degree of prolapse, patients may experience lower back pain or difficulty during sexual intercourse.
Urethrocele:
Urethrocele has more to do with having urinary symptoms, including the presence of stress incontinence (leakage when coughing, laughing, or exercising), feeling that the bladder is never completely empty, and creating a need to change positions in order to urinate.
Rectocele:
Rectocele is more associated with bowel symptoms, including difficulty defecating (straining), feeling like and having difficulty in getting the stool past a specific point in the rectum and needing to use a finger (splinting) in order to empty the bowel.
9. Diagnosing Prolapse:
The diagnosis of prolapse will depend on:
Review of clinical history
Obstetric history:
- Menopause,
- Bowel and
- Bladder issues,
- History of cough and
- Constipation,
- As well as impact on quality of life.
(ability to perform daily activities and have sexual relations).
Pelvic examination:
Lying down or standing (as prolapse may be more evident when the patient is in a
The diagnosis of prolapse occurs through different approaches which include:
1.The clinical history of the patient which is commonly known as the obstetric history in case of women and it involves going over the patient symptoms so that the doctor gets a better understanding of the situation.
2.The pelvic examination is another method which ensures examination of the patient in various positions.
For effective diagnosis, the patient can be examined both
- Lying down and
- Standing up.
3.The third way to diagnose prolapse is by performing the POP-Q measurements.
4.The last way of diagnosing prolapse is through any other approaches possible.
10. Non-Surgical Treatment:
1.Pelvic floor muscle training (Kegel exercises):
This method is the primary form of treatment, which only works if done correctly. The technique consists of identifying the muscles used for stopping urine flow (to do this correctly, no tensing of the buttocks, thighs, or abdomen). When this technique is mastered, it is actually a procedure where the contraction lasts 5-10 seconds, followed by full relaxation for the same amount of time and it is performed 10 to 15 times, three times a day. Many women do not see any benefits from the Kegel exercise because they tense the wrong muscles and a single consultation with the pelvic floor physiotherapist can significantly change the situation.
2. Vaginal pessary is a removable
silicone device that is inserted by a physician to prevent prolapse. There are different shapes of pessary – cube, ring, Gellhorn, etc., so that the fitting of the device requires several visits. Pessary must be regularly removed and cleaned once ever2 few weeks by the patient.
3.Vaginal estrogen therapy:
postmenopausal women would benefit from low-dose vaginal estrogen (available as a cream, tablet, or ring) as an additional treatment. Estrogen is effective in improving the thickness and elasticity of the tissues and often used alongside a pessary or pelvic floor therapy to improve comfort and reduce irritation — a treatment that's frequently left out of general prolapse articles despite being a mainstay of menopausal management.
4. Measures of lifestyle:
changes that can help include the maintenance of healthy body weight, satisfactory management of chronic constipation by increasing the intake of fiber and water, managing the chronic cough, and avoiding excessive lifting whenever possible.
11. Surgical Procedures:
Surgery is generally considered for stages three or four of the disease, where the patients experience the negative effects of symptoms on their quality of life, or when other types of treatment have produced insufficient results.
For uterovaginal prolapse:
These are vaginal hysterectomy with vault suspension, or uterus-preserving techniques such as sacrohysteropexy for women who want to save their uterus.
For urethrocele/cystocele:
anterior colporrhaphy, which is the procedure to make the front wall of the vagina tighter and stronger.
For rectocele:
posterior colporrhaphy, in which the end wall of the vagina and the rectovaginal septum is made stronger.
If there is more than one organ bulging, the procedures can be carried out during one operation. It should be mentioned that regardless of the type of surgery, the recurrence is possible after surgery.
reported recurrence rates vary by procedure and surgeon experience, which is a reasonable and important question to raise directly with your surgeon before choosing an approach.
12. Recovery and prevention of the problem:
Following surgery to the pelvic floor, women must avoid heavy lifting and strenuous workouts for a period of six weeks. The level of physical activity is reinstated gradually depending on the recommendation of the attending physician. It is after recovery that women can return to exercising pelvic muscles, thus supporting the achievements of the surgery performed.
13.Prolapse prevention and recurrence:
Prevention of prolapse and its recurrences involves maintaining an ideal body weight; eliminating constipation in time, as this can keep the person straining.
Some additional details:
Some facts are only rarely mentioned in prolapse articles, although they frequently appear during practice.
1. Prolapse is possible without having children.
2. Prolapse is not the same as a hernia, although patients often confuse the two terms.
3.Intimacy and sexual health are rarely addressed directly.
Discussions surrounding intimacy and sexual health are become few and far between. There are many women who worry about lack of feeling, looseness, discomfort during intercourse, or worrying about bulging, but the good news is that all of those problems can be cured by means of certain treatment options such as pelvic floor therapy, pessaries or surgeries.
In contrast to what many people think, talking directly to one’s doctor is a good idea because many individuals overlook important health issues thinking that they are not serious enough to be brought to a doctor’s attention.
4. An enterocele can also occur
Another type of a prolapse is called enterocele.
Entrocele implies that a tiny segment of a small intestine bulges into the top part of a vaginal wall but it should not be confused with rectocele. Enterocele proves to be the fourth compartment of pelvic organ prolapse, but it is often omitted in medical literature.
5. Cultural and daily-life risk factors matter locally.
There are definitely life and culture related factors to be taken into account. Squatting style toilets, resuming heavy workload too soon after delivery, and family pressures to work hard when giving birth constitute serious health risks but these factors have not been discussed in western literature.
14. When to Seek Medical Advice:
Consult a physician if you detect a bulge or sensation of pressure in the vaginal area that does not go away, if you have started to experience new or increased urinary leakage, having trouble fully emptying your bladder or bowel, worsening pelvic pressure throughout the day or pain during sexual intercourse. You need to obtain medical care without delay if the prolapse starts to hurt, bleeds, or if you are experiencing complete inability to urinate, as these may be signs of a more serious issue.
15. Summary:
Uterovaginal prolapse, urethrocele, and rectocele are not the same condition, even if they are similar to each other. Each condition takes place in a specific pelvic structure, meaning that the approach to dealing with it may not be the same.
16. Frequently Asked Questions:
1. What is the distinction between uterovaginal prolapse, urethrocele, and rectocele?
In uterovaginal prolapse, there is the descent of the uterus and top of the vagina; in urethrocele, the front wall of the vagina protrudes from the descent of the urethra; and rectocele is the protrusion of the back wall of the vagina as a result of the pushing of the rectum. All three conditions may occur separately or together.
2. Is it possible to develop uterovaginal prolapse if I haven’t given birth?
Yes. Conditions that may lead to uterovaginal prolapse include weakness of connective tissue or chronic straining, heavy lifting, or post-menopausal changes in tissues in women who never experienced pregnancy.
3. Is it possible to treat prolapse without surgery?
Yes in many instances. Several options to treat mild to moderate cases of prolapse are available including pelvic floor physiotherapy, properly fitted vaginal pessaries, and treatment of chronic cough or constipation.
4. Does the occurrence of uterovaginal prolapse impact sexual experie konce?
It may lead to diminished sensation, pain at sex, and self-consciousness—causing problems that can be addressed by non-surgical and surgical methods.
5. What is POP-Q staging?
It's the standardized measurement system doctors use to grade prolapse from Stage 0 (no prolapse) to Stage 4 (complete prolapse), based on precise examination findings..
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18. References.
1. American College of Obstetricians and28 Gynecologists (ACOG). Pelvic Organ Prolapse (Practice Bulletin). Last reviewed 2025.
2. Royal College of Obstetricians and Gynaecologists (RCOG). Pelvic Organ Prolapse: Patient Information. Last updated 2024.
3. National Institute for Health and Care Excellence (NICE). Urinary Incontinence and Pelvic Organ Prolapse in Women:
4. Management (NG123). Updated June 2025.
International Continence Society / International Urogynecological Association. Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Accessed July 2026.
NHS. Pelvic Organ Prolapse. Last reviewed 2024.
5. MSD Manual Professional Edition. Pelvic Organ Prolapse. Accessed July 2026.
19. Download Your FREE Pelvic Organ Prolapse Self-Care Guide (PDF):
20 . Disclaimer Regarding Medical Services:
This article is written for educational reasons only and does not constitute professional medical advice, diagnoses, or treatments. The degree of prolapse and the treatment process differ among patients, so it is advised to see a certified gynaecologist or urogynaecologist for a designer pelvic checkup and management plan.
21 . Biography of the Author
Dr. Humaira Latif, MBBS
Gynaecology & Obstetrics Consultant | Ultrasound Expert | Medical Writer
Dr. Humaira Latif is a qualified professional in medicine and obstetrics specializing in Gynaecology and Obstetrics who has been working in the field of women's health for over 14 years, including pelvic floor disorders, high-risk obstetrics, ultrasound diagnostics, and preventive care.
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