What is pelvic organ prolapse?
The bladder, womb and bowel are held up by the pelvic floor muscles and strong connective tissue. When this support weakens, one or more organs slip down and press into the vagina.
- Cystocele (bladder prolapse): the bladder bulges into the front wall of the vagina. This is the type most linked with urinary problems.
- Uterine prolapse: the womb drops down; in severe cases it comes outside the vaginal opening.
- Vault prolapse: after a hysterectomy, the top of the vagina drops down.
- Rectocele and enterocele: the bowel bulges into the back wall or top of the vagina.
The main risks are vaginal childbirth (especially several or difficult deliveries), menopause, age, heavy lifting, chronic cough, constipation and being overweight.
Symptoms of prolapse and how it is staged (POP-Q)
- A bulge, or feeling that something is coming down, often worse at the end of the day
- A dragging ache in the lower tummy or back
- A slow stream, or needing to push the bulge back to pass urine
- Feeling the bladder has not emptied, and repeated urine infections
- Leakage on coughing, or urgency
- Difficulty opening the bowels, or discomfort during intercourse
Doctors grade prolapse with the POP-Q system, which measures how far each part of the vagina comes down compared with the hymen (the rim at the vaginal opening) while you strain.
| Stage | In plain words |
|---|---|
| 0 | No prolapse |
| 1 | Mild; the lowest part stays more than 1 cm inside the opening |
| 2 | The bulge reaches close to the opening, within 1 cm either side |
| 3 | The bulge comes more than 1 cm outside the opening, but not completely |
| 4 | Complete; the womb or vagina is fully turned outside |
The stage alone does not decide treatment. How much the prolapse bothers you, and whether it affects bladder emptying or the kidneys, matter more.
Who needs prolapse surgery, and who does not
A mild prolapse that causes no symptoms does not need treatment. Surgery is considered when:
- the bulge or dragging troubles you despite pelvic floor training
- a pessary does not stay in, causes problems, or you prefer not to use one
- the bladder does not empty well, causing urine retention or infections
- a severe prolapse kinks the ureters and causes swelling of the kidneys (hydronephrosis)
Surgery is usually delayed if you plan more pregnancies; a pessary can be used meanwhile. Women not fit for a long anaesthetic can often use a pessary, or have a shorter closing operation. If your main problem is leakage, see urine leakage treatment for women.
Treatment without surgery: pelvic floor training and a vaginal pessary
Pelvic floor muscle training, supervised by a physiotherapist or trained nurse for about four months, can ease symptoms of a mild or moderate prolapse and stop it from getting worse. Losing weight, treating constipation and cough, and avoiding heavy lifting also help. After menopause, vaginal oestrogen cream improves the tissues.
A vaginal pessary is a soft silicone device, often ring-shaped, that sits inside the vagina and holds the organs up. It is fitted in the clinic, sometimes after trying a few sizes. It is cleaned or changed every few months, at the clinic or by you once you have been taught. It can cause discharge, odour or small sores, so regular checks are needed. Many women use a pessary comfortably for years.
Tests and preparation before prolapse surgery
- Examination lying down and, if needed, standing and straining
- Urine culture and an ultrasound of the kidneys with residual urine
- Urodynamics with the prolapse pushed back, to look for hidden stress leakage that may appear after repair (see what a urodynamic test involves)
- Cystoscopy if there is blood in the urine or other concerns
- A check of the womb and cervix with your gynaecologist when the uterus is involved
- Blood tests and an anaesthesia check
Before surgery, treat constipation and cough, stop smoking, and use vaginal oestrogen if advised.
How pelvic organ prolapse surgery is done
Most operations are done under spinal or general anaesthesia and take one to three hours. Where the uterus is involved, the operation is planned and often done together with a gynaecologist.
Native tissue vaginal repair
Done through the vagina, with no tummy cut. For a cystocele, the front vaginal wall is opened, the bladder is pushed back up, and the supporting tissue is stitched together (anterior repair). A back-wall repair treats a rectocele. When the womb has dropped, it may be removed (vaginal hysterectomy) or kept, and the top of the vagina is fixed to strong ligaments inside the pelvis.
Sacrocolpopexy
Used mainly for vault prolapse or when prolapse returns. Through an open or laparoscopic (keyhole) approach, a strip of mesh is attached from the top of the vagina to the front of the sacrum (the bone at the base of the spine).
Colpocleisis
A shorter operation that closes most of the vagina. It suits older women who are not sexually active and prefer a shorter operation.
Mesh inserted through the vagina for prolapse is no longer recommended as a routine option, because of its complications.
Equipment and where it is done
Surgery is at ManglamPlus Medicity, Mansarovar, using a cystoscope to check the bladder and ureters after repair, laparoscopic camera and instruments for keyhole sacrocolpopexy, and dissolving stitches.
Hospital stay and recovery after prolapse surgery
| Time | What usually happens |
|---|---|
| Day of surgery | A catheter, and sometimes a vaginal pack, for a day or two |
| Days 1-3 | Catheter removed and bladder emptying checked; home in one to three days |
| Weeks 1-2 | Short walks, light housework, stool softeners; spotting and discharge are normal |
| Weeks 3-6 | Desk work often resumes; no heavy lifting or intercourse until about six weeks |
Avoid lifting heavy water buckets, gas cylinders or children for at least six weeks, and limit heavy lifting long-term. Call +91 9649888222 for fever, heavy bleeding, foul discharge, or difficulty passing urine.
Risks of prolapse surgery and treatment options compared
Risks include bleeding, infection, temporary difficulty passing urine, new stress leakage, pain during intercourse, and rarely injury to the bladder, bowel or ureter. Prolapse can come back in the same or another part of the vagina. After sacrocolpopexy, the mesh can occasionally show through the vaginal wall. Keeping weight down, avoiding straining and continuing pelvic floor exercises help protect the repair.
| Option | Usually suits | Points to weigh |
|---|---|---|
| Pelvic floor training | Mild to moderate prolapse | No surgical risk; needs months of practice |
| Pessary | Any stage, or unfit for surgery | Regular checks; discharge or sores |
| Native tissue repair | Most first-time prolapse | No mesh; prolapse can return |
| Sacrocolpopexy | Vault or recurrent prolapse | Longer operation; small mesh risks |
| Colpocleisis | Older women not sexually active | Shorter surgery; intercourse no longer possible |
All women’s services are listed on the female urology page.
Cost of pelvic organ prolapse surgery in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- The type of repair: native tissue vaginal repair, sacrocolpopexy or colpocleisis
- Whether a hysterectomy or a sling for leakage is done at the same time
- Open or laparoscopic approach, and operating time
- Tests before surgery, such as urodynamics and ultrasound
- The room category you choose at ManglamPlus Medicity and the number of nights
- Your insurance policy’s terms, such as waiting periods and room-rent limits
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Pelvic organ prolapse surgery with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Is prolapse dangerous?
Usually not, but it can affect comfort and daily life. A severe prolapse can block urine flow and affect the kidneys, which is why a urologist checks bladder emptying and the kidneys.
Can prolapse go back up with exercises?
Supervised pelvic floor training can reduce symptoms and stop a mild prolapse from getting worse, but it rarely reverses a large one. A pessary or surgery is then considered.
Will my womb have to be removed?
Not always. Depending on your age, wishes and the condition of the womb, it may be removed or kept and supported. This is decided with your gynaecologist.
Can prolapse surgery and a sling for leakage be done together?
Sometimes. If tests show stress leakage, a sling may be added or done later. Both options are discussed before surgery.
When can I lift things and do housework again?
Light housework after one to two weeks. Avoid heavy lifting for at least six weeks, and keep lifting light in the long term to protect the repair.
Can prolapse come back after surgery?
Yes, in some women, in the same or another part of the vagina. Healthy weight, avoiding constipation and continuing exercises help.
Is prolapse surgery covered by insurance?
Cover depends on your policy and the hospital’s empanelment. Please confirm with the ManglamPlus Medicity billing desk. See payment and insurance.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.