Urogynecologic Condition
Pelvic organ prolapse is the descent of one or more pelvic organs — bladder, uterus, or rectum — into the vaginal canal as the supporting structures of the pelvic floor weaken. It feels like pressure, heaviness, or a bulge — sometimes a sense that something is "falling."
It is one of the most common conditions in adult women: by age 80, roughly one in nine will have undergone surgery for it, and many more live with milder grades without treatment. It is also highly treatable at every grade, with options ranging from physical therapy and pessary support to minimally invasive surgical repair.
Most patients tell us they assumed the symptom was minor — or just something they would have to live with. Neither is usually true.
The bladder drops into the front wall of the vagina. The most common form. Often the primary driver of bladder-emptying issues and stress incontinence.
The rectum bulges into the back wall of the vagina. Can cause difficulty with bowel movements and a sensation of incomplete emptying. More on rectocele →
The uterus descends into the vaginal canal. Graded by how far it has dropped — Grade 1 through Grade 4. Treatment depends entirely on grade, symptoms, and what you want your life to look like.
Occurs after hysterectomy when the top of the vagina descends. Often requires specialized reconstructive surgery to restore support.
The small intestine pushes against the upper vaginal wall. Frequently coexists with other forms of prolapse. Diagnosis requires careful examination — often by someone whose subspecialty is exactly this.
Treatment Approach
Most patients with pelvic organ prolapse improve significantly with behavioral, physical, and minimally invasive treatments — long before surgery enters the conversation. Here is the full toolbox, in the order we typically work through it.
Surgery is one tool in a much larger toolbox. When we do recommend a procedure, it is because we have a specific reason — and we will explain exactly what it does, what it doesn't do, and what recovery actually looks like.
What to Expect
A comprehensive first evaluation with Dr. Johnson. Time to be listened to. In-office diagnostics when possible.
Dr. Johnson has read your intake before you walk in. The conversation starts with the impact on your life — not the textbook.
Performed with explanation at every step. Nothing happens without your full awareness and consent.
Diagnostics are performed in-office where possible to avoid extra appointments.
Every option explained. Pros, cons, and what each one would mean for your week, your work, and your life.
A Patient Story
I felt the pressure at the end of every day for two years before I asked. Dr. Johnson explained the grades, fit me with a pessary at my second visit, and walked me through what surgery would and wouldn't change. I chose the pessary. Three years later, I'm still using it. No surgery, no regrets.
— T.W., treated for Grade 2 cystocele and uterine prolapse
Frequently Asked
No. Many patients live well with a pessary and physical therapy for years — sometimes permanently. Surgery is reserved for patients whose symptoms interfere significantly with their lives, or whose grade has progressed beyond what conservative care can manage. The decision is yours, with my full input on what each path actually looks like.
— Lisa L. Johnson, M.D., U.R.P.S.
The standard scale runs from Grade 1 (the organ descends partway down the vaginal canal) to Grade 4 (the organ protrudes outside the body). Grade alone doesn't determine treatment — symptoms and your goals do. A Grade 2 prolapse that is highly symptomatic gets treated more aggressively than a Grade 3 that is not.
— Lisa L. Johnson, M.D., U.R.P.S.
This is one of the most common questions and one of the most important to answer honestly. Most patients report improved intimacy after a well-chosen prolapse repair — because the discomfort and pressure of advanced prolapse interfere with intimacy more than thoughtful surgery does. The exception is colpocleisis, which is reserved for patients who have made an informed choice about vaginal function.
— Lisa L. Johnson, M.D., U.R.P.S.
Sometimes — and only when it is the right choice. Native-tissue vaginal repairs use no mesh. Laparoscopic sacrocolpopexy does use a permanent mesh, and the long-term outcome data is excellent for that specific application. I will tell you which approach I'm recommending, why, and what each option's track record looks like.
— Lisa L. Johnson, M.D., U.R.P.S.
Most patients are back to light daily activities within one to two weeks, lifting restrictions for six weeks, and full return to exercise around eight to twelve weeks depending on the procedure. We are deliberate about the lifting restriction — pushing through it is one of the most common causes of recurrence.
— Lisa L. Johnson, M.D., U.R.P.S.
A thorough, unhurried evaluation with Dr. Johnson. You will leave with a written plan — and clarity on what pelvic organ prolapse is doing in your body, and what to do about it.
