Vaginal Pressure: Causes and When to Worry

What vaginal pressure feels like

People describe it as:

• a heavy or dragging sensation low in the pelvis
• feeling like a tampon is slipping out, or sitting on a ball
• a bulge or lump at the vaginal opening
• fullness or aching in the vagina or lower back
• discomfort that builds through the day or after standing, lifting or exercise, and eases when lying down

Vaginal pressure when not pregnant

Pelvic organ prolapse

Pelvic organ prolapse happens when the muscles and ligaments of the pelvic floor weaken and organs drop into or out of the vagina. It is very common: up to half of women who have given birth have some degree of prolapse on examination, though many have no symptoms. Types include:

Risk factors are vaginal childbirth (especially large babies, long pushing or forceps), menopause, aging, obesity, chronic constipation, chronic cough, heavy lifting and family history.

Uterine fibroids

Large uterine fibroids can press on the bladder and rectum, causing pelvic pressure, frequent urination, constipation, and often heavy periods.

Constipation

A full rectum presses on the back wall of the vagina and can feel like vaginal pressure. Chronic straining also worsens prolapse.

Pelvic floor muscle tension

Overly tight pelvic floor muscles can cause pressure, aching, painful sex and difficulty emptying the bladder or bowel. See pelvic floor dysfunction.

Vaginal cysts and other masses

Vaginal cysts, Bartholin's gland cysts, urethral diverticula and, rarely, tumors can cause a feeling of pressure or a lump.

Infections and inflammation

Vaginitis, urinary tract infections and pelvic inflammatory disease can cause pelvic pressure along with discharge, burning or pain.

Vaginal pressure in pregnancy

Normal causes

• Early pregnancy: increased blood flow to the pelvis and the growing uterus can cause mild pressure.
• Third trimester: as the baby's head descends into the pelvis ("lightening"), often 2 to 4 weeks before labor in a first pregnancy, pressure increases. Pressure on nerves can cause sudden sharp twinges in the vagina, sometimes called "lightning crotch".
• Pelvic girdle pain: loosening of pelvic joints causes aching at the front of the pelvis.

When it may be preterm labor

Before 37 weeks, call your doctor or midwife if you have:

• pelvic or vaginal pressure that feels like the baby is pushing down
• regular tightening or contractions, 4 or more in an hour
• menstrual-like cramps or a dull low backache
• a change in discharge: watery, mucus-like or bloody
• fluid leaking from the vagina

After 37 weeks

Increasing pressure, regular contractions and a "show" of mucus may mean labor is starting.

How the cause is diagnosed

A doctor or gynecologist will ask about your symptoms, childbirth history, bladder and bowel habits, and periods. A pelvic exam, often while you bear down or stand, shows whether there is prolapse and which part is affected. Other tests may include:

• urine test for infection
• bladder scan to measure urine left after emptying
• pelvic ultrasound for fibroids, cysts or other masses
• in pregnancy, a cervical exam or ultrasound to measure cervical length, and a fetal fibronectin test

Treatment

Pelvic floor muscle training

For mild to moderate prolapse, supervised pelvic floor exercises for at least 16 weeks improve symptoms and are first-line under NICE guidance. A pelvic floor physical therapist ensures you contract the right muscles.

Pessary

A pessary is a soft silicone device placed in the vagina to support the prolapsed organs. It is fitted by a clinician, comes in many shapes, and suits people who prefer to avoid surgery or plan more pregnancies.

Lifestyle changes

• Treat constipation with fiber, fluids and not straining
• Lose weight if overweight
• Avoid heavy lifting, and lift with the pelvic floor engaged
• Stop smoking to reduce chronic cough
• Vaginal estrogen after menopause can improve tissue health and pessary comfort

Surgery

Surgery to repair the vaginal walls, support the uterus or vault, or remove the uterus is considered when symptoms are bothersome despite other treatment. Recurrence is possible.

Other causes

Fibroids may be treated with medicines, procedures or surgery. Pelvic floor tension responds to physical therapy focused on relaxation. Infections are treated with the appropriate medicine.

In pregnancy

Rest on your side, use a support belt, and avoid standing for long periods. Preterm labor needs medical assessment and sometimes treatment to delay birth or prepare the baby's lungs.

Frequently asked questions

What causes pressure in the vagina when not pregnant?

The most common cause is pelvic organ prolapse, where weakened pelvic floor support lets the bladder, uterus or rectum drop. Fibroids, constipation, pelvic floor muscle tension, cysts and infections can also cause pressure.

Is vaginal pressure normal in pregnancy?

Mild pressure is common, especially in the third trimester as the baby descends. Before 37 weeks, pressure that comes and goes regularly or comes with cramps, back ache or a change in discharge may be preterm labor and needs prompt assessment.

What does a prolapse feel like?

People describe a heavy, dragging feeling in the vagina, a sensation of something falling out, or a bulge at the vaginal opening. It is usually worse after standing or lifting and better lying down. Bladder or bowel symptoms are common.

Can pelvic floor exercises fix vaginal pressure?

They often improve symptoms of mild to moderate prolapse and pelvic floor weakness, especially when done correctly for at least 3 to 4 months. A pelvic floor physical therapist can help. Severe prolapse may need a pessary or surgery.

When should I see a doctor about vaginal pressure?

See a doctor if you feel or see a bulge, have pressure with bladder or bowel problems, pain during sex, or heavy periods. In pregnancy, contact your provider right away for pressure before 37 weeks with contractions, cramps, back ache or discharge changes.