Bulge or Heaviness in the Vagina? Cystocele vs Rectocele vs Uterine Prolapse

"Prolapse" is the word most women hear, but it is really an umbrella term for three different things that can come down into the vaginal space, and they do not all behave the same way. A cystocele is the bladder bulging into the front vaginal wall. A rectocele is the rectum bulging into the back wall. Uterine prolapse is the womb itself descending lower than it should. Many women arrive at THE FIT CLINIC able to describe exactly how the heaviness feels but unsure which of the three it is, which is completely normal — from the inside, a bulge is a bulge.

The distinction matters because the symptoms that go with each are different, even though the underlying cause — weakened pelvic floor support, most often from childbirth, chronic straining, or the tissue changes of menopause — is shared. A cystocele more often brings a sense of incomplete bladder emptying or a bulge felt low and to the front. A rectocele is more associated with difficulty passing a bowel motion fully, sometimes needing to change position or apply gentle pressure to finish. Uterine prolapse is felt more centrally and, in more advanced cases, as pressure that increases through the day. It is also common to have more than one at once, since the same weakened support structures often affect them together.

Assessment is a physical examination, not guesswork from a description. At THE FIT CLINIC this means checking each compartment individually — front wall, back wall, and the cervix or vaginal vault — while you bear down, since a prolapse that is barely noticeable lying down often becomes obvious standing or straining. This is what tells us which structure is involved and how far it has descended, which is graded on a standard scale rather than described loosely as "mild" or "severe."

Management follows from what is actually found. Pelvic floor muscle training helps many mild to moderate cases regardless of which compartment is involved, because it strengthens the shared support structure. A vaginal pessary — a removable support device fitted to your anatomy — is a well-established non-surgical option for cystocele, rectocele and uterine prolapse alike. Where symptoms are more advanced or do not respond to these measures, surgical options exist and differ depending on which compartment needs repair, which is why an accurate diagnosis has to come first.

If what you are noticing is a new or changing bulge, painful straining, or bladder or bowel symptoms alongside the heaviness, a pelvic floor examination will tell you which of the three is involved and what your realistic options are — rather than treating "prolapse" as one single thing to guess at.

THE FIT CLINIC is on the 8th Floor of EM Tower, EMSPHERE, 628 Sukhumvit Road, a short walk from BTS Phrom Phong, open daily 10:00 to 19:00. No referral is needed; book on LINE @thefitbkk, +66 92 294 6555, or bkkgyne@gmail.com. Consultations are in English or Thai, and an interpreter in another language can be arranged with advance notice if you ask on LINE when booking.