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The uterus and the bladder are held in their normal positions just above the inside end of the vagina by a "hammock" made up of supportive muscles and ligaments. Wear and tear on these supportive structures in the pelvis can allow the bottom of the uterus, the floor of the bladder or both to sag through the muscle and ligament layers. When this occurs, the uterus or bladder can create a bulge into the vagina. In severe cases, it is possible for the sagging uterus or bladder to work its way down far enough that the bulge can appear at the vagina's opening or even protrude from the opening. When the uterus sags downward, it is called uterine prolapse.