OBJECTIVE: To estimate the prevalence of and identify risk factors associated with symptomatic pelvic organ prolapse and level of distress in racially diverse women aged older than 40 years. METHODS: The Reproductive Risks for Incontinence Study at Kaiser is a population-based study of 2,001 randomly selected women. Symptomatic prolapse was determined by self-report of a feeling of bulge, pressure, or protrusion or a visible bulge from the vagina. Risk factors were assessed by self-report, interview, physical examination, and record review. Distress was assessed by self-report. Multivariable logistic regression analysis was used to identify independent risk factors. RESULTS: Symptomatic prolapse was reported by 118 (6%) women. Almost 50% of these women reported moderate or great distress, and 35% reported that the symptoms affected at least one physical, social or sexual activity. In multivariable analysis, the risk of prolapse was significantly increased in women with one (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.1-7.2), two (OR 4.1, 95% CI 1.8-9.5), and three or more (OR 5.3, 95% CI 2.3-12.3) vaginal deliveries compared with nulliparous women. Irritable bowel syndrome, constipation, and self-reported fair or poor health status were strongly associated with prolapse, with ORs of 2.8 (95% CI 1.7-4.6), 2.5 (95% CI 1.7-3.7), and 2.3 (95% CI 1.1-4.9), respectively. African-American women were significantly less likely to report symptomatic prolapse compared with white women (OR 0.4, 95% CI 0.2-0.8). CONCLUSION: Symptomatic prolapse is less common among African-American women and more common among women with a prior vaginal delivery, poor health status, constipation, or irritable bowel syndrome. Nearly one half of women with symptomatic prolapse are substantially bothered by their symptoms.