Pelvic Organ Prolapse
A prolapse diagnosis is frightening to hear and far more manageable than it sounds. Physiotherapy is first-line care for mild to moderate prolapse.
What is pelvic organ prolapse?
Pelvic organ prolapse happens when the support around the bladder, uterus, bowel or vaginal walls becomes lax, allowing one of them to descend into the vaginal space. It's graded by how far the descent goes, though symptoms don't always match the grade — plenty of women with a small prolapse feel it keenly, and some with a larger one barely notice.
It's very common, particularly after vaginal birth and around menopause. Importantly, it is not a sign that your body has failed, and for mild to moderate prolapse, conservative treatment is the recommended starting point.
Common symptoms
- Heaviness or dragging in the vagina, worse by evening
- A visible or palpable bulge
- A feeling of 'something coming down' with lifting or standing
- Difficulty emptying the bladder or bowel fully
- Needing to change position to empty properly
- Reduced sensation, discomfort or pain with intercourse or penetration
- Low back or pelvic ache
What causes it
- Vaginal birth, particularly with instrumental delivery
- Menopause and reduced tissue elasticity
- Chronic constipation and straining
- Persistent coughing
- Repeated heavy lifting without pelvic floor support
- Genetic differences in connective tissue
How physiotherapy helps
Research shows that supervised pelvic floor muscle training reduces prolapse symptoms and can improve prolapse stage in mild to moderate cases. It won't reverse severe prolapse, but it very often makes daily life comfortable again and may avoid or delay surgery.
Equally important is load management: learning how to lift, exercise and manage bowel habits without repeatedly pushing down on the support structures. Most women can keep exercising — including strength training — with the right technique.
- Prolapse-specific pelvic floor strengthening
- Breathing and intra-abdominal pressure management
- Bowel habit and constipation management
- Lifting, exercise and impact modification
- Support pessary discussion and referral where indicated
- Pre- and post-operative rehabilitation if surgery is chosen
When to seek treatment
- Any new sensation of heaviness or bulge
- Symptoms that worsen through the day or with exercise
- Difficulty emptying bladder or bowel
- Before starting or returning to heavy lifting
- After a prolapse diagnosis, before deciding on surgery
Frequently asked questions
Let's get you moving again
If this sounds like what you're dealing with, an assessment is the quickest way to understand it properly. Pelvic Organ Prolapse responds well to the right plan.