Pelvic Organ Prolapse: Understanding the Condition and How Pelvic Floor Therapy and Pessaries Can Help

Carly Gossard
6 days ago
4 min read

Pelvic organ prolapse (POP) is a common condition that affects millions of individuals, primarily those assigned female at birth, especially during the perimenopausal and postnatal years. While it can be unsettling to receive a diagnosis of prolapse, it’s important to know that non-surgical options, including pelvic floor physical therapy and pessary use, are highly effective for managing Grade 1–3 prolapse.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when one or more of the pelvic organs such as the bladder, uterus, or rectum descend from their normal position into the vaginal canal due to weakness or dysfunction in the pelvic floor muscles and supportive connective tissues.

Types of Prolapse Include:

Cystocele (anterior wall) – bladder prolapse
Rectocele (posterior wall) – rectal wall prolapse
Uterine prolapse – uterus descends into the vagina
Enterocele – small bowel descends into the vaginal canal
Vaginal vault prolapse – post-hysterectomy support failure

Symptoms May Include:

Sensation of vaginal bulging or “heaviness” (many describe it as a “full tampon hanging out”)
Pressure in the pelvis that worsens with activity
Difficulty with bowel or bladder emptying
Low back discomfort
Pain or discomfort with intercourse

The severity of POP is graded from Grade 1 (mild) to Grade 4 (complete eversion of the vaginal walls) using the Pelvic Organ Prolapse Quantification System (POP-Q).

Non-Surgical Management for Prolapse

For individuals with mild to moderate prolapse (Grades 1–3), conservative treatment is considered first-line therapy, particularly for those who are symptomatic but wish to avoid or delay surgery. Two of the most effective non-surgical approaches are pelvic floor physical therapy and pessary use.

Pelvic Floor Physical Therapy for Prolapse

Pelvic floor physical therapy (PFPT) plays a critical role in managing POP by addressing the muscular and functional deficits contributing to organ descent.

Goals of PFPT in Prolapse Include:

Strengthening the pelvic floor muscles (PFMs) to improve support for pelvic organs
Optimizing muscle coordination during intra-abdominal pressure activities (lifting, coughing, toileting)
Improving awareness and control of breath, core and pelvic muscle function
Educating on lifestyle modifications (e.g., bowel mechanics, postural alignment, and pressure management)

A 2013 Cochrane Review concluded that pelvic floor muscle training (PFMT) significantly improves symptoms and anatomical outcomes in women with POP, especially when supervised by a trained pelvic floor therapist.

What Therapy Looks Like:

Internal pelvic floor muscle assessment to determine tone, strength and coordination
Guided pelvic floor, core and lower extremity strengthening exercises tailored to prolapse type
Breath and pressure management techniques (e.g., exhalation with exertion)
Functional training to support movement strategies during daily activities

Importantly, physical therapy is not “just Kegels”, it’s individualized, evidence-based, and often includes core integration, postural work, and education on load management.

Pessary Use for Prolapse Support

A pessary is a medical-grade, removable silicone device that is inserted into the vagina to help support the pelvic organs and reduce prolapse symptoms. Pessaries are especially effective for Grade 2–3 prolapse, and are often used alongside pelvic floor therapy for optimal results.

Benefits of Pessary Use:

Provides mechanical support to reduce vaginal bulging and pressure
Can significantly reduce symptoms during activity
Non-invasive and reversible
Appropriate for women of all ages, including those not ready for or avoiding surgery

Studies show that up to 92% of women report symptom improvement with pessary use, and those who use a pessary in conjunction with pelvic floor physical therapy report greater functional improvements than with either treatment alone.

Types of Pessaries:

Ring pessary (with or without support): common for mild to moderate uterine or bladder prolapse
Gellhorn or donut pessary: used for more advanced cases or where more support is needed

Pessary fitting and management should be performed by a trained clinician, such as a urogynecologist, nurse practitioner, or pelvic health therapist trained in pessary care.

Combining Therapy and Pessary Use

For many patients, a combined approach offers the greatest benefits:

PFPT builds strength and control to support long-term outcomes.
Pessary provides immediate relief and support during daily activities and exercise.
Together, they reduce symptoms, improve quality of life, and can delay or eliminate the need for surgery.

A 2021 study emphasized that combining pelvic floor therapy with pessary support increases adherence to conservative treatment and helps women maintain their preferred activity levels and independence.

Conclusion

Pelvic organ prolapse can be distressing, but it is manageable. For Grade 1–3 prolapse, pelvic floor physical therapy and pessary use are safe, effective, and empowering first-line treatments that can restore confidence, reduce symptoms, and improve function without surgery.

If you or a loved one is experiencing symptoms of prolapse, consult a pelvic floor therapist or urogynecologist. Early intervention can make a meaningful difference in outcomes and quality of life.

References:

Bump RC, et al. (1996). The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics and Gynecology, 175(1), 10–17. https://doi.org/10.1016/S0002-9378(96)70243-0
Hagen S, et al. (2013). Pelvic floor muscle training for women with pelvic organ prolapse. Cochrane Database of Systematic Reviews, Issue 5. https://doi.org/10.1002/14651858.CD007471.pub3
Lone F, Thakar R, Sultan AH, et al. (2012). A randomised controlled trial of supervised pelvic floor muscle training with and without vaginal pessary in women with symptomatic pelvic organ prolapse. International Urogynecology Journal, 23(6), 817–825. https://doi.org/10.1007/s00192-012-1693-2
Clemons JL, et al. (2004). Patient satisfaction with pessary use. American Journal of Obstetrics and Gynecology, 190(4), 1025–1029. https://doi.org/10.1016/j.ajog.2004.01.046
Jones KA, et al. (2021). Impact of combined pessary and pelvic floor therapy on symptom relief and quality of life in women with pelvic organ prolapse. Female Pelvic Medicine & Reconstructive Surgery, 27(2), e289–e294. https://doi.org/10.1097/SPV.0000000000000863