Understanding Pelvic Organ Prolapse: Symptoms, Treatment, and When to See a Pelvic Floor Therapist

Hearing the words "pelvic organ prolapse" can feel overwhelming. Many people immediately worry that surgery is their only option or that they will have to stop doing the activities they enjoy. Fortunately, that is often not the case.

For many individuals with mild to moderate prolapse, pelvic floor physical therapy and, in some cases, a vaginal pessary can significantly reduce symptoms and improve quality of life without surgery.

Pelvic Organ Prolapse

Pelvic Organ Prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when the muscles and connective tissues that support the pelvic organs become stretched or weakened. As a result, one or more pelvic organs can shift downward and press into the vaginal canal.

Prolapse is common, especially after pregnancy and childbirth, during perimenopause and menopause, or following years of repetitive lifting or chronic increases in abdominal pressure.

Several different types of prolapse can occur, including:

• Cystocele, where the bladder bulges into the front wall of the vagina

• Rectocele, where the rectum presses into the back wall of the vagina

• Uterine prolapse, when the uterus descends into the vaginal canal

• Enterocele, where the small intestine pushes into the vaginal wall

• Vaginal vault prolapse, which may occur after a hysterectomy

What does pelvic organ prolapse feel like?

Not everyone with prolapse experiences symptoms, but when symptoms are present, they often include:

• A feeling of heaviness or pressure in the pelvis

• A sensation that something is bulging or falling out of the vagina

• Feeling like you're sitting on a tampon

• Difficulty emptying your bladder or bowels completely

• Low back or pelvic aching

• Discomfort during intercourse

Many people notice that symptoms become worse after prolonged standing, exercise, heavy lifting, or at the end of a busy day.

Pelvic organ prolapse is typically graded from Stage 1 through Stage 4 based on how far the pelvic organs have descended. Most people with Stage 1 through Stage 3 prolapse are excellent candidates for conservative treatment.

How can pelvic floor physical therapy help?

Pelvic floor physical therapy is considered one of the first treatments for symptomatic pelvic organ prolapse.

Although therapy cannot completely reverse every prolapse, research shows it can reduce symptoms, improve pelvic floor support, and help people return to daily activities with greater confidence.

Your treatment plan is designed specifically for you and may include:

• A comprehensive assessment of your pelvic floor muscles, breathing mechanics, posture, and movement patterns

• Pelvic floor muscle strengthening when appropriate

• Coordination training to help your pelvic floor respond during lifting, coughing, sneezing, and exercise

• Core and hip strengthening to improve overall support

• Breathing strategies to better manage pressure within the abdomen

• Education on bowel habits, lifting techniques, and daily movement patterns that reduce unnecessary strain on the pelvic floor

One of the biggest misconceptions is that treatment is simply doing Kegel exercises. In reality, successful treatment often involves much more than strengthening. Some people need to improve muscle coordination, while others benefit from learning how to relax muscles that are working too hard.

What is a pessary?

A pessary is a soft, removable silicone device that is placed inside the vagina to provide support for the pelvic organs. It helps reduce symptoms by supporting the vaginal walls and decreasing the feeling of pressure or bulging.

Pessaries are commonly recommended for people with Stage 2 or Stage 3 prolapse, although they can also be helpful in milder cases depending on symptoms and activity level.

Many people choose a pessary because it:

• Reduces pressure and vaginal bulging

• Makes walking, exercising, and standing more comfortable

• Offers a non-surgical treatment option

• Can be removed when desired

• Allows many people to remain active while managing prolapse

  
  

A urogynecologist or other trained healthcare provider will determine the appropriate size and style of pessary based on your anatomy and symptoms.

Why combine physical therapy and a pessary?

Pelvic floor therapy and pessary use often work well together because they address different aspects of prolapse.

A pessary provides immediate mechanical support, helping reduce symptoms throughout the day. Physical therapy focuses on improving muscle strength, coordination, breathing mechanics, and movement strategies to support your pelvic organs over the long term.

Many patients find that combining these treatments allows them to stay active, exercise more comfortably, and delay or even avoid surgery.

When should you see a pelvic floor therapist?

If you're experiencing vaginal heaviness, pressure, a bulging sensation, or difficulty with bladder or bowel function, it's worth scheduling an evaluation with a pelvic floor physical therapist. You don't need to wait until your symptoms become severe.

Early treatment can help manage symptoms, improve pelvic floor function, and give you the tools to confidently return to the activities you enjoy. Whether your goal is to exercise comfortably, care for your children, or simply feel more confident throughout the day, there are effective, non-surgical options available.

Pelvic organ prolapse is common, but you don't have to accept it as a normal part of life. With the right treatment plan, many people are able to successfully manage their symptoms and continue living active, fulfilling lives.

References

1. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics and Gynecology. 1996;175(1):10-17.

2. Hagen S, Stark D. Pelvic floor muscle training for pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. 2011;(12).

3. Lone F, Thakar R, Sultan AH, et al. A randomized controlled trial of supervised pelvic floor muscle training with and without vaginal pessary in women with symptomatic pelvic organ prolapse. International Urogynecology Journal. 2012;23(6):817-825.

4. Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Patient satisfaction with pessary use. American Journal of Obstetrics and Gynecology. 2004;190(4):1025-1029.

5. American Urogynecologic Society (AUGS). Patient Fact Sheet: Pelvic Organ Prolapse.

6. American College of Obstetricians and Gynecologists (ACOG). Pelvic Organ Prolapse Practice Bulletin.