Pelvic organ prolapse can feel alarming — particularly when first noticed during pregnancy or after birth. Many women describe a sensation of heaviness, pressure or a bulge in the vagina and are unsure what it means or whether it will worsen over time.

The reassuring news is that prolapse is common, manageable and often significantly improved with the right support. Understanding what it is — and what it isn’t — can reduce fear and help guide appropriate treatment.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when one or more pelvic organs (such as the bladder, uterus or rectum) descend toward the vaginal walls due to changes in pelvic floor support.

There are different types of prolapse:

Anterior vaginal wall prolapse (cystocele) – bladder involvement
Posterior vaginal wall prolapse (rectocele) – rectal involvement
Uterine prolapse – descent of the uterus
Vaginal vault prolapse – after hysterectomy

Prolapse exists on a spectrum. Many women have mild prolapse without symptoms and may never require significant intervention.

Why Does Prolapse Happen?

Pregnancy and childbirth place considerable load on the pelvic floor. Contributing factors include:

Repeated or prolonged increases in intra-abdominal pressure
Vaginal delivery and tissue stretch
Instrumental birth
Genetic connective tissue differences
Chronic constipation or straining
Returning to high-impact activity before the body is ready

Importantly, prolapse is not simply the result of “weak muscles.” Tissue support, nerve input, coordination and load management all influence pelvic health.

What Are the Symptoms of Prolapse?

Symptoms vary and may include:

A sensation of vaginal heaviness or dragging
A visible or palpable bulge
Pelvic pressure that worsens toward the end of the day
Difficulty emptying the bladder or bowel
Needing to change position to fully empty
Discomfort during exercise

Symptoms often fluctuate depending on fatigue, hormonal changes and activity levels.

Is Prolapse Permanent?

This is one of the most common questions.

In the early postpartum period, prolapse symptoms are often influenced by:

Tissue healing
Hormonal changes
Fluid shifts
Muscle fatigue

Many women experience improvement over the first 6–12 months with appropriate rehabilitation and load management.

Even when anatomical support changes remain, symptoms can frequently be reduced to a level that allows full and active participation in life and exercise.

Prolapse does not automatically mean surgery is required.

Can You Exercise With Prolapse?

Yes — but it depends on the type of exercise, symptom response and pelvic floor capacity. Exercise is not inherently harmful. In fact, appropriate strength training and progressive loading can improve overall support and confidence.
However, some activities may temporarily increase symptoms if:
Load is increased too quickly
Impact is introduced before adequate strength and coordination are restored
Breath-holding or excessive straining occurs
High-impact activities such as running may be appropriate for some women with prolapse, but should be introduced gradually and based on individual assessment.
Exercise should be modified — not avoided — and progressed thoughtfully.

When to See a Women’s Health Physiotherapist. You may benefit from assessment if you:

Notice vaginal heaviness or bulging
Feel unsure about returning to exercise
Experience difficulty emptying bladder or bowel
Have persistent postpartum pelvic symptoms
Want guidance on long-term pelvic health

Assessment allows identification of contributing factors and development of a tailored plan that supports your goals — whether that includes lifting weights, running, or simply feeling comfortable day to day.

Book a Women's Health Consultation

Treatment Options for Pelvic Organ Prolapse

Management of pelvic organ prolapse is focused on improving symptoms, enhancing pelvic support, and empowering you to participate in the movement and lifestyle you value. Treatment is highly individualised — no two bodies, goals or symptom patterns are exactly the same.

Pelvic Floor Muscle Training (PFMT)

A cornerstone of conservative prolapse management involves targeted pelvic floor muscle training. A women’s health physiotherapist will assess:

whether muscles are weak, overactive, or poorly coordinated
how the pelvic floor responds to load
how muscle timing interacts with breath and movement

Training may include:

submaximal contractions focusing on coordination and timing
functional integration (e.g., during lifting, coughing, squatting)
graded strengthening coupled with relaxation

PFMT isn’t just “do more squeezes.” It’s tailored, progressive and focused on real-world movements.

Load Management and Pressure Control

Prolapse symptoms often become more noticeable with increased abdominal pressure. A WHP can teach strategies such as:

optimising breath mechanics
avoiding breath-holding or Valsalva during exertion
learning pressure buffering techniques during lifts, squats, coughs and transitions

By improving how pressure is distributed through the body, symptom flare-ups often reduce.

Down-Training Overactivity

Some women with prolapse also have tight or overactive pelvic floor muscles. In this case, treatment focuses on:

gentle tissue release
breathing practices
guided relaxation drills
habit retraining

This ensures the pelvic floor isn’t rigid or resistant when it needs to lengthen, such as during birthing or high-load activity.

Adjunct Strategies

Depending on symptom severity and individual factors, management may also include:

Core and hip strength training — to support load sharing
Postural and movement retraining — to optimise alignment
Functional integration — teaching pelvic floor coordination during daily tasks and exercise
Pessary use (in collaboration with a medical provider) — a mechanical support option for some women
Collaborative care — working with GP/obstetrician/urogynecologist when required

Physiotherapy often reduces symptom severity and supports confidence even when anatomical prolapse remains present.

Preventing Symptom Progression

While prolapse may not always be fully preventable, sensible strategies can reduce the likelihood of symptom progression and help support long-term pelvic health.

1. Optimise Muscle Function Before Symptoms Escalate

Even before symptoms begin, assessment and tailored guidance from a women’s health physio can help identify pelvic floor tension, muscle weakness and coordination issues.
Early intervention means less time in pain and often faster improvement.

2. Address Constipation & Straining

Chronic straining is one of the most common contributors to pelvic floor strain and symptom worsening. A physio will help you improve your toileting posture, avoid sustained bearing-down to reduce downward pressure on your pelvic tissues. You can also ready our blog on bowel habit optimisation to reduce straining.

3. Strategic Exercise Progression

Movement is medicine, but the way it’s introduced matters:

Start with physiotherapist-guided exercise
Progress strength gradually (not all at once)
Introduce impact slowly, based on your symptoms
Avoid breath-holding or maximal intensity when symptoms are provoked

Appropriate strength training can support pelvic and abdominal systems, reduce symptom flares and improve confidence.

4. Learn Functional Integration

Daily tasks such as lifting toddlers, pushing prams, squatting to pick up items or bending repeatedly can create cumulative pressure. A WHP teaches:

timing breath with movement
hip hinge vs squat patterns
task-specific strategies
positioning to reduce downward pressure

This helps you live actively without unintentionally worsening symptoms.

5. Postnatal Review

One of the biggest missed opportunities is early postpartum assessment. The initial 6–8 weeks after birth is a window:

pelvic tissues are healing
hormonal influences are shifting
load management is essential

A Women’s Health Physio can screen for:

ongoing incontinence
prolapse severity
coordination deficits
abdominal separation
readiness for running or impact returns

Early review often prevents small issues becoming long-term ones.

Living With Prolapse

When I first noticed symptoms of prolapse, I remember feeling devestated. The sensation of heaviness and the awareness that something felt different in my body was so confronting. My mind immediately went to worst-case scenarios — would it get worse? Could I have more babies? Would I have to stop exercising?

What I’ve learned — both personally and professionally — is that prolapse is far more common than we talk about. It does not mean your body is broken. Pregnancy and birth change the pelvic floor, and those changes exist on a spectrum. Early symptoms, especially in the postpartum months, can feel amplified while tissues are healing, hormones are fluctuating and sleep is scarce.

One of the most reassuring things I discovered is that prolapse symptoms are not fixed. They change. They respond to fatigue, load, stress and recovery. A heavy day does not mean permanent worsening. A flare-up does not mean failure. Understanding this helped me move from fear to perspective.

Over time, I realised that living with prolapse does not mean giving up movement. It means progressing thoughtfully, building strength gradually and learning how to work with my body rather than against it. My prolapse meant that I had to strengthen my core before adding on other movement and as a result I am now stronger than before I had babies.

Prolapse can feel isolating, but it shouldn’t be. Many women experience it, even if we don’t always say it out loud. Seeking support isn’t overreacting. Wanting to feel strong and capable isn’t unrealistic. With appropriate management, it is entirely possible to live an active, confident life — even with prolapse.

References:

Braekken IH, Majida M, Engh ME, Bo K (2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology 203: 170-177.

Dietz, HP (2015) Pelvic organ prolapse – a review. Volume 44, Issue 7, July 2015

Dietz HP (2008) The aetiology of prolapse. Int Urogynecol J,19:1323–29.

Gyhagen M, Bullarbo M, Nielsen TF, Milsom I (2013) Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. Br J Obstet Gynaecol;120:152–60.

Hagen S, Stark D (2011) Conservative prevention and management of pelvic organ prolapse in women (review). Cochrane Database of Systematic Reviews: 1-72.

Rogers and Fashokun (2016) Pelvic organ prolapse in women: epidemiology, risk factors, clinical manifestations, and management. 1-11.

Thompson, JA, O'Sullivan, PB, Briffa, KM, Neumann, P (2006) Assessment of voluntary pelvic floor muscle contraction in continent and incontinent women using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. Int Urogynecol J Pelvic Floor Dysfunction. 17(6):624-30.

Whiteside JL, Weber AM, Meyn L, Walters MD (2004) Risk factors for prolapse recurrence after vaginal repair. American Journal of Obstetrics and Gynecology. 191: 1533–1538.

Pelvic Organ Prolapse During and After Pregnancy