Understanding Pelvic Organ Prolapse: How Physical Therapy Can Help

Pelvic organ prolapse (POP) is a common but often overlooked condition that affects many women, especially after childbirth, pelvic surgeries, or with age-related changes. While it can feel overwhelming, prolapse is highly treatable, and physical therapy is one of the most effective conservative treatment options available.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles and connective tissues that support the pelvic organs become weakened or stretched. This allows one or more organs to shift downward and press into the vaginal wall.

Women may experience:

• A feeling of heaviness or pressure in the pelvis

• A bulging sensation

• Difficulty with bowel or bladder function

• Lower back or pelvic discomfort

• Symptoms that worsen after standing, lifting, or at the end of the day

Many people don’t realize how common POP is, and even more don’t know that pelvic floor physical therapy can significantly reduce symptoms and help restore function.

Types of Pelvic Organ Prolapse

Understanding the type of prolapse can help guide proper treatment. The main types include:

1. Cystocele (Anterior Vaginal Wall Prolapse)

When the bladder drops and presses into the front wall of the vagina. Common symptoms include urinary urgency, frequency, or difficulty emptying the bladder.

2. Rectocele (Posterior Vaginal Wall Prolapse)

When the rectum bulges into the back wall of the vagina. This often causes difficulty with bowel movements or a sense of incomplete emptying.

3. Uterine Prolapse

When the uterus descends into the vaginal canal due to weakened pelvic support. Symptoms may include pelvic pressure, low back discomfort, or visible bulging.

4. Enterocele

When a loop of the small intestine drops into the vaginal canal. This may feel like pelvic heaviness that worsens with standing or straining.

5. Vaginal Vault Prolapse

Typically occurring after a hysterectomy, this is when the top of the vaginal canal loses support and begins to descend.

How Physical Therapy Helps Pelvic Organ Prolapse

Pelvic floor physical therapy is recommended as a first-line treatment for many types of prolapse, especially in mild to moderate cases. A pelvic floor therapist can help address symptoms, improve pelvic support, and prevent progression.

What Physical Therapy Can Do:

✔ Strengthen and Coordinate the Pelvic Floor Muscles

Many individuals with POP have pelvic floor weakness, but some have tightness and poor coordination, not just weakness. A therapist evaluates your specific presentation and tailors a program to your body.

✔ Improve Pressure Management

Prolapse often worsens when everyday activities, like lifting, coughing, or exercising, create too much downward pressure. PT teaches strategies to manage intra-abdominal pressure to protect the pelvic organs.

✔ Address Core Weakness and Postural Changes

Your deep abdominal muscles, diaphragm, and pelvic floor all work together. Strengthening and retraining these systems can reduce symptoms and improve support.

✔ Provide Education for Daily Activities

Learn how to:

• Lift safely

• Reduce strain with bowel movements

• Exercise without aggravating symptoms

• Modify daily activities to improve comfort and confidence

✔ Use Supportive Techniques

Your therapist may recommend:

• Pelvic support devices

• Breathing training

• Gentle manual therapy for tight or overactive muscles

• Targeted home exercises to build long-term strength and control

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The Bottom Line

Pelvic organ prolapse is common, and you do not have to live with the discomfort or limitations it creates. Physical therapy provides a gentle, non-invasive, and highly effective approach to managing symptoms, restoring function, and helping you feel confident in your daily activities.

If you're experiencing pelvic pressure, heaviness, or changes in bowel or bladder function, you’re not alone and help is available. Our pelvic floor physical therapists are here to guide you with personalized, one-on-one care.