Clinical Overview Pelvic Organ Prolapse (POP) is the descent of one or more pelvic organs—bladder (cystocele), uterus (uterine prolapse), or rectum (rectocele)—into or through the vaginal canal due to loss of support from the pelvic floor muscles, ligaments, and fascia. This is typically a result of levator ani avulsion, connective tissue laxity, or neuropathic injury following childbirth, chronic strain, or aging. Symptoms include: Sensation of vaginal “heaviness” or bulging Visible prolapse at or near the introitus Urinary hesitancy, urgency, or incomplete voiding Constipation or rectal pressure Dyspareunia or reduced sexual sensation Prevalence and Impact POP affects approximately 50% of parous women, although not all cases are symptomatic (Hagen & Stark, 2011). Its impact on quality of life, sexual function, and mental health can be significant—even in early stages. Evidence-Based First-Line Management: Physiotherapy Recent guidelines and systematic reviews recommend pelvic floor muscle training (PFMT) as the first-line conservative management for Stage I–III POP (NICE, ICS). The POPPY trial (Hagen et al., 2014), a multicenter RCT, demonstrated that individualized PFMT over 16 weeks led to: Clinically significant improvement in prolapse symptoms (measured by POP-SS) Improvement in POP-Q staging Reduction in prolapse severity on examination Better sexual function scores compared to control No reported adverse effects Physiotherapy Intervention Includes: Digital pelvic floor assessment (Oxford scale, Modified Brink, or EMG) Supervised, progressive PFMT tailored to POP-Q findings Symptom management education: posture, breath mechanics, bowel/bladder habits Intra-abdominal pressure control through breathwork and load management Behavioral coaching for voiding, defecation, and sexual activity Collaborative pessary fitting (as per gynecologist referral) Ideal Referral Candidates: POP Stage I–III (non-surgical candidates or surgery-averse) Postpartum patients with vaginal laxity or pelvic heaviness Patients with concurrent stress or mixed urinary incontinence Patients requiring pre- or post-operative pelvic floor conditioning Those seeking prevention of POP recurrence following prior treatment Multidisciplinary Collaboration Pelvic floor physiotherapists complement gynecologic and urogynecologic care through: Preventing progression in early-stage prolapse Enhancing surgical outcomes when used pre- or post-operatively Reducing surgical burden in healthcare systems Educating patients on long-term pelvic health maintenance Conclusion High-quality RCTs support pelvic floor physiotherapy as an effective, low-risk, first-line treatment for women with symptomatic POP. Early intervention can delay or eliminate the need for surgical correction in many cases, and it significantly improves functional outcomes and quality of life. Prompt referral for PFMT should be considered standard care for women with mild to moderate prolapse. References Hagen, S., Stark, D. (2011). Conservative management of pelvic organ prolapse in women: A systematic review of randomized controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology, 118(8), 868–878. https://doi.org/10.1111/j.1471-0528.2011.02955.x Hagen, S., Stark, D., Glazener, C. M., Dickson, S., Barry, S. J., & Logan, J. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): A multicentre randomised controlled trial. The Lancet, 383(9919), 796–806. https://doi.org/10.1016/S0140-6736(13)61977-7
Pelvic Organ Prolapse: What It Is and How Physiotherapy Can Help You Feel Strong and Supported Again
Have you ever felt a heaviness or bulge in your vaginal area, especially after standing for a long time or lifting something heavy? You may be experiencing pelvic organ prolapse (POP) — a condition that happens when the organs in your pelvis (like the bladder, uterus, or rectum) drop or press against the vaginal wall. It can feel scary or uncomfortable, but the good news is: you are not alone, and you can get better without surgery. What Is Pelvic Organ Prolapse? Pelvic organ prolapse occurs when the muscles and connective tissues that support your pelvic organs become stretched or weakened — often due to childbirth, aging, heavy lifting, or hormonal changes during menopause. Organs such as the bladder, uterus, or rectum can slip down and bulge into the vaginal wall. You might feel: A feeling of “heaviness” or “falling out” A visible bulge near the vaginal opening Pressure or discomfort in the pelvic area Difficulty fully emptying your bladder or bowels Pain or decreased sensation during intimacy How Common Is It? POP is more common than people realize. According to large studies, up to 50% of women who have given birth vaginally will experience some form of prolapse, though not all feel symptoms (Hagen & Stark, 2011). Do I Need Surgery Right Away? Not at all. In fact, pelvic floor physiotherapy is now the first-line treatment for mild to moderate prolapse. A high-quality randomized controlled trial (Hagen et al., 2014) found that women who did 12 weeks of pelvic floor exercises had significantly improved symptoms and reduced prolapse severity. What Does Physiotherapy Involve? As a pelvic health physiotherapist, I guide women through a personalized, evidence-based plan that includes: Pelvic floor muscle training (PFMT) to strengthen internal support structures Education about safe lifting, posture, and breathing techniques Bladder and bowel management strategies Supportive devices like pessaries (if referred by a doctor) Guidance on returning to exercise safely How Long Before I See Results? Many women begin to notice improvement in symptoms like heaviness, pressure, and urinary leakage within 6–12 weeks, especially when exercises are done consistently. You Are Not Broken — You Just Need Support Pelvic organ prolapse is a physical condition — not a failure. With the right exercises, education, and support, your body has the power to heal and adapt. Takeaway Pelvic organ prolapse is common — but treatable. With guidance from a trained pelvic floor physiotherapist, you can feel stronger, more confident, and regain control of your daily life — naturally and without surgery. References Hagen, S., Stark, D. (2011). Conservative management of pelvic organ prolapse in women: A systematic review of randomized controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology, 118(8), 868–878. https://doi.org/10.1111/j.1471-0528.2011.02955.x Hagen, S., Stark, D., Glazener, C. M., Dickson, S., Barry, S. J., & Logan, J. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): A multicentre randomised controlled trial. The Lancet, 383(9919), 796–806. https://doi.org/10.1016/S0140-6736(13)61977-7