Pelvic Organ Prolapse

There are many physiotherapists, doctors, athletes and fitness coaches living with prolapse. Many continue to exercise or play sport, even at competition level.

Prolapse can be mild to severe in its stage. The bladder may bulge through the front wall of the vagina, or the rectum may bulge through the back vaginal wall, and even the uterus or top of the cervix  may drop down into the vagina or birth canal. More than one organ (bladder, uterus, bowel) may also bulge into the vagina. Once the organ is prolapsing, it is clear that you don’t have the strength to hold up your organs.  Your ligaments in your pelvis will take the load for a while but eventually they will stretch beyond repair and prolapse will continue to increase unless proper treatment is undertaken. It will not go away on it’s own!

The best cure for prolapse is prevention and physiotherapy. Prolapse can also occur in women who have had a C-section delivery. True, a vaginal birth puts you at higher risk but c-section mums are not without complete risk, especially as they approach menopause.

Symptoms can include but are not limited to:

  • An uncomfortable heaviness, loose or fullness sensation inside vagina or rectum
  • Dragging or a bearing down sensation
  • Difficulty peeing or pooping properly
  • Incontinence of bowel or bladder
  • Painful sex
  • Difficulty inserting a tampon, or tampons falling out
  • Feeling like something is in your vagina or something is “falling out” 😬
  • Back pain
  • If something doesn’t feel right down there, chances are it is prolapse.

If you experience any of these symptoms you must see a women’s health physiotherapist. Symptoms will not go away on their own and are likely to progress if left untreated. And if your kids are grown up a physio can help improve the health of your pelvic floor. Only under the direct care and therapy of a pelvic floor physio can you diagnose prolapse.

The online guidebook “Strategies for Exercising with POP” is here for you to be able to educate yourself on how to manage your prolapse as well as show you strategies to be able to remain active, whether that’s just being abble to lift up your kids, or competing in sport. A sedentary and inactive lifestyle increases not only the risk of the prolapse progressing but also increases the number 1 cause of death in the western world – cardiovascular disease.

There is so much information about what you can’t and shouldn’t do with POP, however there is not a great deal of information on what exercises you CAN do and HOW you do them. So, I’ll be addressing all that you can do and the strategies you need to manage your POP so you can continue exercising for life without the need for surgery!

Principles for Exercise with Prolapse

An internal exam with a Women’s health Physiotherapist will help you assess and diagnose the degree of your prolapse and strength, tone, relaxation and endurance of your pelvic floor muscles. A good WHP should also advise on an individual basis what YOU can and shouldn’t do (rather than fear mongering or advising generalised guidelines). Make sure you utilise these appointments to discuss your fears and concerns as well as your goals. Ask questions!

If you have recently been diagnosed, You may not be able to get off the floor without symptoms right now. If that is the case, then floor based exercises will be your starting point. If you can lift heavy weights, but you can’t run without symptoms, then working on the automatic function of your pelvic floor, as well as glute (your butt muscles) and leg strength will be your program to getting where you want to be – for example, you may want to return to running.

Remember, progress is not always linear, and it may be much slower than someone without POP. We may have days or weeks where we feel like things have regressed. Usually this is NOT the case, but just a fluctuation in hormones or tension, and does not always reflect the level of descent of the pelvic organ(s) that is prolapsed.

How do you begin exercising after POP diagnosis?

  1. Identify your Goals
  2. Master the Basics First!
  3. START at the beginning! To rebuild the foundation of your core and pelvic floor you must start with the foundation – Pelvic Floor isolation/activation/strengthening/endurance and relaxation (includes alignment, breathing and lifestyle adjustments)
  4. PF coordination with low impact, body weight based basic movements (preferably floor based with foundational breath.
  5. Progress to kneeling, standing, then basic movement patterns such as a squat, lunge, hinge, push, pull.
  6. Increase complexity, ROM and load.
  7. Finally add dynamic movements.
  8. Repeat process with dynamic piston breath.
  9. Awareness (but not obsessively) of downward pressure or bearing down or exacerbation of symptoms
  10. Stay below the symptom brink. The ultimate goals are to retrain the automatic function of your Pelvic floor, so that you don’t have to think about it every step of the day.


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