Pelvic Organ Prolapse: What Is It and How Can Pelvic Physiotherapy Help?

By Mandy Roscher, Physiotherapist and Director, Brisbane Pelvic Physiotherapy

If you’ve recently been diagnosed with pelvic organ prolapse, or you’re experiencing symptoms such as heaviness, pressure, or a vaginal bulge, you’re not alone.

Pelvic organ prolapse is incredibly common, yet many women feel embarrassed, frightened, or unsure where to turn for help. One of the most important things to know is that a prolapse diagnosis does not mean your active life is over.

Many women successfully manage prolapse and continue exercising, working, lifting children, travelling, and doing the activities they love.

The first step is understanding what prolapse is and what options are available.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when one or more of the pelvic organs move downward and create a bulge within the vagina.

The organs that may be involved include:

• The bladder

• The uterus

• The rectum

Pelvic organ prolapse occurs through the vagina and is different from a rectal prolapse, which occurs through the rectum.

Many women first notice symptoms as:

• A feeling of heaviness or dragging

• A sensation that something is “falling down”

• A visible or palpable bulge in the vagina

• Increased pressure after standing for long periods

• Symptoms that worsen throughout the day

• Bladder or bowel difficulties

  
  

Who Is At Risk Of Developing Prolapse?

While prolapse can occur in women of any age, certain factors increase the likelihood of developing pelvic organ prolapse.

These include:

Vaginal Birth

Pregnancy and childbirth place significant demands on the pelvic floor muscles and connective tissues. Assisted deliveries involving forceps or vacuum extraction may increase the risk further.

Menopause

Oestrogen plays an important role in maintaining tissue health. After menopause, changes in tissue quality can affect the support structures of the pelvis.

Hypermobility and Connective Tissue Disorders

Women with hypermobility or connective tissue disorders such as Ehlers-Danlos Syndrome often have naturally more flexible connective tissues. This may increase the likelihood of developing prolapse symptoms.

Genetics

Some people simply inherit stronger or weaker connective tissue than others. This is often why prolapse can run in families.

Understanding Prolapse: The Ball, Net and Trampoline Analogy

One of the ways I explain prolapse to patients is by using a simple analogy.

Imagine a ball suspended inside a room.

The ball represents your pelvic organs.

There are three support systems helping to keep that ball in place.

The Net

The most important support system is a strong net underneath the ball.

This net represents the fascia and connective tissue that support the pelvic organs.

Fascia is a specialised connective tissue that acts like an internal support network throughout the body.

The Ropes

The ball is also attached to the ceiling by ropes.

These ropes represent the ligaments that help support and suspend the pelvic organs.

The Trampoline

Underneath the net is a trampoline.

The trampoline represents the pelvic floor muscles.

The pelvic floor provides dynamic support. It responds when you move, cough, lift, run, jump and exercise.

When all three systems work together, the pelvic organs remain well supported.

Why Does Prolapse Occur?

In many cases, prolapse develops when the connective tissue support system becomes stretched, weakened, or damaged.

Using our analogy, imagine that the net has become loose or developed a hole.

The ropes and trampoline now have to work much harder to provide support.

This is why many women with prolapse also have pelvic floor muscles that feel tight, overworked or fatigued.

The issue is not always simply muscle weakness.

Often the support system as a whole needs to be considered.

Different Types of Prolapse

The vagina can be thought of as a soft tube or “sock” that sits between the bladder and the rectum.

Anterior Vaginal Wall Prolapse (Cystocele)

The bladder sits in front of the vagina.

When the front vaginal wall loses support and descends, this is often associated with a cystocele.

Symptoms may include:

• A vaginal bulge

• Bladder emptying difficulties

• Increased urinary frequency

• A sensation of pressure

  
  

Posterior Vaginal Wall Prolapse (Rectocele)

The rectum sits behind the vagina.

When the back vaginal wall loses support, this may be associated with a rectocele.

Symptoms may include:

• Difficulty emptying the bowel

• A sensation of incomplete emptying

• Vaginal pressure

• The need to support the vaginal wall during bowel motions

  
  

Uterine Prolapse

This occurs when the uterus descends lower into the vagina.

Symptoms vary considerably depending on the degree of prolapse and individual tissue support. An early symptom of uterine prolapse can be lower back pain and eventually there is normally a heavy, dragging feeling in the pelvis.

How Is Pelvic Organ Prolapse Assessed?

At Brisbane Pelvic Physiotherapy, we believe prolapse assessment should involve more than simply identifying what is bulging.

We want to understand why it is happening and how your body is functioning as a whole.

A comprehensive assessment may include:

• Detailed medical history

• Discussion of symptoms

• Pelvic floor muscle assessment

• Internal vaginal examination

• Functional pelvic floor movement assessment

• Pressure management

• Bladder and bowel screening

One of the unique aspects of our assessment process is evaluating how you manage pressure during movement.

This helps us understand how forces are being transferred through your pelvis during daily life.

How Can Pelvic Physiotherapy Help?

Every prolapse is different, which means every treatment plan should be different.

There is no single prolapse protocol that suits everyone.

Treatment may include:

Pelvic Floor Rehabilitation

For some women, strengthening is appropriate.

For others, relaxation and improved coordination are more important.

A pelvic floor that is constantly gripping and working overtime is not necessarily functioning well.

Our goal is to create a responsive and dynamic support system.

Pressure Management

Many women unknowingly create excessive pressure through the abdomen during lifting, exercise and daily activities.

Learning how to better manage pressure can significantly reduce symptoms.

Bowel Management

Addressing constipation and reducing straining is often an important part of prolapse management.

Exercise Modification

The goal is rarely to stop exercising.

Instead, we help modify activities so that you can remain active while minimising symptom aggravation.

Pessary Fitting

A pessary is a removable device inserted into the vagina to provide support.

For suitable candidates, pessaries can be highly effective and allow women to remain active while managing symptoms.

Do All Prolapses Need Surgery?

No.

Many women successfully manage prolapse without surgery.

Management options range from education and monitoring through to pelvic physiotherapy, pessaries and lifestyle modifications.

For some women, surgery may eventually be appropriate, but surgery is not the only option and is certainly not the first step for everyone.

Living Well With Prolapse

Perhaps the most important message is this:

A prolapse diagnosis does not define you.

Many women continue to enjoy exercise, sport, work, travel and family life while successfully managing their symptoms.

The key is understanding your individual presentation and developing a personalised plan that addresses both the support structures below and the pressure systems above.

Need Help With Prolapse?

If you are experiencing symptoms of pelvic organ prolapse, our team at Brisbane Pelvic Physiotherapy can help.

We provide comprehensive prolapse assessments, pelvic floor rehabilitation, functional movement assessment, pessary management and personalised treatment plans designed to help you return to the activities that matter most to you.

Book an appointment today to learn more about your options and take the first step towards managing your prolapse with confidence.