Pelvic organ prolapse (POP) is a condition that affects many individuals, yet it is often underreported due to embarrassment or lack of awareness.

Prolapse occurs when one or more of the pelvic organs—such as the bladder, uterus, or rectum—descend from their usual position and push against the vaginal wall. While this condition can be distressing, pelvic health physiotherapy offers effective treatments that can improve symptoms and help individuals regain control over their pelvic health.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse is classified into different types, depending on which organ is affected. The most common forms include cystocele (bladder prolapse), rectocele (rectal prolapse), and uterine prolapse (uterus descending into the vaginal canal). POP can occur when the pelvic floor muscles, which provide support to the pelvic organs, become weakened or damaged, often due to pregnancy, childbirth, aging, or chronic pressure on the abdomen from factors like obesity or constipation.

The symptoms of prolapse can vary depending on the severity and type of prolapse, but they often include a feeling of heaviness or fullness in the pelvic area, urinary incontinence, difficulty with bowel movements, and a visible bulge in the vaginal canal. These symptoms can significantly impact an individual’s quality of life and emotional well-being.

Did you know over 60% of women in the UK have at least one symptom of poor pelvic health, and 53% did not seek help from a healthcare professional?

The Role of Pelvic Health Physiotherapy in Managing Prolapse

Pelvic health physiotherapy is a key component non-surgical treatment for prolapse. Based on the assessment and examination of the pelvic floor muscles, a tailored treatment plan will be created to help alleviate symptoms and prevent further progression of the prolapse.

  • Pelvic Floor Muscle Strengthening

One of the most effective treatments for POP is pelvic floor muscle strengthening. Strengthening these muscles can provide better support to the pelvic organs, reduce the downward pressure that causes prolapse and improve bladder and bowel control. Pelvic floor muscle strengthening often involves exercises like Kegel exercises, which involve contracting and relaxing the pelvic floor muscles. As a pelvic health physiotherapist, I can guide individuals on how to perform these exercises correctly and provide a structured progressive programme.

  • Pelvic Floor Muscle Retraining

Retraining techniques are used for women with muscle dysfunction or poor coordination of pelvic floor muscles. These techniques include relaxation and stretching exercises, in combination with strengthening exercises, to improve muscle function. If these muscles are poorly coordinated, they may fail to provide adequate support, contributing to the descent of the organs (prolapse).

  • Breathing Techniques

Breathing exercises, like diaphragmatic breathing, helps reduce intra-abdominal pressure. This can reduce the strain on the pelvic floor muscles and prevent further descent of the POP.

  • Electrical Stimulation

Electrical stimulation uses mild electrical impulses to stimulate muscle contractions and improve muscle strength, which is particularly useful in patients with weak pelvic floor muscles. You can get devices to use at home and I can provide an individualised programme.

  • Lifestyle Modifications and Education

We can work together on lifestyle modifications, aimed at reducing symptoms of POP. This includes:

  • Weight management: Excess weight can increase intra-abdominal pressure, contributing to prolapse. Reducing weight can ease symptoms.
  • Avoidance of constipation and straining: Education on strategies to prevent constipation and good bowel habits is key as this can have a significant impact on prolapse symptoms. Read more on constipation here – Constipation Unclogged blog
  • Bladder and bowel training: I can guide you on proper bladder habits to help manage overactive bladder symptoms, which in turn can affect POP.

 

  • Pessaries

A pessary is a removable device, that comes in various shapes and sizes, inserted into the vagina to support the pelvic organs that have descended. It is effective in managing symptoms for those with mild to moderate prolapse or those who wish to manage their prolapse conservatively.

They are generally inserted by a trained healthcare professional, and you will have regular follow-ups to ensure the pessary is fitted correctly and remains comfortable.

While pessaries provide a good alternative to surgery, they do not address the underlying pelvic floor dysfunction. For effective treatment, a combination of pessary use, pelvic floor muscle training and education should be used.

  • Manual Therapy and Soft Tissue Techniques

Manual therapy techniques, including pelvic floor mobilisation, myofascial release, and soft tissue techniques, may be used to improve muscle tightness, release trigger points, and reduce pain associated with prolapse.

 

Pelvic organ prolapse can be a challenging condition, but with the right interventions, it is possible to manage symptoms and improve quality of life.

If you are experiencing symptoms of prolapse, consulting with our specialist pelvic health physiotherapist could be the first step toward reclaiming your pelvic health and well-being.

If you or anyone you know, would like to have a Women’s Health Physiotherapy assessment with Evie or Anna at Dorking  or Leatherhead, book online here or contact us here.

Blog post guest written by Evie Spreadbury, Women’s Health Specialist Physiotherapist, member of Pelvic, Obstetric & Gynacological Physiotherapists (POGP),  Dorking, & Leatherhead Clinics.

Evie Spreadbury

References

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Bø, K., & Sherburn, M. (2010). Evaluation of female pelvic-floor muscle function and strength. Physical Therapy, 90(3), 377-387. https://doi.org/10.2522/ptj.20090188

Brennan, S. (2020). Pelvic Health Physiotherapy for Pelvic Organ Prolapse: A Comprehensive Approach. Physiotherapy Theory and Practice, 36(6), 650-659. https://doi.org/10.1080/09593985.2020.1800154

Ciccone, M. (2017). Pessary Use in Pelvic Organ Prolapse: Clinical Considerations. Journal of Women’s Health Physical Therapy, 41(3), 200-206. https://doi.org/10.1097/JPT.0000000000000105

Dumoulin, C., & Hay-Smith, E. J. C. (2010). Pelvic floor muscle training for urinary incontinence in women. Cochrane Database of Systematic Reviews, 1, CD001407. https://doi.org/10.1002/14651858.CD001407.pub3

Dumoulin, C., Hay-Smith, E., & Bradley, C. (2018). A Systematic Review of Pessary Use in Pelvic Organ Prolapse. Neurourology and Urodynamics, 37(4), 1123-1133. https://doi.org/10.1002/nau.23482

Glazener, C. M., & Dietz, H. P. (2015). Pelvic organ prolapse and its management. Obstetrics and Gynecology Clinics of North America, 42(4), 553-570. https://doi.org/10.1016/j.ogc.2015.07.003

Hagen, S., & Stark, D. (2011). Pelvic floor muscle training for prevention and treatment of urinary incontinence in women. Cochrane Database of Systematic Reviews, 12, CD001407. https://doi.org/10.1002/14651858.CD001407.pub4

Milsom, I., & Gyhagen, M. (2017). The prevalence of pelvic organ prolapse and female urinary incontinence. Current Opinion in Urology, 27(4), 372-379. https://doi.org/10.1097/MOU.0000000000000382

Shafik, A., El-Sherbiny, M., & Shafik, I. (2000). The Role of Pelvic Floor Muscles in Pelvic Organ Prolapse. International Urogynecology Journal, 11(4), 196-200. https://doi.org/10.1007/s001920070004