Pelvic Organ Prolapse: What You Need to Know & How Physiotherapy Can Help

Pelvic organ prolapse (POP) affects up to 50% of women who have given birth vaginally, though not all experience symptoms. It occurs when the pelvic organs (bladder, uterus, bowel) descend into the vaginal space due to weakening of the pelvic floor muscles and connective tissues. Symptoms may include a sensation of vaginal heaviness or bulge, pelvic discomfort, bladder or bowel changes, and sexual dysfunction.

While surgery is one treatment option, conservative management is recommended as the first line of care, especially for mild to moderate cases and for women who wish to avoid or delay surgery. At the heart of this conservative approach is physiotherapy—particularly pelvic floor muscle training (PFMT).

What Does the Evidence Say?

The National Institute for Health and Care Excellence (NICE) recommends offering supervised PFMT for at least 16 weeks as a first-line treatment for prolapse in women who have not previously had pelvic floor surgery (NICE NG123, 2019).

A Cochrane Review (Hagen & Stark, 2021) found that women with prolapse who undertook PFMT reported improved symptoms, better pelvic floor support, and reduced need for surgical intervention. These results are consistent across multiple studies and support the role of physiotherapy as an effective, non-invasive option.

In real-world clinical settings, women often report substantial improvements in their prolapse symptoms, especially when they follow an individualised program that combines PFMT with education on posture, bladder and bowel mechanics, breathing techniques, and lifestyle adaptations (Bo et al., 2017; Nygaard et al., 2020).

What Does Pelvic Health Physiotherapy Involve?

Physiotherapy for POP is much more than kegels. It includes:

• Thorough assessment of pelvic floor function, posture, and movement patterns.
• Individualised PFMT to restore strength, endurance, and coordination.
• Education on behaviour modifications that reduce intra-abdominal pressure (e.g., avoiding breath-holding, managing constipation).
• Supportive strategies, including the use of pessaries (in collaboration with medical providers) and external supports like support shorts or belts if appropriate.

Physiotherapists also play a crucial role in pregnancy and postpartum care, both of which are key risk periods for POP development. Early intervention can help manage symptoms safely during pregnancy and support tissue recovery postnatally.

Takeaway

If you're experiencing heaviness, pressure, or a bulging sensation, you are not alone—and help is available. Pelvic health physiotherapy offers safe, evidence-based management for pelvic organ prolapse with high levels of patient satisfaction and measurable results.

As a first-line treatment recommended by national guidelines, physiotherapy empowers women to take control of their pelvic health without surgery. Whether you're newly postpartum or navigating menopause, early intervention makes a difference.

References:

• NICE Guideline NG123: Urinary incontinence and pelvic organ prolapse in women: management (2019)
• Hagen S, Stark D. Pelvic floor muscle training for pelvic organ prolapse in women. Cochrane Database Syst Rev. 2021;5:CD012975.
• Bo K, Nygaard IE, Berghmans B. Evidence-based physical therapy for the pelvic floor. 2nd ed. Elsevier; 2017.
• Nygaard I, et al. Pelvic organ prolapse: epidemiology, risk factors, and pathophysiology. Obstet Gynecol Clin North Am. 2020;47(3):505–521.