How Pelvic Health Physiotherapy can help your Pelvic Organ Prolapse

Pelvic Organ Prolapse

Do you feel something coming out of your vagina?

Do you feel pressure on your pelvic region that gets worse with standing but better with lying?

A pelvic organ prolapse is a functional disorder that is described as:

  • a bulge at or near the vaginal opening
  • pelvic pressure
  • changes in bowel movements
  • difficulty emptying the bladder

50% of people who have birthed children have a prolapse. The incidence increases with age.

What causes a prolapse?

Well, the bladder, uterus and rectum sit VERY close together. And, the support base is the pelvic floor.

The pelvic floor muscles support organs against gravity and any increases in intra-abdominal pressure (like coughing), and the vaginal and rectal walls.

Take this as an example:

Imagine carrying a baby for 9 months. As the baby grows, there is increasing pressure on the pelvic floor. Ligaments can stretch over time and if the pelvic floor is not in good health, it may not support your organs very well. Then, you push hard during delivery and you strain, applying more pressure on the pelvic floor and potentially damage it. Out comes the baby (congrats!) but the pelvic floor weakens (dang!) and it cannot act as a good support base anymore.

So, pretty much, things inside your body start to slowly move down.

Other causes of prolapse:

  • Chronic coughing
  • Chronic constipation and straining on the toilet
  • Constant heavy lifting


  • The bulge that you feel at or near the vagina is not the actual bladder and/or rectum. The bulge is the vaginal wall, which is being pushed into the vagina by the bladder or rectum.

So now what?

Go get an internal pelvic examination for a thorough assessment!

A pelvic health physiotherapist can provide an internal pelvic examination to determine the state of your pelvic floor muscles and if you have a prolapse and the grade of the prolapse (degree of protrusion/bulge).


  • There are many different kinds of prolapses.
  • The pelvic health physiotherapist can touch the protrusion and determine what kind of prolapse you have (bladder, uterus and/or rectum).

Image from London Sciences Health Centre

 How can Pelvic Health Physiotherapy help?

First of all, pelvic health physiotherapy is conservative management – NOT surgery. Consider trying non-surgical options prior to going under the knife. And research shows that pelvic floor muscle training works!

Supervised Pelvic Floor Muscle Training is effective and cost-effective in reducing prolapse symptoms.

Supervised Pelvic Floor Muscle Training should be offered as a first-line management to all people with a prolapse.

The GREAT NEWS: With approximately 2 months of hardcore Pelvic Floor Muscle Training, your symptoms can improve:

  • less pressure in your pelvic region
  • less leakage of urine
  • less bowel symptoms like constipation
  • and improve the degree of protrusion!

The TOUGH NEWS: If you don’t use it, you lose it. The pelvic floor exercises need to be maintained in strength in order to sustain the benefits of training. In some cases, surgery may be necessary.


  • Have you heard about a pessary? It is a plastic or silicone device that is temporarily or permanently inserted into the vagina (or rectum). A pessary provides extra support to reduce the protrusion of the bladder, uterus or rectum into the vaginal wall.
  • Pessaries can be fitted by trained Pelvic health Physiotherapists, Registered Nurse Practitioners and Gynecologists.

What are the Dos and Don’ts of Prolapse?If you have a prolapse, here are some tips to consider:

Do’s of Prolapse:

  • Relief position – Lie down on your back and place your calves on a stool or chair to relieve the pelvic pressure. You can try placing a pillow under your hips too.
  • Eat lots of fibre – If you have constipation, treat it! The easier the bowel movements, the less stress on the pelvic floor when toileting.
  • Train the muscles – Practice supervised physiotherapy training that may include pelvic floor muscle and core retraining and strengthening.
  • Consider a pessary – Talk to your care team to see if this is an option for you!

Don’ts of Prolapse

  • Don’t strain on the toilet.
  • Don’t stand all the time. Alternate activities to relieve pelvic pressure.
  • Don’t stop breathing when you are exercising.

Conclusion: Research shows that symptoms of a pelvic organ prolapse can improve with supervised pelvic floor exercises with a specialized physiotherapist. A Pelvic Health Physiotherapist can provide conservative management strategies including proper toileting practice, constipation management, lifestyle modification and pelvic floor exercises.

Have more questions? Reach out today!

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Emmanuelle Ravez Gomez    RMT,CDT
 Tel: 416-533-2639
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