Breaking Down Pelvic Organ Prolapse.

Pelvic Organ Prolapse (POP) is a downward descent of pelvic organs into the bony pelvis. POP is extremely common after child birth and after menopause. The structures that are usually implicated with pelvic organ prolapse include the bladder, urethra, uterus, rectum and small intestine. The type of prolapse is named based on the structure that has shifted and graded based on how far the pelvic organs are dropping into the pelvis (Graded 0-4). See figure below.




Risk factors for developing POP include having children (increased risk with each subsequent pregnancy), chronic coughing, respiratory disease, repetitive heavy lifting, straining with constipation, increased BMI: specifically increased abdominal tissue.


It is estimated that about 50% of women have a prolapse (Beck, 1991). Some women are completely asymptomatic and some have symptoms. Women that have symptomatic prolapse will often report pelvic heaviness, pressure, bulging, inefficient toileting, and/or just a general feeling that something is right “down there”.


While a woman is breastfeeding and after menopause, estrogen levels in the vaginal tissue decrease, which decreases vaginal wall strength and support, and can thus give rise to symptoms. Evaluation of the prolapse will be performed by a physician or pelvic physical therapist. Assessment should be performed in a variety of positions to determine how the organs are shifting in response to different movements and postures.


Research shows that pelvic floor physical therapy is very effective at helping reduce symptoms and sometimes severity of prolapse. Some things that help women manage their symptoms include:

• Instruction on proper abdominal and pelvic floor engagement with functional activities such as lifting and toileting
• Improving postural control in different positions
• Increasing strength and flexibility in order to increase the ability of the body and core to manage load and pressure.

Sometimes depending on severity and symptoms, women may benefit from wearing a pessary, which is essentially an intra-vaginal support for your pelvic organs.


The goal with rehabilitating prolapse is always to reduce or abolish a patient’s symptoms and to discuss ways to prevent further progression of the prolapse. Symptoms should always guide what activities are safe to perform. A pelvic floor physical therapist is trained to help manage prolapse symptoms and can help guide you to what activities are safe, according to your specific prolapse.

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