Early Signs of Prolapse and How Physio Can Help

Pelvic organ prolapse (POP) is a condition that many women experience, particularly after pregnancy, childbirth, or menopause, but few talk about it openly. While it can feel frightening or embarrassing to notice changes in your body, recognising the early signs of prolapse is essential. The good news? In many cases, early intervention, including pelvic floor physiotherapy, can significantly improve symptoms and restore confidence.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when one or more of the pelvic organs, such as the bladder, uterus, or rectum, descend from their normal position and press into the vaginal walls. This typically happens when the pelvic floor muscles and connective tissues become weakened or stretched.

There are different types of prolapse depending on which organ is involved:

• Cystocele (bladder prolapse)

• Rectocele (rectal prolapse)

• Uterine prolapse

• Enterocele (small bowel prolapse)

• Vaginal vault prolapse (after hysterectomy)

Although it’s common, prolapse isn’t something you should just “put up with.” Early assessment and conservative management, including physiotherapy, can help you avoid surgery and feel better in your body again.

What Causes Pelvic Organ Prolapse?

Several factors increase the risk of prolapse:

• Vaginal childbirth (especially with prolonged labour, large babies, or forceps delivery)

• Pregnancy (due to weight and hormonal changes)

• Menopause (due to oestrogen decline)

• Chronic constipation or straining

• Repetitive heavy lifting

• Persistent coughing (e.g. from asthma or smoking)

• Previous pelvic surgery

• Genetic predisposition to weaker connective tissue

Understanding the underlying cause helps guide your recovery and prevent worsening.

Early Signs to Watch Out For

It’s important to know that not all prolapses cause symptoms right away. However, being aware of the early signs can help you take action before things progress.

1. A Sensation of Heaviness or Pressure:

Many women describe feeling a dragging, heavy, or “falling out” sensation in the vagina, especially after standing for long periods, during physical activity, or at the end of the day.

2. A Bulge or Lump in the Vagina:

You may notice or feel a bulge at the vaginal opening, which can increase in size throughout the day. In some cases, it may be visible with a mirror.

3. Difficulty Emptying the Bladder or Bowels:

Struggling to start urinating, a sense of incomplete emptying, or needing to change position to pass stool could be signs of bladder or rectal prolapse.

4. Recurrent Urinary Tract Infections (UTIs):

Incomplete bladder emptying due to prolapse can lead to recurrent UTIs or an increase in urinary frequency.

5. Lower Back or Pelvic Pain:

While not always present, dull aches or pain in the lower abdomen or lower back may be associated with certain types of prolapse.

6. Pain or Discomfort During Sex:

Some women experience vaginal discomfort, dryness, or a sensation of obstruction during intercourse.

7. Tampons Not Sitting Right:

If tampons feel like they’re falling out, are uncomfortable, or sit differently, this can be an early sign of changes in pelvic anatomy.

Why Early Intervention Matters

Pelvic organ prolapse tends to worsen over time without treatment, especially if the underlying issues, like muscle weakness, connective tissue changes or constipation, aren’t addressed. However, if detected early, conservative treatment is highly effective.

Physiotherapy-led intervention can:

• Improve muscle strength and tone

• Reduce or eliminate symptoms

• Prevent worsening

• Restore function and confidence

Early support also helps you understand your condition, rather than feeling confused, overwhelmed, or ashamed.

How Can Physiotherapy Help?

Pelvic floor physiotherapy is often the first line of treatment for prolapse, particularly in mild to moderate cases. Here’s how it can help:

1. Pelvic Floor Muscle Training (PFMT):

A pelvic health physiotherapist will teach you how to correctly engage and strengthen the pelvic floor. Many women perform pelvic floor exercises incorrectly or target the wrong muscles. Tailored exercises help build strength and endurance, which are crucial for supporting your pelvic organs.

2. Postural and Breathing Strategies:

Your posture and breathing technique play a major role in pelvic health. Physiotherapists teach strategies to reduce downward pressure and improve intra-abdominal pressure control, especially during lifting, exercise, or even coughing.

3. Bowel and Bladder Management:

Repetitive straining is a significant factor in prolapse. Physios can provide techniques and routines for managing constipation, improving emptying, and avoiding habits that make symptoms worse.

4. Individualised Exercise Plans:

Rather than avoiding all exercise, your physiotherapist can guide you through safe, supportive movement. This might include clinical Pilates, core training, and strength work that protects your pelvic floor while improving overall fitness.

5. Education and Support:

Understanding your body, your options, and how to manage symptoms is empowering. Physiotherapists offer education, reassurance, and ongoing guidance to help you stay in control.

6. Lifestyle Adjustments:

Together, you’ll look at your daily habits, like lifting, toileting, or how long you’re on your feet, and identify small changes that make a big difference.

7. Pessary Use (in collaboration):

Some women benefit from using a pessary (a device inserted into the vagina to support the pelvic organs). Specialised Women’s Health Physiotherapists or Gynaecologists can appropriately assess whether a pessary would be useful for managing your symptoms and assist with ongoing management .

When to See a Physiotherapist

If you’ve noticed any of the symptoms mentioned above—or if you’re unsure whether what you’re experiencing is “normal”—book an assessment with a women’s health physiotherapist. You don’t need a referral to get started.

You should also consider physio if you:

• Have recently given birth

• Are approaching menopause

• Have a history of pelvic surgery

• Want to stay active without fear of worsening symptoms

You’re Not Alone

Pelvic organ prolapse affects up to 50% of women at some point, yet shame and stigma prevent many from speaking up. But this is a common, treatable issue, and you deserve support.

Early signs are your body’s way of asking for help. The sooner you act, the more you can do to protect your pelvic health, improve symptoms, and feel confident in your body again.