The Best First Step for Prolapse Recovery (Itβs Not Surgery)
Dr. Amelia May, PT, DPT
Pelvic organ prolapse (POP) sounds intimidating — and it certainly can feel that way, especially when you first hear the diagnosis or start Googling symptoms. But here’s the truth: Prolapse is treatable!! And in many cases, pelvic floor therapy is the first — and best — place to start, not surgery.
Let’s break it down.
What Is Prolapse? π€·π½βοΈ
Pelvic organ prolapse occurs when one or more pelvic organs — like the bladder, uterus, rectum, or even the urethra — shift into the vaginal space. This happens when the muscles and tissues that support those organs (aka your pelvic floor) weaken or become stretched for too far or too long past their normal capacity. Now the surrounding structures need to help pick up the slack to provide some stability for those organs.
There are different grades or levels of severity, and while some people worry about organs “falling out,” that’s actually more rare than you'd think. It is also very common to have a mismatch in symptoms and the grade or degree of prolapse present - meaning just because your symptoms are severe does not also mean the stage of tissue prolapse is severe as well.
Common Signs & Symptoms of POP:
- A feeling of heaviness, pressure, or bulging in the vaginal, perineal or rectal area
- Urinary incontinence (aka leakage)
- Difficulty with bowel movements or incomplete emptying
- Pelvic pain or discomfort
- Pain or pressure during intimacy
If this sounds familiar, know that you’re not alone — and you’re not doomed to a life of discomfort or limitations.
Don’t Panic — It’s Treatable πͺπ½
Yes, prolapse can feel scary and overwhelming, especially given the misinformation and fear-mongering online. But it’s important to know: your body isn’t broken — it’s asking for support.
And that support can begin with something as simple and powerful as pelvic floor therapy.
What the Research Says π§
A 2009 study published in the International Journal of Obstetrics and Gynecology found that physical activity related to training the pelvic floor significantly improved prolapse symptoms and quality of life in women with stage I or II POP (Wiegersma et al., 2009). The authors concluded:
"Pelvic floor muscle training appears to be effective in the treatment of prolapse symptoms and should be considered as a first-line therapy."
(Wiegersma et al., 2009)
So while surgery is often presented as the “fix,” it shouldn’t be the default — especially early on.
Another study published in National Science Review notes that while the mechanism of prolapse isn’t fully understood, several risk factors are known to contribute:
- Vaginal childbirth
- Chronic constipation or straining
- Persistent coughing (due to respiratory issues)
- Obesity
- Pregnancy
- Repetitive heavy lifting (occupational or fitness-related)
(Zhu et al., 2015)
These are common life experiences — and they don’t make prolapse inevitable. They simply highlight why proactive care matters.
What About Pessaries? π€Έπ½βοΈ
In some cases, a pessary can be a great addition to pelvic floor therapy. A pessary is a small, removable medical device inserted into the vagina to help support the pelvic organs and reduce the sensation of bulging or pressure. There are different shapes and sizes, and a trained healthcare provider (usually a pelvic floor therapist or urogynecologist) will help fit you for one that’s comfortable and effective for your body. Luckily, a couple of our therapists here at Genesis have taken the advanced training to be able to fit pessaries, so you don’t have to worry about making an extra doctor appointment – we got you covered!
Pessaries don’t “fix” prolapse, but they temporarily help to make movement and daily life more manageable while you are doing the activity that causes increased symptoms. They’re especially helpful for people who:
- Want to avoid or delay surgery
- Are actively rehabbing their pelvic floor
- Need symptom relief for workouts, running, or daily activities
- Have more advanced prolapse symptoms but still want to stay active
Pessaries can be empowering tools — not a sign of failure or “giving in.” For many of my patients, they’re a bridge to healing that allows them to stay connected to the activities they love while giving their body the support it needs.
Real-Life Recovery Is Possible βΊοΈ
I’ve worked with so many women who were initially devastated by their diagnosis. They thought they had to give up so many facets of their active life that they valued. But here’s what really happened – After personalized pelvic floor therapy, they returned to half marathons without leakage, lifting weights without heaviness, and reformer Pilates classes with confidence. They even went back to trampoline parks with their kids while having zero fear of that “bulgy” feeling.
Recovery isn’t just possible — it’s probable with the right guidance.
Start with Conservative, Compassionate Care β€οΈ
Another study published in the World Journal of Urology echoes this approach, emphasizing that conservative management — like physical therapy — should be the priority before considering surgery.
"Conservative management of pelvic organ prolapse... has the potential to significantly improve symptoms and quality of life without the risks of surgery."
(Dietz, 2011)
Surgery has its place in certain cases, but for many people, it’s simply not necessary.
If You’re Experiencing Symptoms, You Have Options π
Experiencing downward pressure, incontinence, or pelvic discomfort? You don’t have to “wait and see,” and you don’t have to stop doing all of the physical activity you enjoy forever. There’s a middle path — one that honors your body’s needs, supports your lifestyle, and helps you return to the activities you love.
Pelvic floor therapy is evidence-based, empowering, and often life-changing!
Contact us here to help you virtually, or in-person in TX or CO!
