Pelvic Organ Prolapse (POP)
Reviewed by Cheryl Long, AHPC-registered physiotherapist, Goji Physio
Pelvic organ prolapse (POP) occurs when one or more of the pelvic organs — the bladder, uterus, or rectum — descend from their normal position. It affects approximately 1 in 3 women who have given birth, though many women are not aware they have it. The large majority of women with POP can achieve meaningful improvement with physiotherapy, particularly when it is identified and managed early.
What causes pelvic organ prolapse?
The pelvic organs are supported by a combination of ligaments, connective tissue, and the pelvic floor muscles. Prolapse occurs when this support system is overloaded, damaged, or overwhelmed. Key contributors include:
Childbirth: vaginal birth — particularly with prolonged second stage, instrumental delivery (forceps, vacuum), or large babies — is the most significant risk factor. Caesarean section reduces but does not eliminate the risk.
Menopause: oestrogen plays a role in maintaining the strength and elasticity of pelvic floor tissues. After menopause, the reduction in oestrogen is associated with increased risk.
Chronic increased intra-abdominal pressure: persistent coughing (from asthma or smoking), heavy lifting, obesity, and chronic constipation all increase downward pressure on the pelvic floor over time.
Connective tissue factors: some women have inherently more lax connective tissue, which increases susceptibility.
What does prolapse feel like?
Prolapse symptoms vary depending on the type and severity. Common descriptions include:
A sensation of heaviness, pressure, or dragging in the pelvis or vagina — often worse at the end of the day or after prolonged standing
A feeling of "something coming down" or a bulge at the vaginal opening
Difficulty with fully emptying the bladder or bowel
Urinary leakage or urgency
Discomfort or reduced sensation with intercourse
Some women with POP have no symptoms at all; others find that symptoms significantly affect their quality of life. Physiotherapy is valuable in both contexts.
Does prolapse mean I will need surgery?
No. Surgery is one option for significant prolapse, but it is not the first-line recommendation and it carries its own risks, including recurrence. The current evidence and international guidelines (including from the ICS and IUGA) support pelvic floor muscle training under physiotherapy supervision as the first-line treatment for symptomatic POP. Surgery is typically considered when conservative management has been tried adequately and symptoms remain severe.
What does a session at Goji involve?
Our physiotherapist will take a detailed history of your symptoms, your birthing history, and how prolapse is currently affecting your life. Assessment then includes:
Pelvic floor muscle assessment: a key component, as the muscles are the active support system for the pelvic organs. This includes both internal (vaginal) and external assessment — the internal component is offered and explained, never compulsory.
Load and symptom mapping: identifying which activities provoke or worsen symptoms, so the management plan can be specific rather than generic
Education on lifestyle factors: bowel habits, lifting mechanics, intra-abdominal pressure management, and the role of hormones — all of which influence symptoms
Your management plan will focus on progressive pelvic floor strengthening, postural and movement strategies, and lifestyle adjustments. The goal is to reduce symptoms and support you to do the activities you care about.
Frequently asked questions
Can I make prolapse worse by exercising?
The relationship between exercise and prolapse is nuanced. High-impact exercise and heavy lifting can increase symptoms if the pelvic floor is not functioning well. However, avoiding exercise entirely is not the answer — deconditioning is itself a risk factor. The goal is progressive load management: building pelvic floor capacity alongside returning to activity, guided by your physiotherapist.
Is prolapse permanent?
Prolapse may not "go back" anatomically with physiotherapy, but symptoms can improve significantly with pelvic floor rehabilitation — sometimes dramatically. Many women with POP become symptom-free or largely symptom-free with appropriate conservative management.
I had a prolapse repair but symptoms have returned. Can physio help?
Yes. Recurrence after surgical repair is not uncommon, and pelvic floor physiotherapy is important both before and after prolapse surgery. Post-surgical rehabilitation focuses on rebuilding pelvic floor function and reducing the behaviours and load factors that contributed to the original prolapse.
What type of prolapse do I have?
The most common types are cystocele (bladder into the anterior vaginal wall), rectocele (rectum into the posterior vaginal wall), and uterine prolapse. Some women have more than one type. A physiotherapist can screen for prolapse type during pelvic floor assessment, and a gynaecologist can provide formal grading. Knowing the type helps tailor the management plan.
I am pregnant and have been told I have prolapse. Is it safe to continue physiotherapy?
Prolapse during pregnancy is manageable with physiotherapy. Pelvic floor support strategies, load management, and symptom monitoring are all appropriate during pregnancy. Our physiotherapist will work within the constraints of your pregnancy and coordinate with your obstetric team as needed.
Do pessaries work for prolapse?
Vaginal pessaries are an effective non-surgical option for managing prolapse symptoms, particularly for women who are not yet candidates for surgery or who prefer to avoid it. They are typically fitted by a gynaecologist or women's health GP. Physiotherapy can complement pessary use by addressing the underlying pelvic floor function.
Tell us about your symptoms and what is affecting your quality of life — we'll help you understand your options.
Reviewed by Cheryl Long, BSc (Hons) Physiotherapy, AHPC-registered
Clinical Director, Goji Physio — Women's and Family Physiotherapy, Lentor, Singapore
Related conditions:
Urinary Incontinence | Bowel Dysfunction & Constipation | Perimenopause, Menopause & Bone Health
