Are you pregnant or following delivery? Or maybe you have never been pregnant before, but you’re a chronic strainer when you go to the bathroom to poop? You could have something called pelvic organ prolapse which is commonly referred to as “prolapse or POP.”

what is pelvic organ prolapse?

Prolapse is when one, or potentially multiple, pelvic organs (like your uterus, bladder, intestines, or rectum) sit lower in the pelvis than they are supposed to. Sometimes when prolapse is more advanced or problematic the pelvic organs can actually bulge outside of the pelvis.

The pelvic floor muscles and pelvic ligaments help to support the pelvic organs and keep them sitting in the pelvis where they are supposed to be.

how common is pelvic organ prolapse?

Research shows that anywhere between 30-50% of people who are assigned female at birth (AFAB) struggle with prolapse. Pelvic organ prolapse affects around 1 in 4 people (AFAB) in their 40s and around 1 in 3 people (AFAB) in their 60s. By the time a person reaches their 80s, around 1 in 2 people (AFAB) will have prolapse.

Prolapse isn’t just something that exclusively impacts people who are assigned female at birth, but can also affect people assigned male at birth (AMAB).

what increases your risk for developing pelvic organ prolapse?

Certain things can increase a persons risk for developing pelvic organ prolapse, regardless of whether or not they have been pregnant before. Different risk factors for developing prolapse include:

Vaginal delivery
This one is a major bummer, but vaginal delivery is a common factor associated with developing pelvic organ prolapse. In addition to this, delivering multiples (like twins) and having a baby with a larger birthweight (over 8 lbs 12 oz) further increases the chance that you may develop pelvic organ prolapse due to an increased risk of injuries that may occur to the pelvic floor muscles during delivery.
Getting older
We literally are all aging and with this comes an eventual changes in hormones, the main one being a decrease in estrogen which starts during perimenopause and continues during menopause. Estrogen is important for helping to promote collagen production which helps with ligament and tendon strength. So when estrogen decreases we frequently also see a decrease in pelvic floor muscle strength and the strength of the ligaments supporting the pelvic organs.
Increased pressure to the abdomen for prolonged periods of time
Things like chronic constipation or straining when you go to the bathroom to poop or pee, chronic coughing, and frequent heavy lifting without appropriate body and breathing mechanics can strain the pelvic floor muscles and cause them to become weak increasing the risk for developing prolapse.
Connective tissue disorders
For folks who have connective tissue disorders, including Ehlers-Danlos Syndrome, there is already a predisposition to the collagen having irregularities which can weaken the connective tissues in the pelvic floor and at the joints increasing the risk for developing pelvic organ prolapse.
Different medical conditions
Various types of injuries including spinal cord injuries and stroke, as well as folks who have dementia, may lead to more difficulty with bowel movements (like straining and constipation), decreased mobility, and cognitive impairments which can impact the ability to feel the urge to have a bowel movement and increase the stress placed on the pelvic floor muscles and ligaments.

there are varying stages or progressions of prolapse

Not all prolapse is created equally and while some folks with prolapse will experience symptoms, others may be completely asymptomatic and potentially not even aware that they have prolapse. Another thing I talk about with my clients is that your symptoms are not always an indicator of severity when it comes to prolapse.

The POP-Q, or Pelvic Organ Prolapse Quantification system, helps to classify prolapse based on how progressed or severe the prolapse actually is and ranges from 0-4:

0=no prolapse is observed
1=the base of the prolapse closest to the hymen (tissue that covers or is a remnant at the vaginal opening) is >1 cm above the hymen (in non-medical terms, there is a slight degree of prolapse)
2=the base of the prolapse closest to the hymen is between 1 cm above and 1 cm below the hymen (in non-medical terms, the prolapse is moving closer to or is almost at the vaginal opening)
3=the top of the prolapse is >1 cm beyond the hymen but not more than 2 cm (in non-medical terms, the prolapse is now beyond or outside of the vaginal opening)
4= complete protrusion or eversion of the pelvic organ outside of the vagina (in non-medical terms, the prolapsed organ is fully or for the most part outside of the vagina)

what does prolapse feel like?

Common symptoms of prolapse include:

Bulging, pressure, heaviness, or aching in the pelvis, vagina, or anus
Feeling as though something is falling out of the vaginal or anal (pelvic) openings
Pain or feeling an aching sensation in the low back
Pain during sex including pressure or feeling as though something is “being hit” with penetration or deeper thrusting
Pressure or a bulge sensation that worsens as the day goes on
Pressure or bulge sensation when you are in gravity-dependent positions for prolonged periods of time (like standing) or when you do different activities like cough, sneeze, laugh, or lift objects
Difficulty emptying your bladder or bowels when toileting
Dribbling following urination
Having to shift your pelvic organs at the outside or inside of your pelvis to help you have a successful bowel movement or when urinating
Spotting from the vagina

a note on pelvic organ prolapse

Just know that if you have pelvic organ prolapse, it is NOT your fault and also not something that you have to deal with if you are struggling with symptoms. There are so many things that can be done conservatively to help treat symptoms of prolapse and to actually improve your prolapse for folks that have more minor forms of pelvic organ prolapse.

A great first step is to work with a pelvic floor physical therapist (like me!) who is skilled in the assessment, treatment, and management of prolapse to help go over education to prevent your prolapse from progressing and to also get you back into doing the exercises and daily activities that you want to be doing.

It is also incredibly common to be told by your medical care provider that you have pelvic organ prolapse, but to not actually be experiencing any symptoms from your prolapse. If this is the case for you and you now know you have prolapse, but aren’t struggling with any symptoms, great! You can absolutely live your life with prolapse and be symptom-free without it impacting how you go about your day-to-day.

I usually educate clients who I am working with to be mindful about body mechanics and breathing mechanics while doing exercise and lifting and how to appropriately manage their intra-abdominal pressure (think not straining while pooping) to prevent their prolapse from progressing or becoming symptomatic.

recommendations to help with pelvic organ prolapse

As Board-Certified Pelvic Floor Physical Therapist there are SO many things that we can do during pelvic floor physical therapy to help improve symptoms of prolapse, and in some cases even improve your prolapse. So I would 100% recommend seeing a skilled pelvic floor physical therapist for an assessment to get specific recommendations for you and your body.

Here are some recommendations that I like to give to folks who are struggling with pelvic organ prolapse for symptom relief:

Pressure management
Anything that we can do to make sure you’re not increasing the pressure or stress placed on the pelvic floor muscles and ligaments will be helpful if you already have prolapse or are struggling with symptoms of prolapse.
Specifically with pressure management we want to make sure that you are not straining with different forms of exercise like lifting weights or while performing everyday activities such as when lifting heavy objects. When we lift weights or heavy objects this increases the pressure placed on the pelvic floor muscles and ligaments which can potentially make symptoms of prolapse worse if we aren’t breathing correctly (or aren’t breathing at all and are instead holding our breath).
The key to this is making sure to exhale or breathe out during activities of increased exertion to help decrease some of the pressure that is being placed on the pelvic floor. So whenever you lift a heavy object or are lifting weights make sure that you are actually breathing with these activities and exhale with the movement that feels more challenging to you (so if you are doing a squat with weights exhale as you bend forward into the squat) to decrease the pressure placed on your pelvic floor muscles.
Don’t strain while pooping
For many people with prolapse, typically constipation and straining with bowel movements over time has the potential to make the prolapse itself, as well as symptoms of prolapse, worse.
So ideally with pooping we want to make sure we are staying hydrated by drinking enough water during the day and eating the needed amount of fiber in our diets to keep our poop consistency soft making it easier to pass.
In addition to this, we also want to make sure that we don’t strain when we go to the bathroom to poop because straining actually causes your pelvic floor muscles to tense and tighten (so you’re literally working against yourself when you strain with constipation). A technique I like to teach my clients is making your “belly big, belly hard,” which is where you gently push your abdomen out and keep it out as you blow out through your mouth as though blowing out birthday candles. This will help to increase the pressure that we need to help the poop to come out while also keeping your pelvic floor muscles lengthened which should make it easier to go. This is literally the only level of exertion you should be using when you go to the bathroom to poop.
Use optimal pooping mechanics
Pooping positioning is so incredibly important when it comes to helping the pelvic floor muscles lengthen and release. We have a specific pelvic floor muscle, called the “puborectalis,” that wraps around the rectum which helps to keep us from leaking poop and gas throughout the day. But this specific muscle also needs to lengthen and release when we go to the bathroom to have a bowel movement to allow for easier emptying.
A good way to help this muscle to release? Using a step stool! My go-to recommendation is the Squatty Potty which helps to elevate the knees above the level of the hips allowing the puborectalis muscle to lengthen and release. You also want to make sure that you lean forward from your hips, keeping your back straight, and let your forearms rest on your legs which will further lengthen the pelvic floor muscles.

Elevating your hips above the level of the heart
Frequently for folks who are struggling with prolapse specifically when on their feet for prolonged periods of time symptoms of prolapse can feel significantly worse.
Want a tip to give you some quick relief? Lay on your back and elevate your hips above the level of your heart by doing a bridge position actively, put pillows under your hips to do a passive bridge position, or you can lay your legs up against a wall. This will allow gravity to do the work for you to help to reduce the prolapse of the affected pelvic organ and should also help to improve your symptoms. Want a little more relief? You can put a bag of frozen peas over clothing and a towel at your vulva to give a little cold which should further help the discomfort.
Compression garments
As a Certified Lymphedema Physical Therapist I also frequently recommend using different types of compression garments to help improve symptoms of pelvic organ prolapse.
Some of my go-to garment recommendations include using a Labium Swell Spot or an Oval Swell Spot which you can place in your underwear or wear from the comfort of your home to give you symptom relief. Another undergarment I like is compression underwear from LoveSteady to help give added support to the pelvis without increasing the abdomen and potentially making your prolapse worse (these underwear are frequently marketed to folks who are pregnant or postpartum, but anyone can use them!).
See a pelvic floor physical therapist!
If you are struggling with prolapse or symptoms from prolapse just know that it’s common, but not normal and absolutely not something that you have to deal with. Working with a skilled pelvic floor physical therapist can help improve your symptoms and even improve your prolapse in some cases. The right pelvic floor therapist should be able to do a pelvic assessment in the position that most bothers you (yes, we can and are very happy to do pelvic floor assessments in standing, squatting, and with pretty much any other activity you can think of) so we can get a better idea of how your pelvic floor muscles are functioning and the degree of prolapse. Then from there we can come up with a treatment plan specific to you and your goals. So if this sounds like you and you are located in Durham, NC I would love to hear from you. Please don’t hesitate to reach out using the link below!

Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you’re looking for treatment for pelvic organ prolapse and you’re located in Durham, North Carolina I would love to work with you! Reach out to me here to tell me a little more about what is going on so we can chat more and get the process started. Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor physical therapy treatment.

Struggling with prolapse or other pelvic floor conditions? Check out my website here to see what other conditions I treat as a pelvic floor physical therapist.

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