Short on time? Then the key things to know are:
- Vaginal prolapse happens if your pelvic organs (bladder, intestines or uterus) are not supported enough by your pelvic floor when under pressure, and can cause a dragging sensation or bulge in the vagina
- Mild vaginal prolapse symptoms including discomfort and pelvic pain can be reversed with pelvic floor exercises, guided by a physiotherapist
- As many as 50% of women will be affected by vaginal prolapse in their lifetime
- It’s important to exercise with the correct technique to avoid worsening your symptoms so ensure you speak to a pelvic floor physiotherapist
- You can continue to carry out your pelvic floor exercises throughout pregnancy to protect your pelvic floor
Have you heard of vaginal prolapse or pelvic organ prolapse (POP)? It is something that occurs in up to 50% of women in their lifetime, so it’s extremely common!
Often, this vaginal prolapse is caused by too much downward pressure on your pelvic floor, for example during pregnancy or weight lifting. Keeping it protected is just one of the many reasons to keep up with your pelvic floor exercises through pregnancy.
It is also not uncommon for women with prolapse to experience incontinence issues too. Not all leaking is related to POP, however some women with prolapse have urinary or faecal incontinence as a symptom.
In this article, we will delve into what a vaginal prolapse feels like, what causes it and how to seek help - as well as answering your most frequently asked questions.
What is vaginal prolapse?
Vaginal prolapse happens if your pelvic organs (bladder, intestines or uterus) are not supported enough by your pelvic floor when under pressure. It can cause a dragging sensation in the vagina, and even cause your organs to bulge out of the vaginal entrance.
Symptoms of vaginal prolapse
It is worth noting that there are MANY women living with prolapse, with no symptoms at all that have no issues whatsoever. For other women, prolapse can be extremely uncomfortable and may require medical attention and physical examination, before physiotherapy rehabilitation.
Some signs and symptoms that you may have a pelvic organ prolapse (POP) include:
- Heaviness in your vagina and pelvis, generally worsening at the end of the day or if standing for long periods
- A bulge or protrusion from the vagina
- A feeling of dragging in the vagina
- Discomfort during sex
- Unable to fully empty when peeing, leaking, or urgency
- A feeling of sitting on a small ball
- Back and pelvic pain
What causes vaginal prolapse?
Some people are genetically disposed to pelvic organ prolapse due to a connective tissue weakness (hypermobility or Ehlers Danlos Syndrome), which doesn’t give their pelvic organs adequate support. Prolapse is also common in menopausal women who’ve had a drop in oestrogen as this affects muscle quality.
Pressure on the pelvic floor throughout pregnancy and vaginal deliveries may cause prolapse, along with heavy lifting, obesity, chronic coughing and pelvic or abdominal surgery.
When to see your GP
If you are experiencing high level pain, itching or dryness, book in to speak to your GP. They may be able to prescribe vaginal oestrogen to ease your discomfort, or refer you onto the Gynaecology team for further medical support.
Are there different types of prolapse?
There are a few different types of prolapse, depending on where the pressure is coming from:
- Anterior vagina wall prolapse (also called a bladder prolapse or cystocele)
- Posterior vagina wall prolapse (also called a rectal prolapse or rectocele)
- Uterine prolapse (due to descent of the uterus)
- Enterocele (due to descent of the intestine)
Do pelvic floor exercises work for a prolapse?
Good news! Mild prolapse symptoms can be improved and even reversed by pelvic floor exercises!
A pelvic floor physiotherapist can give you guidance for your pelvic floor and diaphragm, and will create an individualised program to suit your body. Generally, this produces very positive results, since your pelvic floor muscles are your support system for your pelvic organs.
If you improve the support for your pelvic organs, you’ll be able to improve your POP. In some cases, silicone pessaries (vaginal wall supports) can also be useful to provide a lift and to help control symptoms.
Surgical repair can be offered to those who have completed their family (i.e. don't plan to fall pregnant again), however this is not required for mild to moderate prolapse cases.
What about nutrition for prolapse symptoms?
Avoiding constipation is highly recommended for most pelvic floor issues. In the case of pelvic organ prolapse, constipation during a bowel movement can cause an increase in too much pressure and can even worsen symptoms.
Start by ensuring you have adequate water intake (up to 3 litres if you’re breastfeeding!) to ease constipation. Tailored guidance on nutrition is also recommended if you’ve been struggling with constipation for years.
Vaginal prolapse: your questions answered:
I have a prolapse - can I exercise?
Absolutely! Depending on your symptoms and pelvic floor strength, you will be able to do many forms of exercise. Once you are comfortable with engaging and relaxing your pelvic floor as you stand or squat (rather than laying down), this will enable you to do most sports.
Running is a high impact exercise and may not be suitable for someone with a prolapse, however weight lifting, HIIT and pilates can be safe options, if you have been guided on your technique.
I have a prolapse - will I be able to have sex?
Yes - there has been no evidence to prove that penetrative sex worsens prolapse symptoms. It is completely up to you and your partner. Lubricant may be helpful, though.
I have a prolapse and want to get pregnant again, what do I do?
Having a prolapse during pregnancy does not mean that you cannot go through pregnancy again nor have a vaginal delivery, if that’s what your preference is. Ideally, you should feel comfortable in carrying out your pelvic floor exercises standing and squatting before the pregnancy.
It will be a decision between you and your medical team regarding the type of delivery you choose, and this will mostly depend on your symptom severity. You can continue to carry out your pelvic floor exercises throughout pregnancy to protect your pelvic floor.
I have had a caesarean section delivery - does this affect me?
After a c-section, your physiotherapist will guide you on pelvic floor exercises and how to release the fascial tissue around your scar via massage. This is important for pressure management between your abdomen and pelvic floor when you return to exercise.
Get support for vaginal prolapse
NB: This article contains generalised medical advice and may not be suitable for all pelvic floor symptoms; if in doubt please seek professional guidance.
If you think you’re struggling with any of the symptoms above, then please access reputable healthcare support so you can get the right guidance.
There are lots of treatment options available to you so please don’t suffer alone. Speak to one of our women’s health physiotherapists here at Naytal for personalised support. Or if you find you are struggling with low mood due to your symptoms, our mental health counsellors can help you.
Other resources for support
Burgio, K.L. (2014). Pelvic floor muscle training for pelvic organ prolapse. The Lancet, 383(9919), pp.760–762.
Forner, Lori B., et al. “Do Women Runners Report More Pelvic Floor Symptoms than Women in CrossFit®? A Cross-Sectional Survey.” International Urogynecology Journal, vol. 32, no. 2, 21 Sept. 2020, pp. 295–302, 10.1007/s00192-020-04531-x.
Maxwell, M. et al. (2017). PROPEL: implementation of an evidence based pelvic floor muscle training intervention for women with pelvic organ prolapse: a realist evaluation and outcomes study protocol. BMC Health Services Research, 17(1). Woodley, S.J., Hay-Smith, E.J.C. Narrative review of pelvic floor muscle training for childbearing women—why, when, what, and how. Int Urogynecol J 32, 1977–1988 (2021). https://doi.org/10.1007/s00192-021-04804-z
Liz, Naytal Women's Health Physio
Liz is a POGP certified women’s health physio who specialises in supporting women with their postnatal recovery and offers pilates-based rehab.