Can physical therapy help prolapse?

Updated: Dec 27, 2021

The short answer is yes! Absolutely! Pelvic Health physical therapy should be your first stop if you have a grade 1, 2 or 3 prolapse-- in other words, if your organ is not completely falling out of your body-- you should do physical therapy. A 2010 randomized controlled trial of women with grades I, II and II prolapse concluded "Pelvic floor muscle training is without adverse effects and can be used as treatment for prolapse” (Brækken). But, physical therapy is way more than just “kegels” or pelvic floor muscle training…

So, let’s dive into some details!

What is prolapse?

Pelvic organ prolapse (POP) occurs when the female organs drop down below their normal anatomic position. (Saunders) The name is based on what organ is “falling”: bladder prolapse (cystocele), urethral prolapse (urethrocele), rectal prolapse (rectocele), small intestine prolapse (enterocele). Prolapse of the uterus and/or vagina may also occur. Symptoms can be:

  • Pelvic heaviness

  • Vaginal bulging

  • Incomplete bowel or bladder emptying

  • Urinary or fecal incontinence

  • Needing to splint (push up on) the area between the vagina and anus OR inside the vaginal wall to have a bowel movement

  • Sexual discomfort

Some women also report the sensation of having a “golf ball” in their vagina or rectum. While this might seem like a prolapse symptom, it is often irritation of the pudendal nerve. Because of this common mistake, seeing a physical therapist specializing in pelvic health is very important.

About ½ of women lose support (or have some degree of pelvic organ prolapse) after childbirth (Saunders, Bo), though not all have symptoms. Prolapse can be very scary for patients! At RVA Holistic PT, we are always talking about “control the controllables!” However, some risk factors for prolapse are out of your hands.

Risk factors for prolapse include:

  • Older age

  • Menopause

  • Vaginal childbirth(s)

  • Neurologic issues

  • connective tissue abnormalities

  • Joint hypermobility syndromes (like Ehler’s Danlos)

  • Family history (genetic component)

  • Frequent increases in intra-abdominal pressure (heavy lifting, chronic constipation, chronic cough)

  • Increased BMI

  • Smoking (Saunders)

While there are risk factors that are out of control (such as a family history), there are others that you can influence (weight, smoking, constipation). So, let's control the controllables...

Prevention: Honestly, most women are unconcerned with prolapse until they have prolapse, but prevention is always the best cure! Tips to prevent a prolapse are…

  1. Keep your bowels moving! Straining, pushing and sitting on the toilet for prolonged periods of time (over years or decades) puts a lot of strain on the ligaments and fascia that hold the organs up. Use a squatty potty and eat a diet rich in fruits and vegetables.

  2. Maintain an optimal weight (I know, I know, this is hard!).

  3. In pregnancy: the pelvic floor stretches 3-5 times it’s length during delivery, so prepare your pelvic floor muscles and bones for birth with appropriate strengthening and stretching exercises (click to learn more in another blog post). While there is no evidence that perineal massage helps prevent perineal tearing, it is useful to teach you to relax into an intense sensation.