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Specialist treatment

Pelvic Organ Prolapse

A prolapse diagnosis is not a sentence to live with symptoms. With the right physiotherapy, many people experience significant improvement, often without surgery.

Pelvic organ prolapse physiotherapy

What is pelvic organ prolapse?

Prolapse occurs when pelvic organs, the bladder, uterus, or rectum, descend because the muscles, fascia, and ligaments that normally hold them in position have been stretched or weakened. The descent is measured relative to the vaginal opening and described in stages.

Common symptoms include a sense of heaviness or pressure in the pelvis, a feeling that something is falling out, urinary leakage or difficulty emptying, and discomfort that worsens with prolonged standing or by end of day.

Stage 2a vs 2b, why it matters

Within Stage 2 prolapse, the distinction between 2a and 2b guides treatment decisions. At Stage 2a, the prolapse stays above the vaginal opening even with straining. At Stage 2b, it reaches the level of the opening, symptoms are more pronounced and flare more readily with everyday activities.

Conservative management: pelvic floor exercises + pessary

Pelvic floor muscle training (pelvic floor exercises) is first-line treatment for prolapse. At Stage 2b in particular, combining pelvic floor exercises with a pessary often produces significantly better outcomes than pelvic floor exercises alone:

  • Immediate symptom relief, the pessary reduces the "falling out" sensation, making it easier to persist with pelvic floor exercises long enough to see meaningful change.
  • Better training mechanics, with the organs supported, pelvic floor contractions feel clearer and more effective.
  • Functional skill-building, pelvic floor exercises is ultimately about timing and anticipation. With structural support in place, these skills can be practised in upright, loaded positions.
  • Ligament and fascia rest, passive support structures cannot be strengthened through exercise. The pessary offloads them while muscles are re-trained.
Evidence shows that combining a pessary with pelvic floor exercises improves prolapse symptoms and quality of life compared with pelvic floor exercises alone. Side effects including vaginal irritation can occur and require monitoring.

Lifestyle modifications that help

  • Managing constipation, straining significantly worsens prolapse
  • Load management strategies for lifting and exercise
  • Breathing and pressure management during exertion
  • Topical oestrogen, where appropriate after menopause

Our assessment includes

  • Full symptom history and functional goals
  • Prolapse staging with a standardised staging system
  • Pelvic floor muscle assessment (Modified Oxford Scale)
  • Bladder and bowel function review
  • Pressure management and breathing evaluation
  • Pessary fitting where appropriate

When surgery may be considered

Surgery is typically considered when symptoms significantly impair quality of life and conservative measures, well-supervised pelvic floor exercises with or without a pessary, have not provided adequate relief. We work collaboratively with specialist gynaecologists when onward referral is appropriate.

Related reading

Understanding prolapse, our full patient article →

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