by Sue Croft Physiotherapist
Adapted from author’s blog first published Mar 5, 2014 at SueCroftPhysiotherapy.com.au
Pelvic organ prolapse is more common than many women realise, yet it often goes undetected in its early stages. Once identified, managing prolapse can feel overwhelming at first, but breaking it into simple, practical steps makes it easier to understand and act. In this five-part series, we’ll explore:
Overview: A 5 Step Plan for Managing Prolapse
Step 1: Knowing you have a prolapse – Recognising the signs, symptoms and understanding the causes
Step 2 : Find your prolapse physiotherapist or pelvic floor mentor – Why guidance and support matter.
Step 3: Pelvic floor muscle training, bracing, functional strengthening – Building confidence through movement.
Step 4: Managing your bowels well – Practical strategies to reduce strain.
Step 5: Keep moving mindfully – Safe Ways to Exercise and Stay Active with Prolapse
In this first blog, we’ll start with the foundation: knowing you have a prolapse.
Step 1: Knowing you have a prolapse – Recognising the signs, symptoms and understanding the causes
Understanding prolapse, the symptoms and risk factors every woman should know
- Over 50% of women complain of some vaginal wall prolapse
- Only 10-20% of women with a prolapse seek medical attention
- 10% of diagnosed women undergo surgery for vaginal wall prolapse
- Up to 30% of those who undergo surgery have repeat surgery due to failure of surgery and recurrence
- Many women are unaware they have mild prolapse
- Prolapse usually w
orsens with obesity, menopause and aging
Poor collagen can be a factor in prolapse - Women often present for treatment 6 months after joining a gym or going to pilates or boot camps
How to recognise the symptoms of prolapse in women
“A patient’s awareness of an actual bulge has the highest correlation with pelvic organ prolapse severity.” (Cundiff et al 2007).
So, if it doesn’t feel right get it checked!
Signs of vaginal prolapse
- Vaginal bulging: complaint of a “bulge” or “something coming down” through the vaginal introitus (opening). The woman may state that she can either feel the bulge by direct palpation or see it aided with a mirror.
- Pelvic pressure: Complaint of increased heaviness or dragging in the supra-pubic area, perineum and/or pelvis.
- Bleeding, discharge, infection: Complaint of vaginal bleeding, discharge or infection related to dependent ulceration of the prolapse.
- Splinting/digitation: Complaint of the need to digitally replace the prolapse (push the prolapse up) or to otherwise apply manual pressure, e.g. to the vagina or perineum (splinting), or rectally (digitation) to assist voiding or defaecation.
- Low backache: Complaint of low, sacral (or “period-like”) backache associated temporally with pelvic organ prolapse.
- Other symptoms can include urinary hesitancy, slow urine stream, history of recurrent urinary tract infections, post-defaecation soiling.
Source: Haylen et al 2010
Causes of prolapse and how physios can help manage prolapse
Most common causes
Vaginal Delivery: especially operative vaginal deliveries, such as forceps
Levator avulsion: (see picture below) leads to anterior, posterior wall prolapse
Deficient perineal body between the vagina and the anus: leads to the descending perineum syndrome (DPS)with increasing difficulty with defaecation, worsening posterior wall prolapse.
Other causes and conditions with physio treatment management options
Encourage accountability and strategies to avoid further weight gain and recommending dietitian support; encourage pelvic floor friendly exercising to burn more fat
Defaecation training and bowel management for prolapse
Safe lifting strategies
Education such as, avoid sit-ups, full planks, double leg lifts, leg press; pelvic floor friendly exercising.
Encourage preventative treatment
Encourage preventative treatment
Encourage active treatment and hand support for the perineum
Bladder retraining and urge control techniques
Bladder retraining and urge control techniques
Bladder retraining and urge control techniques
Specific pelvic floor and deep abdominal muscle training
Provide reassurance that intercourse is good for prolapse but no bearing down with orgasm. Local oestrogen use if appropriate and may recommend using a lubricant. Provide advice re libido issues.
Different types of prolapse and common signs
The different types of prolapse can show up in various ways and recognising the early signs of prolapse is an important step in understanding what might be happening in your body. Here are some of the common signs linked with each type of prolapse, that can help women detect changes early and seek the right support as needed.
Anterior Wall Prolapse: Discovery
- Women may first feel a bulge or lump in the shower
- After joining a gym, boot camp, Pilates, Yoga
- Drag, ache
- Back pain
- Difficulty holding in a tampon
- Difficulty with penetration with intercourse
- Identified at PAP smear / Cervical Screening Test (CST)
Posterior Wall Prolapse: Discovery
- Lump/bulge
- Drag/ ache/ heaviness
- Increasingly difficult defaecation
- Multiple trips back to the toilet
- Incomplete evacuation
- Requires hand support to defaecate
- Needs to digitate
- Hard to navigate insertion of a tampon
- Intercourse is uncomfortable
- Identified at PAP smear / Cervical Screening Test (CST)
Uterine Prolapse: Discovery
- Tampons dislodge
- Bulge
- Discomfort with intercourse- uncomfortable/impossible in certain positions
- Heavy drag
- Identified at PAP smear / Cervical Screening Test (CST)
- Vault Prolapse: Just because you’ve had a hysterectomy, doesn’t mean you can’t prolapse anymore. In a vaginal vault prolapse, the vagina can collapse into itself.
- Difficulty using tampons
- Feeling or seeing a bulge in the vagina
- Discomfort with intercourse
- Heaviness or pressure in the vagina
Let’s eradicate unnecessary prolapse with prevention, prevention, prevention. By knowing the signs, recognising risk factors, and understanding how prolapse can develop, women can take the first and most important step towards protecting their pelvic health.
If you’d like to learn more about prolapse symptoms, prevention, and management, or if you’re seeking personalised care, contact Active Women’s Health in Toowong or Highgate Hill to book an appointment with our women’s health physiotherapy team.
Reference sources:
- Haylen, B.T., de Ridder, D., Freeman, R.M. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21, 5–26 (2010). https://doi.org/10.1007/s00192-009-0976-9
- Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, Handa VL. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol. 2007 Apr;196(4):405.e1-8. doi: 10.1016/j.ajog.2007.02.018. PMID: 17403437.
