If you have just been told you have a pelvic organ prolapse, or you have noticed a heavy, dragging feeling in your vagina, surgery is probably the first thing on your mind. It helps to know that surgery is not always the next step. Many women with a mild to moderate prolapse see real improvement through pelvic floor physiotherapy, some simple changes to daily habits, and support devices called pessaries. This guide explains what tends to happen to a prolapse without surgery, what non-surgical treatment involves, and when surgery is still the right choice for some women.
What is pelvic organ prolapse
Your bladder, uterus and bowel sit inside your pelvis, held in place by a sling of muscles and tissue called the pelvic floor. When this support is stretched or weakened, one or more of these organs can drop down and press into the walls of the vagina. This is called a pelvic organ prolapse.
There are a few types, and it is common to have more than one at the same time. A bladder prolapse presses into the front wall of the vagina, a bowel prolapse presses into the back wall, and a uterine prolapse is when the uterus itself drops down. Most women describe prolapse as a heavy or dragging feeling in the vagina, or a sense of something bulging or coming down. Symptoms often feel stronger later in the day or after standing and exercising, and they tend to ease when you lie down. Some women also notice bladder or bowel changes, lower back ache, or discomfort during sex.
How common is prolapse in Australia
Prolapse is far more common than most women expect, and having one does not mean your body has let you down. More than half of Australian women will notice some degree of vaginal wall prolapse at some point in their life, though far fewer ever seek treatment or need surgery for it. Around 1 in 2 women who have had a baby will experience some level of prolapse, and many find that the right support makes a genuine difference to how they feel.
Prolapse becomes more likely with pregnancy and vaginal birth, after menopause, with long term coughing, constipation and straining, and with heavy lifting or carrying extra weight. Knowing the common causes helps explain why lifestyle changes are such an important part of non-surgical treatment.
Can prolapse improve without surgery
A prolapse usually will not correct itself completely on its own. What tends to happen instead is that, with the right early support, many women’s symptoms settle and improve without ever needing a pessary or surgery. How much things improve depends largely on how severe the prolapse is.
Health professionals grade prolapse in stages, from stage 1, simply termed laxity, where the organ has only dropped slightly, through to stage 4 where it sits fully outside the vagina. Stage 1 and stage 2 prolapse are the most common, and these mild to moderate cases respond best to conservative, non-surgical care such as pelvic floor physiotherapy and lifestyle changes. A 2021 review of pelvic floor muscle training research found clear benefits for women with mild to moderate prolapse, including for those who wanted to avoid or delay surgery. More recent international research from 2026 confirms that structured pelvic floor training eases prolapse symptoms and the distress that comes with them, even though it does not always change what a doctor sees on examination. In other words, treatment can make you feel significantly better even if the prolapse itself is still technically present.
How a pelvic health physiotherapist can help
A pelvic health physiotherapist is trained to assess exactly which muscles and tissues need support, and to build a plan around your body and your goals. This usually starts with a thorough conversation about your symptoms and history, followed by an assessment of your pelvic floor. From there, your physiotherapist can teach you how to correctly activate and strengthen your pelvic floor muscles, which is a skill that is genuinely hard to get right on your own.
Your treatment plan may also cover safe lifting technique, how to brace your pelvic floor before coughing or sneezing, and strategies for emptying your bowels without straining. Many physiotherapists also work alongside your GP or gynaecologist, so your care stays connected whether you end up needing further treatment or not.
Everyday changes that support your pelvic floor
Alongside physiotherapy, small changes to daily habits can take real pressure off your pelvic floor. Keeping bowel movements soft and regular by eating enough fibre and drinking plenty of water helps you avoid straining on the toilet, which is one of the biggest contributors to prolapse getting worse. Reaching and maintaining a healthy weight for your body also reduces the load on your pelvic organs.
It is also worth treating anything that causes a long-term cough, such as asthma or a smoking habit, since repeated coughing puts pressure on the pelvic floor over time. Your physiotherapist can guide you on which types of exercise and lifting are safe for your particular prolapse, since very heavy lifting and high impact activity are usually best modified rather than avoided altogether.
Vaginal pessaries: a non-surgical support option
A pessary is a soft, flexible device that a trained health professional fits inside the vagina to support the organs that are prolapsing. Pessaries come in different shapes and sizes, and your physiotherapist or doctor will usually try a few options to find the one that suits your body and feels comfortable.
Many women can be taught to insert and remove their own pessary, similar to a tampon, though regular reviews with your health professional are still important. A large trial published in 2023 compared women who managed their own pessary at home with women who had all their care done in clinic, and found similar quality of life between the two groups, with fewer pessary related complications among those managing their own care. A pessary is not a cure for prolapse, but for many women it is a genuinely effective, low risk way to reduce symptoms for as long as it is needed.
When might surgery still be recommended
For some women, particularly those with a more severe prolapse, or whose symptoms have not settled enough with physiotherapy, lifestyle changes and a pessary, surgery is still the right path. Your gynaecologist will talk through the options with you, taking into account how the prolapse is affecting your daily life, your general health, and whether you are planning any future pregnancies.
Even when surgery is needed, pelvic floor physiotherapy still has a role to play. Being seen by a physiotherapist before your operation, and again afterwards, tends to support a smoother recovery and better long-term results. Choosing surgery is not a sign that conservative treatment has failed. It is simply the right next step for some women, made together with their health team.
What results can you expect
For many women with a mild to moderate prolapse, dedicated pelvic floor training and a few lifestyle changes lead to a noticeable easing of symptoms over some weeks to months, with your physiotherapist checking your progress and adjusting your plan along the way. The prolapse itself may still be present on examination, but the dragging sensation, the feeling of a bulge, and the impact on daily life often improve a great deal.
Prolapse is best thought of as something to manage well over time, rather than a problem with a single fix. Hormonal changes around perimenopause and menopause can affect symptoms, so ongoing check ins with a pelvic health physiotherapist are worthwhile even once you are feeling better. The earlier you seek support after noticing symptoms, the more options you generally have.
How Active Women's Health can help
If you are noticing any of these symptoms, you do not need to manage them alone. At Active Women’s Health, our pelvic health physiotherapists have years of experience helping women in Brisbane and beyond understand their prolapse and build a treatment plan around their own body and goals.Whether you need a pelvic floor exercise program, guidance on lifting and daily habits, a pessary fitting, or support before and after surgery, our team is here to help you feel confident and in control again. Appointments are available in our Brisbane clinics or through online video consultations, so you can get expert care wherever you are. Book an assessment today and take the first step toward feeling like yourself again.
Frequently Asked Questions
A prolapse does not usually correct itself completely without any support at all. However, with early treatment such as pelvic floor physiotherapy, many women find their symptoms settle down a great deal, especially with a mild to moderate prolapse.
For most women, the first step is an assessment with a pelvic health physiotherapist, who can then recommend pelvic floor exercises, lifestyle changes, and sometimes a pessary. Surgery is generally considered later, if these approaches do not give enough relief or if the prolapse is more severe.
This varies from woman to woman, and depends on the severity of the prolapse and how consistently the exercise plan is followed. Your physiotherapist will check your progress regularly and adjust your program, so it is worth discussing realistic timeframes with them at your first appointment.
A pessary can be used for as long as it continues to help, for some women that is months, and for others it becomes a long-term part of managing their prolapse. It does need regular review with your health professional, whether or not you are managing it yourself at home.
Not necessarily. Movement and exercise are generally encouraged, though very heavy lifting and high impact activity may need to be modified depending on your prolapse. A pelvic health physiotherapist can help you work out which activities are safe and how to adjust the ones that need a little extra care.
Surgery is usually considered for a more severe prolapse, or when symptoms have not improved enough with physiotherapy, lifestyle changes and a pessary. Your gynaecologist will discuss the options with you based on your individual situation and goals.
Prolapse can be a lifelong pelvic health consideration, and symptoms can change over time, particularly around menopause. This is why ongoing check ins with a pelvic health physiotherapist are valuable, even after your symptoms have improved.
In most cases you can book directly with a pelvic health physiotherapist without a referral, though your GP or gynaecologist may also suggest one as part of your care. Check with your chosen clinic about their specific booking process.
This article is general information only and does not replace individual advice from your doctor or women’s health physiotherapist. If you have symptoms of prolapse or concerns about your pelvic health, please book an assessment with a qualified health professional.
References
Jean Hailes for Women’s Health – Pelvic Organ Prolapse
Continence Health Australia – Pelvic Organ Prolapse and Pelvic Floor Support
healthdirect Australia – Prolapsed Uterus
Better Health Channel – Prolapsed Uterus
Basnet, R. Impact of pelvic floor muscle training in pelvic organ prolapse. (2021). Int Urogynecol J, 32, 1351–1360. https://doi.org/10.1007/s00192-020-04613-w1
Kearney, R., Wagg, A., Bower, W., Chapple, C., Khullar, V., Robinson, D., Taithongchai, A., Hobson, P. T., Wein, A., & Abrams, P. (2026). How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management? ICI-RS 2025. Neurourology and Urodynamics, 45(6), 1220–1229. https://doi.org/10.1002/nau.70272
Hagen S., Kearney R, Goodman K et al. (2023). Clinical Effectiveness of Vaginal Pessary Self-Management vs Clinic-Based Care for Pelvic Organ Prolapse (TOPSY): a randomised controlled superiority trial. eClinicalMedicine, 2023; 66
This article provides general information about pelvic organ prolapse and is not a substitute for individual medical advice. Every prolapse is different, so please see a pelvic health physiotherapist or your doctor for a proper assessment and a treatment plan suited to your body and your goals.
