Understanding Your Prolapse
& Pelvic-Floor Physiotherapy
For the questions you had at your first appointment, the ones you thought of afterwards, and the things nobody quite explained.
You may have been told you have a prolapse, handed some exercises, or referred for pelvic-floor physiotherapy.
Perhaps you left your appointment understanding very little about what was happening to your body. Or you've been following the advice you were given, but you're still wondering whether you're doing the right things.
There is more to understanding prolapse than being given a diagnosis and a sheet of exercises.
Here, we'll look at what prolapse means, how your pelvic-floor muscles work, what physiotherapy may involve, and the questions you can ask along the way.
What actually happens when you have a prolapse?
When you're told you have a pelvic organ prolapse, it can be difficult to picture what that means. You may know something has changed, but not understand which part of your body is involved.
Your pelvic organs are supported by muscles, ligaments and connective tissue. When that support becomes weakened or stretched, one or more organs can move downwards, causing the vaginal walls or uterus to descend.
There are several types of prolapse, depending on which area is affected. Some women have more than one type at the same time.
Bladder prolapse
The bladder presses against the front wall of the vagina, causing it to bulge downwards. Some women notice a feeling of pressure or heaviness, while others experience changes in how they pass urine.
Rectocele
The rectum pushes against the back wall of the vagina, creating a bulge. Some women notice difficulties emptying their bowels or feel that something is pressing towards the vagina.
Uterine prolapse
The uterus moves downwards from its usual position and may descend into the vagina. Depending on how far it has moved, some women notice heaviness, pressure or a bulge near the vaginal opening.
Vaginal vault prolapse
After a hysterectomy, the upper part of the vagina can sometimes lose support and move downwards. This may cause a feeling of fullness, pressure or a noticeable vaginal bulge.
What do prolapse grades mean?
You may have been told you have a grade 1, grade 2 or grade 3 prolapse without anyone explaining what those numbers mean. Grades describe how far the prolapse has descended, rather than how uncomfortable your symptoms are.
A mild descent. The affected area remains higher inside the vagina.
The prolapse has descended further and approaches the vaginal opening.
The prolapse extends beyond the vaginal opening.
The prolapse is more extensive, with significant descent outside the vaginal opening.
Different healthcare professionals may use different grading systems, so the exact meaning of a grade can vary. Your clinician can explain which system was used during your assessment.
Something worth knowing: Two women with the same grade of prolapse can experience very different symptoms. A higher grade does not automatically mean surgery is needed, and a lower grade does not mean your symptoms should be dismissed. Treatment decisions should consider how prolapse affects your everyday life, alongside your examination findings and personal preferences.
Your pelvic-floor muscles: it's not always about strengthening
Perhaps you've been given a sheet of pelvic-floor exercises or told to download an app.
But has anyone explained how your pelvic-floor muscles actually work, or why those particular exercises were recommended?
These muscles help support your bladder, bowel and uterus. They also help you control when you pass urine or open your bowels.
They need to be able to tighten when needed and relax properly afterwards. Both are important.
You might hear the words hypotonic or hypertonic. They're medical terms used to describe different levels of muscle tension. Here's what they mean in everyday language.
When your muscles struggle to tighten
Some pelvic-floor muscles have less tension when they're resting. This is called low muscle tone.
Sometimes these muscles aren't as strong as they need to be, or they become tired quite quickly. Low tone and weakness aren't exactly the same thing.
A pelvic-health physiotherapist can check how well your muscles tighten, how long they can keep working, and whether they relax afterwards.
If strengthening would help, they can recommend exercises suited to your needs.
When your muscles struggle to relax
Sometimes pelvic-floor muscles stay too tense, even when you're trying to relax.
This may contribute to pelvic pain, discomfort during intimacy, or difficulties passing urine or opening your bowels.
It doesn't necessarily mean the muscles are strong. A muscle can be tense and still struggle to work properly.
A pelvic-health physiotherapist may recommend relaxation techniques, breathing exercises or movements that help the muscles work more comfortably.
Can your pelvic floor be both weak and tense?
Yes, and this can be confusing if you've always been told that pelvic-floor problems are caused by weak muscles.
Muscles can be overly tense but still struggle to tighten effectively. Some women also find it difficult to relax their muscles fully between contractions.
This is why two women with the same type of prolapse may need different approaches.
An assessment can help identify whether your muscles need strengthening, help with relaxing, or a combination of both.
What if you've been told to do Kegels?
Pelvic-floor exercises, often called Kegels, can help many women manage prolapse symptoms.
But perhaps you've been doing them for weeks or months and haven't noticed much difference. Or you're not even sure whether you're tightening the right muscles.
Sometimes the exercises need adjusting. Sometimes a woman needs help learning to relax her pelvic floor before focusing on strengthening.
This doesn't mean pelvic-floor exercises are wrong. It means the approach may need to be tailored to you.
Something worth knowing: If your exercises aren't helping, or they're causing discomfort, you can ask for your pelvic-floor function to be reassessed. A pelvic-health physiotherapist can explain what your muscles are doing and what might help.
What happens at a pelvic-floor physiotherapy appointment?
Perhaps you've been referred for pelvic-floor physiotherapy and aren't quite sure what to expect.
Will you need to undress? Will someone examine you internally? What if you feel uncomfortable or don't understand what's happening?
Or perhaps you've already attended an appointment but left wondering what was being checked and why.
Appointments can vary, but here's what you might expect and what you can ask along the way.
First, you'll usually have a conversation
Your physiotherapist may ask when you first noticed symptoms, what they feel like and how they affect your everyday life.
They may also ask about bladder and bowel habits, previous pregnancies or operations, pain, intimacy and the activities you enjoy or find difficult.
You can explain anything you're worried about, including advice you've previously received or exercises that haven't helped.
Understanding how your muscles work
Your physiotherapist may look at how you breathe and move, and how your pelvic-floor muscles respond when you try to tighten or relax them.
Depending on your symptoms, they may suggest an examination to understand your pelvic-floor muscles or assess your prolapse.
They should explain what they're recommending, what it involves and why it may be helpful.
Will you need to undress?
Not necessarily. Some parts of an assessment can be carried out while you're fully dressed.
If an examination of your pelvic floor or prolapse is recommended, you may be asked to remove clothing from your lower half.
You should be told what clothing needs to be removed, offered privacy to change, and kept covered as much as possible.
You can ask for an explanation before agreeing to any examination.
What about an internal examination?
Sometimes a physiotherapist may recommend an internal vaginal examination.
If you agree to an internal examination, the physiotherapist may use a gloved, lubricated finger to feel how your pelvic-floor muscles tighten and relax. They should explain what they're doing before they begin..
They may also assess the position of the vaginal walls or uterus, depending on the reason for your appointment.
An internal examination is not something you automatically have to undergo. Your physiotherapist should explain why they're suggesting it and discuss your options.
What happens afterwards?
Your physiotherapist should explain what they've found and what it may mean for your symptoms.
They may recommend exercises, relaxation techniques, changes to everyday activities, or further assessment if needed.
You can ask them to show you how to do an exercise, explain why it's been chosen and discuss when your progress will be reviewed.
If you're leaving with an exercise sheet or app, it's reasonable to ask what those exercises are intended to help.
Questions you can take to your appointment
You don't need to remember everything. You could write a few questions on your phone or a piece of paper and take them with you.
When your bladder doesn't feel empty
You've been to the toilet, but shortly afterwards, you feel as though you need to go again.
For some women living with prolapse, bladder changes can be confusing, especially when you're unsure whether your bladder is emptying properly.
We've put together a gentle guide explaining what might be happening, what to look out for and when it's worth asking for a little more help.
What are your treatment options?
Once you understand a little more about your prolapse and how your pelvic-floor muscles are working, the next question is often, "What can I actually do about it?"
There isn't one treatment that suits every woman. What helps will depend on your symptoms, the type of prolapse you have, how it affects your everyday life and what feels right for you.
Pelvic-floor physiotherapy
Pelvic-floor physiotherapy can help you understand how your muscles are working and what they might need.
For some women, this involves strengthening exercises. Others may need help learning to relax their muscles, improve coordination or make everyday movements more comfortable.
A physiotherapist can work with you to find an approach suited to your symptoms.
Pessary support
A vaginal pessary is a removable device placed inside the vagina to help support the prolapsed area.
Some women find a pessary helps them feel more comfortable when walking, exercising or going about their day.
There are different types and sizes, and finding a comfortable fit can take time. A pessary can be considered on its own or alongside other treatments.
Surgery
Surgery may be an option when prolapse symptoms significantly affect everyday life, particularly if other treatments haven't helped enough or aren't suitable.
There are different surgical approaches, depending on the type of prolapse and your individual circumstances.
A diagnosis of prolapse does not automatically mean you'll need surgery.
Does having a prolapse mean I'll eventually need surgery?
Not necessarily.
Some women manage their symptoms for many years without surgery. Others find that treatment helps them return to activities they had stopped doing.
Your symptoms, examination findings and personal preferences all matter when considering treatment.
Something worth knowing: Feeling better doesn't always mean the prolapse itself has disappeared. But improvements in comfort, bladder or bowel symptoms, and everyday activities can still make a meaningful difference.
How will I know if things are improving?
Perhaps you've started pelvic-floor physiotherapy or you've been trying the exercises you were given. Now you're wondering how long it might take before you notice a difference.
Sometimes changes are easy to recognise. Other times, you only notice them when you think back to how things felt a few weeks or months ago.
How long before I notice a difference?
Perhaps you've been doing your exercises for a few weeks and you're wondering whether they're making any difference.
Some women begin noticing changes quite early. For others, it takes longer.
Strengthening your pelvic floor can take time. For women who would benefit from strengthening exercises, a physiotherapist may recommend a course of at least 16 weeks before reviewing how things are going
There's no exact date when you should suddenly feel better. What matters is whether the approach is helping you over time.
What might improvement actually feel like?
It might be getting through the supermarket without that familiar heaviness.
Or realising you haven't needed to rush to the toilet quite so often.
Perhaps you've been out walking and haven't spent the entire time wondering how you'll feel afterwards.
Improvements can be small at first. And sometimes you only recognise them when you think back to how things felt a few months ago.
What if I've been trying and nothing has changed?
Perhaps you've followed the exercises you were given, but you're still experiencing the same discomfort.
It's worth going back and talking about what's happening.
Sometimes exercises need adjusting. Sometimes the muscles need help relaxing before strengthening. And sometimes another approach may be more suitable.
You shouldn't have to keep repeating exercises indefinitely without understanding what they're meant to help.
Why do I feel better some days than others?
You might wake up feeling reasonably comfortable, only to notice that familiar heaviness later in the afternoon.
Perhaps you've been standing for longer than usual, you've been constipated, or you've had a particularly busy day.
Prolapse symptoms can change throughout the day.
Feeling more uncomfortable doesn't automatically mean something has become worse. But if you're noticing new symptoms, or things are becoming consistently more difficult, it's worth speaking to your GP or pelvic-health physiotherapist.
Do I need another assessment?
Perhaps it's been months since your last appointment.
Maybe things have improved, but you're still avoiding certain activities because you're worried about making your prolapse worse.
Or perhaps you've been doing everything suggested and you're wondering whether there's something else you could try.
A follow-up appointment can help you understand where things stand now.
You can talk about what's improved, what's still bothering you and anything you'd like to feel comfortable doing again.
You don't have to wait until things become difficult before asking for another assessment.
FINDING YOUR WAY BACK
Can I return to the things I used to enjoy?
Perhaps you've stopped going for long walks, lifting weights, running or doing something else you used to love.
Maybe someone advised you to stop. Or perhaps you noticed your symptoms afterwards and decided it was safer not to try again.
Even when things begin to improve, that original worry can stay with you.
And you may find yourself wondering whether returning to those activities could make your prolapse worse.
Does having prolapse mean I have to stop exercising?
Not necessarily.
Having a prolapse doesn't automatically mean you need to give up every form of exercise.
Some women continue with activities they enjoy. Others find they need to make changes, particularly when something causes discomfort or makes their symptoms more noticeable.
What feels comfortable will depend on your symptoms, the activity and your own circumstances.
A pelvic-health physiotherapist can help you understand which activities may suit you and whether any adjustments could help.
What if an activity makes my symptoms more noticeable?
Perhaps you've been out walking and noticed that familiar heaviness afterwards.
Or you've spent the afternoon gardening and feel more uncomfortable than you did earlier in the day.
Prolapse symptoms can change with activity. Feeling more uncomfortable doesn't automatically mean your prolapse has become worse.
You may find it helpful to notice what you were doing, how long you were doing it and whether your symptoms ease afterwards.
If an activity repeatedly causes discomfort, or your symptoms are becoming more troublesome, speak with your GP or pelvic-health physiotherapist.
Can I return to running, weights or more demanding exercise?
Perhaps running used to be part of your morning routine.
Or you loved going to the gym, dancing or taking part in exercise classes.
Being told to stop can leave you wondering whether you'll ever feel comfortable doing those things again.
Some women can return to more demanding activities, sometimes with changes to how they exercise or how gradually they build up.
If there's something you've been missing, it may be worth talking to a pelvic-health physiotherapist about returning to it. They can help you understand what might be suitable for you and how to begin again.
You don't have to decide on your own whether an activity is suitable for you.
What about everyday lifting and movement?
Not everything involves a gym or exercise class.
There are shopping bags to carry, grandchildren to pick up, washing baskets to move and gardens to look after.
These are ordinary parts of life, but they can become things you think twice about after a prolapse diagnosis.
You may find that changing how you lift, breaking a larger task into smaller parts or taking a rest makes some activities more comfortable.
If you're unsure what you can manage, a pelvic-health physiotherapist can help you look at the movements you make in your everyday life.
What if I'm still frightened to try?
Perhaps your symptoms have improved, but you still hesitate before doing something you once enjoyed.
You remember being told to stop. Or you remember how uncomfortable things felt before you began to improve.
That worry can stay with you, even when your body feels different now.
If there's something you'd like to return to, it may be worth talking about it at your next appointment.
You can explain what you've stopped doing, what you're worried might happen and what you'd like to be able to do again.
A pelvic-health physiotherapist can help you understand whether that activity is suitable for you now and what might make returning more comfortable.
Feeling better physically and feeling confident enough to try again aren't always the same thing.
You may still have questions
Perhaps you've found an answer to something that's been worrying you. Or perhaps reading through this page has brought up a few more questions.
You might be wondering about pessaries, noticing changes with your bladder or bowels, or simply trying to understand what living with prolapse means for your everyday life.
There are other pages here that may help you find the information you're looking for.
No need to read everything today.
Gentle Pessary Support
Perhaps a pessary has been suggested, or you're wondering what having one might actually be like.
From your first fitting to everyday comfort, this library brings together answers to questions women often have.
Explore Pessary Support →Gentle Digestion & Bowel Support
Perhaps you're struggling with constipation, feeling uncomfortable after meals, or finding that bowel movements have become more difficult.
Here you'll find everyday ideas for food, drinks and small changes that may help make things a little more comfortable.
Explore Bowel Support →Gentle Steps
Perhaps you've only recently been diagnosed, or you're still trying to make sense of everything you've been told.
Gentle Steps brings together a few useful starting points, without overwhelming you with information.
Take a look at Gentle Steps →Quiet Questions
Some questions feel too personal to bring up during an appointment. Others only come to mind afterwards.
Quiet Questions offers a private way to share what's been on your mind.
Visit Quiet Questions →You may have arrived here looking for one particular answer and found yourself reading about things you hadn't considered before.
Take what has been useful to you today. The rest will still be here whenever you want to come back.
Live on your terms.
Floored & Fabulous shares general information and lived experience to help women better understand pelvic organ prolapse. The information on this page is not a substitute for individual medical advice, diagnosis or treatment.
Every woman's circumstances are different. If you have concerns about your symptoms, pelvic-floor exercises, examinations or treatment options, please speak with your GP or a qualified pelvic-health professional. If you develop new, severe or rapidly worsening symptoms, seek medical advice promptly.