May 08, 2019

Pelvic Organ Prolapse: When Things are Threatening to Come Down and Out

By Nav Grewal, PT, Registered Pelvic Physiotherapist

Pro-what?! This is a term many of my patients have not heard of, yet 40-50% of women post-partum have some degree of prolapse. Prolapse is the descent of one or more of the pelvic organs (urethra, bladder, uterus, rectum) from their normal position downwards towards the vaginal entrance. Depending on the degree of prolapse or how far the organs have descended, women may have varying symptoms including: bulging at the vaginal entrance, heaviness, pressure in the pelvic region, the feeling of something coming out, difficulty with urination and bowel movements, or pain with intercourse in certain positions. Some women may experience the symptoms all the time, for others, it may be with going from sitting to standing, after walking for a long time, or with heavier physical exertion such as running and jumping. Many women are also walking around with minor prolapse that does not cause any symptoms but can be confirmed with a visual inspection by your physician or pelvic floor physiotherapist.

What can cause prolapse?

The pelvic floor is a set of muscles and connective tissue that act as a sling from front to back to support the bowel, bladder, and uterus. If these muscles become weak or have extra pressure on them, the organs may then start to shift. Childbirth, chronic constipation or coughing/respiratory diseases, and heavy physical exertion are most often the culprits, as they cause the muscles to be strained and eventually weaken.

What are my options?

Several. Pelvic floor strengthening exercises, or kegels, have strong research behind them to help reduce prolapse as well as prevent its progression. A pelvic floor physiotherapist can guide you on how to properly perform kegels (50% of women do not perform them correctly), which positions to do them in, as well as which activities to avoid and how to perform your exercise routine safely.

If you have seen a pelvic floor physiotherapist and have had some relief of symptoms but not completely, then a pessary may help. Pessaries are rings that can be custom fitted to be inserted internally to provide support to the organs and help relieve symptoms. A urogynaecologist or a pelvic physiotherapist with special training may be able to assist you with this. You should be able to insert and remove the pessary by yourself. Some women may wear this during the day and take it out at night, or others may wear it during physical activity only.

Finally, surgery may be recommended by your physician to help “lift” the organs upwards, but if strengthening and/or a pessary can help reduce or eliminate symptoms, this route may not be required.

Consulting with your pelvic floor physiotherapist and/or physician should be the first route of action. You do not require a referral for pelvic floor physiotherapy. Your therapist will assess your breathing, movement, and perform an internal examination to visually inspect the prolapse, see how the tissues are, test your muscle strength and then provide treatment and recommendations. As a pelvic floor physiotherapist, I have treated and helped many women with pelvic organ prolapse to return to fitness, activity, and day to day living. Don’t let prolapse affect your quality of life. Take action.


Nav Grewal, PT, is a Registered Physiotherapist with a special interest in Women’s Health and Pelvic Rehabilitation. She treats various pelvic health conditions, and her goal is to empower women to take charge of their health. If you would like to book a consultation with Nav, please contact IHH at 905-844-8884.

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