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5 Key Insights on Pelvic Organ Prolapse: Managing Pressure Down There


Pelvic Organ Prolapse (POP) affects numerous women and can cause discomfort and pressure in the pelvic area.


This condition occurs when the pelvic floor muscles weaken or tighten, resulting in insufficient support for the pelvic organs. In this blog, we will explore five key insights into pelvic organ prolapse, including its symptoms, causes, and potential solutions for managing pressure in the pelvic region.

  1. Recognizing Symptoms:

One of the primary signs of pelvic organ prolapse is the presence of a bulge in the vagina. This bulge may lead to discomfort, pressure, or aching sensations in the pelvis. Additionally, individuals with POP might experience urinary or bowel incontinence and encounter difficulties with urination or bowel movements.

  1. Understanding the Pelvic Floor:

The pelvic floor comprises a group of muscles responsible for supporting the bladder, uterus, and rectum. These muscles play a vital role in maintaining the proper function of the pelvic organs and preventing prolapse. When the pelvic floor weakens or tightens, it fails to offer adequate support, leading to the development of POP.

  1. Common Causes:

Several factors contribute to pelvic organ prolapse:

  • Childbirth: The process of childbirth places significant strain on the pelvic floor muscles. The stretching and tearing that occur during delivery can weaken these muscles, increasing the risk of developing POP.
  • Pressure Imbalance: Chronic coughing, straining during bowel movements, and weakness in the deep core muscles can create an imbalance of pressure within the abdomen. This pressure imbalance can contribute to the development of pelvic organ prolapse.
  • Hormonal Changes: Hormonal changes during menopause, such as decreased levels of estrogen, can lead to a loss of muscle tone and support in the pelvic floor, making women more susceptible to POP.
  1. Pelvic Floor Rehabilitation:

Pelvic floor rehabilitation focuses on addressing pelvic floor dysfunction, including pelvic organ prolapse. It offers several benefits:

  • Reducing Muscle Tone: Pelvic floor rehabilitation includes exercises and techniques to reduce excessive muscle tension. By relaxing and lengthening the pelvic floor muscles, they can function better and provide improved support to the pelvic organs.
  • Improving Posture and Alignment: Correcting posture and alignment issues is crucial in pelvic floor rehabilitation. Strengthening the muscles that attach to the pelvis and promoting better overall posture can help the pelvic floor regain its optimal functionality.
  • Restoring Deep Core Strength: Strengthening the deep core muscles, particularly the transversus abdominis (TrA), is vital for normalizing pressure within the abdomen. Enhanced core strength reduces the downward force exerted on the pelvic floor, alleviating symptoms of prolapse.
  • Enhancing Breathing Strategies: Pelvic floor rehabilitation also focuses on improving breathing techniques to manage abdominal pressure effectively. Proper breathing strategies optimize pressure management in the abdomen, reducing strain on the pelvic floor.
  1. Empowering Well-being:

By addressing pelvic organ prolapse through pelvic floor rehabilitation, individuals can regain control and improve their overall well-being. Reducing muscle tension, improving posture, restoring core strength, and optimizing breathing techniques can alleviate pressure and discomfort associated with pelvic organ prolapse. This empowers women to lead healthier, more fulfilling lives.

Pelvic organ prolapse can significantly impact a woman’s quality of life. Recognizing the symptoms and understanding the causes are crucial for managing the condition effectively. Pelvic floor rehabilitation offers a comprehensive approach to address pelvic floor dysfunction and alleviate the symptoms of POP. By reducing muscle tension, improving posture and alignment, restoring deep core strength, and enhancing breathing strategies, individuals can manage pressure and discomfort in the pelvic region, promoting better overall well-being.

Make sure to contact us at rebalance PT if you are having any of this discomfort!

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Pelvic organ prolapse is a condition in which the support mechanism of organs in the pelvis start to fail, slip out of place and fall downward. This usually occurs due to overstretching of the supportive structures like pelvic floor muscles that become weak or overstretched. The bladder, urethra, uterus and rectum are structures most affected. The prolapse typically occurs from overstraining with childbirth or chronic constipation. Pelvic surgery like a hysterectomy can also change organ support.

Prolapse is very common when you’ve had children, especially multiple children. Carrying and delivering the baby puts a lot of pressure on the organs, specifically the uterus, bladder and rectum.

That pressure can push down on those organs and push them out of the vaginal or rectal canal and cause pressure or discomfort in the low back or it sometimes causes a dull type pain in the vaginal area or rectal area (not common put some people come in with that). You can have constipation, because the rectum, if that’s fallen enough, blocks the opening so you might feel like you have to move something out of the way in order to have a bowel movement.

Common symptoms of Prolapse:

  • vaginal, rectal pressure/ heaviness
  • feeling of something foreign or lumpy in the vagina/rectum
  • feeling of something falling out of the vagina/ rectum
  • incomplete emptying of bowels/ constipation
  • urinary incontinence
  • groin stretch/pain, lower back and sacral pain/pressure
  • painful sex

There are four types of prolapses you can have: 

  • *Uterine prolapse, uterus has fallen into vaginal canal
  • *Vaginal prolapse, vagina falls into the vaginal canal
  • *Bladder prolapse, Bladder falls into the vaginal canal
  • *Rectal prolapse, rectal falls into the Rectal canal

What do I do?!

It’s nothing to be scared about, it’s not a medical emergency. But you don’t want to walk around with a prolapse.

The first thing I would recommend is to see your gynecologist and see if they think it’s significant enough and what to do about it.

We’re fortunate in the Philadelphia/Main Line area to have wonderful hospital systems and many gynecologists are conservative and they will recommend pelvic floor physical therapy as a more conservative treatment. However, if you were told to go straight to surgery, especially if it’s mild to moderate, I highly recommend getting evaluated by an integrative holistic pelvic floor physical therapist.

What I mean is that someone who’s not just going to give you Kegel exercises to do for strengthening your pelvic floor. That was the old model for how to treat prolapses conservatively way back. We’ve come to the understanding that it’s not just doing Kegel exercises to strengthen the pelvic floor that’s going to keep these organs up.

How can my alignment affect a prolapse?

One of the big things you also have to address when treating a prolapse is the alignment of the body.

Your organs sit in your pelvis. Depending on the posturing of the body, if you tilt in one direction more, the organs will sit in a position based on the alignment of your body and push down in a different direction. When you’re in good alignment, the normal pressure in the body will push them forward toward the pubic bone versus down through the opening of the vagina and the rectum. When your alignment is off, you’re going to have an imbalance of pressure and that pressure can push things down outside of the canal.

There’s a lot of things such as stretching, strengthening, soft tissue and hands on work to improve this that will help to balance the pressure so it’s pointing more forward instead of down. And then if we need to go in to teach you exercises to strengthen the pelvic floor we may add that in addition to a lot of other things.

Kegels might make pelvic pain WORSE

For some of you experiencing pain, as well as having a prolapse, vaginal pain in general, rectal pain in general, pain with intercourse, IBS, the pelvic floor could actually be TOO tight. There are many people who have tightness of their pelvic floor AND they have a prolapse. You don’t want to strengthen your pelvic floor if it’s already too tight because that will just create more imbalance and more pain.

Your body works as a whole, it doesn’t work in different pieces. We need to look at everything in an integrative fashion – everything in your body works together.

For those of you experiencing a pelvic organ prolapse, I highly recommend getting evaluated by an integrative pelvic floor therapist prior to getting surgery.

Think you might have a prolapse? You can schedule a complimentary phone consultation to discuss your symptoms here.


Surgery can be indicated if the prolapse is severe enough but conservative treatment can include physical therapy to help increase strength of the pelvic floor and other pelvic muscles to reduce pressure/pain. At Rebalance Physical Therapy, our treatment for prolapse consists of a holistic approach beyond strengthening pelvic floor muscles. We differ from traditional therapy treatments by looking at the whole body to identify contributing dysfunctions with individualized evaluation and treatment. We use the Integrated Systems Model (ISM) for Pain & Disability (Lee & Lee, 2007) as framework for treatment to interpret the unique picture of each individual patient. The goal of the ISM approach is to facilitate better strategies for posture and functional movement to eliminate the prolapse symptoms.

An underlying postural dysfunction often accompanies prolapse. The consequent muscular gripping patterns that accompany it cause greater intra-abdominal pressure on the pelvic organs. This pressure causes falling of the organs in the pelvic cavity increasing strain on the support structures. Because all areas of the body are linking and interacting with each other during total body function, by treating the underlying postural and movement dysfunctions, the prolapse can be better reasoned, explained and treated appropriately.

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