Pelvic organ prolapse (POP) is a common form of pelvic floor dysfunction during pregnancy and postpartum, yet many people are not sure what they are experiencing when symptoms first appear. The good news is that POP is often manageable with the right support, movement strategies, and rehabilitation approach. That’s exactly what we’ll discuss in this article.
Read on to learn:
- What your pelvic floor actually is, and what it does
- What Pelvic Organ Prolapse (POP) is
- Common symptoms of POP
- What causes POP
- POP treatment options, exercises, and support resources
Quick Answer: Pelvic organ prolapse (POP) occurs when one or more pelvic organs — such as the bladder, uterus, or rectum — descend lower than their normal position in the pelvic cavity. Symptoms may include pelvic heaviness, pressure, bulging, urinary changes, or discomfort. Pregnancy, childbirth, hormonal changes, pressure management issues, and pelvic floor dysfunction can all contribute to prolapse. Pelvic floor physical therapy, 360˚ Breathing, neutral alignment, and targeted pelvic floor exercises can often help improve symptoms and support recovery.
What Your Pelvic Floor Is and What it Does
Your pelvic floor is made up of three layers of muscles (14 muscles in total) that form a supportive “sling” at the bottom of your core, with attachment points at the front (pubic symphysis), back (coccyx or “tailbone”), and sides (left and right ischial tuberosities or “Sits” bones).
A well-functioning pelvic floor is responsible for:
- Supporting your pelvic organs: uterus, bladder, rectum
- Helping to stabilize your spine and pelvic-hip region
- Controlling continence (making sure you pee when you want to, and don’t pee when you don’t want to)
- Aiding in sexual response and satisfaction
- Assisting in guiding the baby out during delivery
What is Pelvic Organ Prolapse?
POP is when one or more of the pelvic organs (bladder, rectum, or uterus) descend lower than their normal position in the pelvic cavity. There are four grades of POP, as shown in the diagram below. The higher the grade, the more severe the prolapse. Grade 0 means no prolapse, while Grade 4 is the most advanced form, when one or more of the pelvic organs descend beyond the vaginal opening or rectum. In some cases, surgery may be recommended, though this level of prolapse is far less common.
Common Symptoms of Pelvic Organ Prolapse
Depending on which organ is affected, different symptoms may occur. According to pelvic floor physical therapist, Dr. Mukta Chauhan, common symptoms of POP may include:
- Heaviness, pressure, or ache in the groin area
- Incontinence (urinary or fecal)
- Urgency/ frequency of urine
- Hesitancy to start the stream or a weak or prolonged stream
- Incomplete emptying (urinary or fecal)
- Painful intercourse
It is important to note that the severity of symptoms may not mirror the severity of organ descent (or POP grade). For example, Dr. Mukta says that she has many patients with lower grade prolapse who exhibit more severe symptoms than those with a higher grade.
What Causes Pelvic Organ Prolapse
There are several potential causes of POP. Below are some common factors that can increase the likelihood of developing it.
- Hormonal changes as you age: POP is incredibly common in older age (Nygaard, et. al., 2004). A key reason for this is hormonal changes, which alter the soft tissues of the pelvic floor, making them less supportive.
- Childbirth: This should come as no surprise. Either delivery method — vaginal or cesarean — impacts the pelvic floor. In a vaginal birth, the pelvic floor muscles help guide the baby out during delivery. However, if these muscles are underactive, or in a weakened and shortened state, this could result in increased tearing. A C-section also traumatizes the pelvic floor muscles because the procedure involves moving the abdominal muscles, which are intricately connected to the pelvic floor. The more children one has given birth to, the greater the likelihood of developing POP (Walker & Gunasekera, 2011).
- Pregnancy Alignment Shifts: During pregnancy, the growing belly tends to tip the pelvis forward into an anterior pelvic tilt (as shown below). This increases the stress on the pelvic floor muscles.
- Weak (or overwhelmed) deep core muscles: The deep core muscles of the “Core Canister” (diaphragm, transverse abdominis, and pelvic floor) help regulate pressure in the core (or intra-abdominal pressure). If these muscles are weak — or overwhelmed by the stresses of pregnancy — they cannot regulate pressure as well, thereby increasing stress on the pelvic floor.
- Breath-holding upon exertion: During exertion, holding your breath can increase pressure in the abdominal and pelvic cavities, placing excessive downward pressure on the pelvic floor. One example of this is the “Valsalva maneuver,” which is sometimes used to generate more force when lifting very heavy loads (this is also a key reason many powerlifters experience various forms of pelvic floor dysfunction). Another example of breath-holding upon exertion is bearing down on the toilet during a difficult bowel movement. Unfortunately, constipation is a common side effect during pregnancy, but consistent bearing down puts tremendous downward pressure on the pelvic floor.
- Chronic core engagement: Whether intentional or not, many of us maintain chronic tension in our core muscles (for aesthetics, or because we mistakenly think more engagement results in a stronger core). However, chronic core engagement increases pressure in the core, especially the downward pressure onto the pelvic floor.
POP Treatment Options, Exercises, and Support Resources
In most cases, pelvic floor physical therapy is the most effective first step for managing prolapse symptoms and improving pelvic floor function. It may include specific pelvic floor and core exercises, as well as the use of a pessary—a device that provides internal support for the prolapsed organ. You can use this PT Locator provided by APTA (American Physical Therapy Association) Pelvic Health to find a qualified Women’s Health PT near you.
In addition, here are some other strategies that can help.
1. Get in neutral alignment: Neutral alignment eliminates excess stress on the pelvic floor muscles. Learn how to find and move in neutral alignment below.
2. Master 360˚ Breathing: We refer to this as the #1 most effective core exercise, and it is the first exercise to master to activate and restore strength to your deep core muscles, including your pelvic floor. When your deep core muscles are functioning optimally, they help manage the pressure within your core (to alleviate excess stress on your pelvic floor). Watch the video below to learn how to perform 360˚ Breathing and how to incorporate it into movement by exhaling on the effort. Exhaling on the effort is very important when you are working to heal POP. It allows you to generate the necessary force for a movement (like lifting, carrying, pushing, etc.) while decreasing the pressure in your core.
3. Avoid Breath-holding and chronic engagement: As mentioned above, both these strategies significantly increase pressure on the pelvic floor muscles. Instead, focus on exhaling on the effort.
4. Restore strength to the pelvic floor muscles: The key is to work your pelvic floor muscles through a full range of motion (ROM). Watch the video below to learn how to perform Pelvic Floor Activations (PFAs). The video will walk you through a 4-step process to first find all four of your pelvic floor attachment points (your “pee-stopping” muscles are only the front), then how to work the muscles through a full ROM coordinated with your 360˚ Breathing. The lengthening portion of the movement is especially important when healing from POP.
5. Consider a prolapse-specific garment like this one from SRC Health. It provides support and comfort, and helps manage continence, without increasing intra-abdominal pressure (use code PRONATAL10 for 10% off).
Pelvic organ prolapse is common during pregnancy and postpartum, and symptoms can vary widely from person to person. Understanding how the pelvic floor functions — and how pressure, alignment, breathing, and strength all contribute to pelvic health — can help you make more informed decisions about movement, exercise, and recovery. With the right support and rehabilitation approach, many people see significant improvement in symptoms and function over time.
If symptoms are interfering with daily activities, exercise, or comfort, working with a pelvic floor physical therapist can be extremely valuable. Additional support tools and movement strategies may also help improve symptom management and pelvic floor function.
Post Contributor
Dr. Mukta Chauhan, DPT, OCS, WCS is one of the few physical therapists in the country with a double board certification in orthopedics and women’s health. Because of this dual training, Dr. Mukta understands the delicate interplay between neurophysiology, biomechanics, musculoskeletal, fascial and organ systems and their combined contribution to a person’s overall wellbeing. She is a firm believer in addressing health from a bio-psycho-social perspective, because we aren’t just our tissues. The whole person is at the center of her practice. She lives and practices in New York City. Connect with her on IG @thepelvic.connection.
Sources
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Nygaard, I., Bradley, C., & Brandt, D. (2004). Pelvic organ prolapse in older women: prevalence and risk factors. Obstetrics & Gynecology, 104(3), 489-497.
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Walker, G. J., & Gunasekera, P. (2011). Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. International urogynecology journal, 22(2), 127-135.