Feel Supported Again

Heaviness, dragging, or a feeling that something is coming down.

Many women describe prolapse as something bulging down there, a feeling that something is falling out, or a sensation like sitting on a ball.

It may be worse by the end of the day, after a long walk, following lifting or exercise, or at certain times of the month.

These symptoms can be unsettling, particularly when you’re unsure whether exercise, lifting or simply getting older will make things worse.

Pelvic organ prolapse is common, and the reality is often much more manageable than women initially fear.

At CoreGood, we start by understanding which structures are involved, how the prolapse is affecting you, how your pelvic floor and pressure-management system are functioning, and what you want to get back to.

Then we build the appropriate pathway forward.

What Does Prolapse Actually Feel Like?

The most common symptoms are heaviness or dragging in the vagina, a bulge you can feel or see, or a sensation that something is sitting lower than it used to.

Other symptoms can include:

A dragging or pulling feeling low in the pelvis

Something you can feel with your fingers or while washing

Difficulty completely emptying your bladder

Difficulty emptying your bowels

Needing to press against the vaginal wall or perineum to help empty your bowels

Discomfort or a feeling of obstruction during sex

Symptoms that become more noticeable after prolonged standing, lifting or activity

Some women have very few symptoms and only discover a prolapse during an examination.

And many women immediately wonder:

The answers are often more encouraging than you might expect.

Understanding What’s Changed

Your pelvic organs are supported by a system, not one muscle.

Ligaments and connective tissue provide support from above.

The pelvic floor muscles provide active support underneath.

The vaginal walls and surrounding connective tissues contribute structural support.

And the whole system responds to changes in abdominal pressure every time you breathe, cough, lift, strain, exercise or move.

Pelvic organ prolapse occurs when this support system changes enough that the bladder, uterus, bowel or top of the vagina descends towards or into the vaginal canal.

Importantly, the amount of descent doesn’t always predict how much it will affect you.

Two women can have a similar prolapse on examination and experience very different symptoms.

That’s why we treat the woman and her goals — not simply the stage written on an examination report.

What Are the Different Types of Prolapse?

Prolapse is named according to which structure has descended.

Many women have more than one type at the same time, and understanding which structures are involved can help explain the symptoms you’re experiencing.

You don’t need to know which type you have before asking for help.

Determining what’s involved is part of the assessment.

What Do the Stages of Prolapse Mean?

Prolapse is commonly described using the POP-Q system, which measures how far the prolapse has descended relative to the vaginal opening.

Stage 0

No prolapse.

Stage 1

The prolapse remains well above the vaginal opening.

Stage 2

The leading edge is close to the vaginal opening — within approximately 1 cm above or below it.

Stage 3

The prolapse extends beyond the vaginal opening but is not completely everted.

Stage 4

Complete or almost complete eversion.

The important thing to understand is that stage doesn’t determine your future or automatically determine your treatment.

Mild descent is common, particularly after childbirth, and some women with stage 1 or 2 prolapse have very few symptoms.

Others with a similar stage are considerably more bothered.

Your symptoms, pelvic floor function, lifestyle, goals and what you want your body to be able to do are just as important as the number.

Why Did This Happen?

Prolapse usually develops because of a combination of factors rather than one single event.

These can include:

Pregnancy and childbirth

Assisted or difficult vaginal delivery

Changes or injury to pelvic floor muscles and connective tissues

Repeated constipation and straining

Persistent coughing

Repeated heavy physical loading

Menopause and changes in tissue quality

Genetic differences in connective tissue

Previous pelvic surgery, including hysterectomy

Other factors that repeatedly increase load on the pelvic support system

Some of these factors cannot be changed.

Others can.

Understanding the factors that are still influencing your symptoms is an important part of conservative rehabilitation.

Can Prolapse Improve Without Surgery?

This deserves a clear answer.

Pelvic health physiotherapy cannot restore stretched or injured connective tissue to exactly what it was before, and we shouldn’t promise to make a prolapse disappear.

But that doesn’t mean there is nothing meaningful we can change.

Rehabilitation can help improve pelvic floor function, reduce symptoms, improve how you manage pressure and load, address bowel habits and help you return more confidently to exercise and everyday activity.

For many women, symptoms become manageable enough that surgery isn’t something they want or need at that point.

Other women benefit from combining rehabilitation with a pessary.

And some women ultimately choose surgery.

None of these pathways represents success or failure.

The goal is to understand your situation and help you choose the approach that best supports the life you want to lead.

What Does Conservative Management Involve?

Conservative management means improving the things we can influence without surgery.

Depending on your assessment, this may involve:

Pelvic Floor Rehabilitation

Improving contraction, relaxation, strength, endurance and coordination according to what your pelvic floor actually needs.

The first priority is making sure you’re lifting and supporting rather than inadvertently bearing down.

Breathing, Pressure & Load Management

Learning how your pelvic floor, diaphragm and abdominal system work together during lifting, coughing, exercise and everyday movement.

The goal isn’t to avoid load.

It’s to build your ability to manage it.

Bowel Management

Constipation and repeated straining can place considerable load on the pelvic support system.

Stool consistency, toilet position, breathing and emptying technique can all make a difference.

Exercise Modification & Progression

For most women, the answer isn’t to stop exercising.

We may temporarily modify certain activities, build capacity and then progressively work back towards what you want to do.

Pessary Support

For some women, a pessary provides useful mechanical support alongside rehabilitation.

Medical Support Where Appropriate

Hormonal changes, tissue health and other medical factors may also be relevant.

Where appropriate, we may recommend discussing options such as vaginal oestrogen with your GP or specialist.

What Is a Pessary?

A pessary is a removable device placed inside the vagina to provide mechanical support to the prolapsed structures.

Different shapes and sizes are available depending on the type of prolapse and the woman. Some women use a pessary every day, while others use one specifically for running, exercise, work or longer periods on their feet.

A pessary doesn’t repair the underlying connective tissue. Instead, it provides additional support while you’re wearing it — and for many women that can make an important difference to comfort, confidence and activity.

Pelvic floor rehabilitation and pessary use can work well alongside one another. Rehabilitation focuses on improving the function and capacity of your pelvic floor and how you manage load and pressure, while the pessary provides additional mechanical support where needed.

What if a pessary may help me?

CoreGood does not fit pessaries.

If, after assessing your prolapse, we think a pessary could be a useful part of your management, we’ll discuss why and refer you to an appropriate women’s health provider for assessment and fitting.

You can then continue your pelvic floor rehabilitation with us alongside pessary use.

The aim isn’t to choose between rehabilitation or a pessary. For some women, the best solution is a combination of both — particularly when the goal is returning confidently to exercise, lifting, work or other activities that increase pelvic floor load.

When Is Surgery Considered?

Surgery may be considered when prolapse symptoms are significantly affecting quality of life and conservative options haven’t provided enough improvement, or when the prolapse is more advanced.

That decision belongs between you and an appropriately qualified gynaecologist or urogynaecologist.

Pelvic health physiotherapy can still be useful before and after surgery.

Before surgery, we can address pelvic floor function, bowel habits, breathing and pressure management.

Afterwards, rehabilitation can help guide your return to lifting, exercise and everyday activity once your surgeon is happy for you to progress.

If you already have a surgical date, let us know because it changes what we prioritise.

How We Assess It

We don’t begin by simply giving you pelvic floor exercises.

We begin by understanding what has changed and how it is affecting you.

Understanding Your Situation

We’ll talk about:

What you’re feeling

When symptoms are better or worse

Your pregnancy and birth history

Bladder and bowel function

Exercise, work and lifting demands

Menopause where relevant

What you’ve stopped doing because of your symptoms

What you’d most like to get back to

We also want to understand what you’re worried about.

For many women, uncertainty about whether they’re causing damage or making the prolapse worse can become almost as limiting as the symptoms themselves.

Objective, Non-Invasive Assessment

Where appropriate, we can begin with objective, non-invasive assessment.

Real-time ultrasound can help us observe pelvic floor movement, contraction, relaxation and coordination.

It can also help us see whether you’re creating an effective lift or inadvertently bearing down during a contraction.

Biofeedback may provide additional objective information about pelvic floor recruitment and control.

We also assess how your pelvic floor coordinates with breathing and how you manage pressure during movement, coughing, lifting and activities relevant to your symptoms.

Where bladder emptying is a concern, ultrasound may also be used to assess the bladder before and after emptying.

Will I Need an Internal Examination?

For prolapse, an internal vaginal examination can provide particularly useful information because it allows us to assess which vaginal walls are involved, the degree of descent, tissue support and pelvic floor muscle function.

Ultrasound cannot provide all of that information.

However, an internal examination is still your choice.

If we recommend one, we’ll explain what information we’re hoping to gain and how it may change your rehabilitation plan.

You can consent, decline or defer it.

Nothing happens without your understanding and consent.

Your Personalised Pathway

Once we understand what’s contributing to your symptoms, we build rehabilitation around what you actually need.

Your pathway may include:

Pelvic Floor Rehabilitation

Improving strength, relaxation, endurance, timing and coordination, then progressing those skills into the movements and activities that matter to you.

Breathing, Pressure & Movement

Improving how your pelvic floor works with your diaphragm and abdominal system during lifting, exercise and everyday activity.

Bowel & Bladder Strategies

Reducing unnecessary straining and improving emptying where this is contributing to symptoms.

Biofeedback & Rehabilitation Technology

Real-time ultrasound, biofeedback, MAPLe or PelviPower may be incorporated where they provide useful information or improve rehabilitation.

Return to Exercise & Load

Building capacity rather than simply restricting activity.

Pessary or Medical Support

Where appropriate, we can discuss whether additional support or medical assessment may be worthwhile and help guide you towards the right provider.

Surgical Preparation & Rehabilitation

If surgery becomes the right pathway for you, physiotherapy can help prepare your pelvic floor and pressure-management system beforehand and support your return to activity afterwards.

You don’t need to know which pathway is right for you before booking. That’s our job.

What Improvement Can I Expect?

The goal isn’t simply to change a measurement on an examination.

It’s to help your prolapse become less influential in your life.

That may mean:

Less heaviness or dragging by the end of the day

More confidence lifting and carrying

Returning to walking, running or the gym

Easier bladder or bowel emptying

Feeling more comfortable during intimacy

Worrying less about whether everyday activity is making things worse

How much improvement you can expect depends on the type and degree of prolapse, your pelvic floor function, tissue support and the demands placed on your body.

Some women experience substantial improvement with rehabilitation.

Others improve but still benefit from a pessary.

And some eventually decide that surgery offers the outcome they’re looking for.

After your assessment, we’ll explain what we think is realistic in your situation.

If we believe you’d be better served by gynaecology or urogynaecology input, we’ll tell you.

Frequently Asked Questions

Can prolapse be fixed without surgery?

Rehabilitation doesn’t restore stretched connective tissue to exactly what it was before or guarantee that a prolapse will disappear.

What it can often do is reduce symptoms, improve pelvic floor function, improve pressure and load management and help you return more confidently to everyday activity and exercise.

For some women that’s enough.

Others benefit from a pessary or eventually choose surgery.

Will my prolapse get worse?

Not necessarily.

Prolapse doesn’t progress at the same rate in every woman, and symptoms can fluctuate.

Factors such as repeated straining, constipation, coughing, tissue changes and how your body manages load may influence symptoms and potentially progression.

Part of rehabilitation is identifying the factors we can modify rather than asking you to avoid normal life.

Can I still run, exercise and go to the gym?

For many women, yes.

The aim is generally to build capacity rather than permanently restrict activity.

Sometimes we modify load or exercise temporarily while improving pelvic floor function, breathing, pressure management and overall capacity.

Then we progressively work towards the activities that matter to you.

Should I avoid lifting my child?

For most mothers, avoiding lifting their child isn’t realistic.

Instead, we can work on how you breathe, manage pressure, position the load and build the physical capacity required for the lifting your life actually demands.

I can feel a bulge. Does that mean my prolapse is severe?

Not necessarily.

The amount of descent and the severity of symptoms don’t always match.

An examination can help determine which structures are involved and the degree of descent, but your symptoms and how the prolapse affects your life are just as important when deciding what to do about it.

Do I need a pessary?

Not everyone does.

For some women, a pessary provides useful additional support for everyday life or specific activities such as exercise.

Others manage well with rehabilitation alone.

Whether it’s worth considering depends on your prolapse, symptoms, goals and preferences.

Will I need an internal examination?

An internal examination can provide particularly useful information for prolapse because it allows us to determine which structures are involved and assess the degree of descent.

If we recommend one, we’ll explain why and what information it will provide.

It remains your choice, and you can decline or defer it.

Should I see a gynaecologist instead?

For many women with mild to moderate prolapse symptoms, conservative management with pelvic health physiotherapy is a reasonable place to begin.

If your prolapse is more advanced, symptoms are severe, there are unexplained symptoms such as bleeding, or we believe specialist medical assessment would improve your care, we’ll recommend it.

We work alongside your GP, gynaecologist or urogynaecologist where appropriate.

Does ACC Cover Prolapse Physiotherapy?

ACC may cover some pelvic organ prolapse related to an eligible maternal birth injury occurring on or after 1 October 2022.

Eligibility depends on the circumstances of the injury and current ACC criteria.

If you think this may apply to you, please ask when booking and we can help clarify the appropriate pathway.

If ACC doesn’t apply, treatment can still be accessed privately.

Ready to Take the First Step?

You don’t need to know what type or stage of prolapse you have before asking for help.

Your first appointment is about understanding what’s changed, identifying which factors are contributing to your symptoms and working out what can realistically improve.

You’ll leave with a clearer understanding of your own situation, practical things you can start doing and a pathway built around the life you want to lead.