Pelvic Organ Prolapse – How to Best Protect and Strengthen a Prolapse

Pelvic organ prolapse self management involves prolapse exercises and ongoing prolapse protection strategies. pelvic organ prolapse

Read on to learn the health professional answers and techniques for these frequently asked prolapse questions:

  • What causes a vaginal prolapse?
  • What are the symptoms of a mild and more severe prolapse?
  • What is the treatment for a prolapse?
  • Do kegel exercises or pelvic floor exercises help a prolapse?
  • How to manage a prolapse and prevent it worsening?
  • How to exercise safely with a prolapse?

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International best selling prolapse exercise guide for women with prolapse and after prolapse surgery.

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Prolapse Exercises teaches you how to:

  • Exercise safely after prolapse surgery
  • Reduce your risk or repeat prolapse
  • Avoid unsafe exercises
  • Choose pelvic floor safe exercises
  • Reduce your risk of prolapse worsening
  • Improve prolapse support
  • Increase your strength and fitness
  • Strengthen your core
  • Lose weigh

What is Pelvic Organ Prolapse?

Pelvic organ prolapse refers to one more of your pelvic organs slipping down or protruding through a defect in your pelvic floor. Your pelvic organs include your bladder, urethra, uterus, vagina, anus and rectum.

Some common types of pelvic organ prolapse include vaginal prolapse, rectal prolapse and anal prolapse.

Vaginal prolapse

  • A prolapsed bladder or cystocoele involves the bladder protruding through the front wall of the vagina. People often refer to a bladder prolapse as a “fallen bladder” or “dropped bladder”.
  • A urethral prolapse involves the urethra or urine tube sagging into the front wall of the vagina.
  • A uterine prolapse involves the uterus, cervix and top part of the vagina descending into and sometimes out of the vagina. This is also known as a “fallen womb”. A prolapsed uterus can involve the vagina turning inside out and protruding out of the vaginal entrance.
  • The rectum can also protrude into the back wall of the vagina and is also known as a rectocoele. This is not the same as a rectal prolapse.

Rectal prolapse and anal prolapse

A rectal prolapse involves the walls of the rectum moving down and protruding out of the back passage. This type of prolapse is also known as a “bowel prolapse”.  An anal prolapse involves the membrane lining the anus protruding out through the anus.

Causes of Pelvic Organ Prolapse

A prolapse is like a hernia. When the strong layers of tissue (called fascia) and the pelvic floor muscle that hold your organs in place become weak or damaged, this allows the organs they support to bulge through this tissue.

To understand a vaginal prolapse, think of when you stretch really thick plastic. The weakened floppy areas that you see in the plastic are like the weakened areas in the walls of your vagina. When thin floppy vaginal walls cannot support the pelvic organs (bladder, uterus, bowel) and they protrude into the vagina.

Pelvic Organ Prolapse Symptoms

Prolapse symptoms for a small to moderate size prolapse

A prolapsed bladder or bowel prolapse commonly present as a lump or a bulge that you can feel and sometimes see coming down out of your vagina. You will notice that it tends to bulge more when there is an increase in pressure inside your abdomen, such as when you cough or open your bowels. The bulge usually lessens when you lie down. A prolapse may also create a feeling of heaviness within your vagina which may be worse when you are standing up, or even immediately prior to using your bowels. In general, in the case of a small- or moderate-sized prolapse, sex is not usually uncomfortable or problematic.

Prolapse symptoms for a moderate to large size prolapse

As a prolapse becomes larger, the vaginal lump usually becomes more obvious. Many women describe their prolapse as an “egg” at the entrance of their vagina, and they can feel it when washing. As a prolapse gets bigger, some women describe a dragging sensation in their pelvis. In the case of a large uterine prolapse, sex can be very uncomfortable and in some cases not possible if the prolapse blocks the vaginal entrance. With a larger prolapse, sex can cause pain, and some women experience low back ache and difficulty inserting a tampon. If the prolapsed tissue drags on your underwear, it can cause bleeding.

You may experience bladder prolapse symptoms such as frequent and/or urgent need to empty your bladder. Some women find that having a bladder prolapse makes it difficult to fully empty their bladder. This can cause chronic bladder infection. Bowel prolapse into the back wall of the vagina can make using your bowels difficult, and some women need to use their hand to support and lift the tissue between their vagina and anus.

Pelvic Organ Prolapse Treatment

Vaginal prolapse treatment involves:

  1. Preventing a prolapse if you are at risk of having a prolapse.
  2. Managing your existing prolapse and preventing your prolapse from worsening with vaginal pessary devices and/or Kegel exercises for pelvic floor muscle training. Read more on prolapse management below.
  3. Vaginal surgery for pelvic floor repair.

Kegel Exercises for Prolapse

Kegels may help you to prevent or manage pelvic prolapse:

  • If you can learn to contract your pelvic floor muscles before pressure is placed upon your prolapsed tissue, such as before you cough or lift, this may reduce your prolapse symptoms and prevent your prolapse from worsening.
  • Pelvic floor exercises or Kegel exercises can make your pelvic floor into a stronger, thicker and firmer support, which may also prevent your prolapse from worsening or may reduce your symptoms.

Inside Out by Pelvic Floor Physiotherapist Michelle Kenway and Urogynaecologist Dr Judith Goh guides you step by step through how to do kegel exercises or pelvic floor exercises effectively. Inside Out also includes core workouts to teach you how to use your pelvic floor muscles to reduce the pressure of everyday activities on your prolapse and your pelvic floor.

Prolapse Management Strategies

A prolapse will not go away once you have one. You may, however, reduce your prolapse symptoms and avoid worsening your prolapse with the following measures:

  • Stop smoking – Coughing associated with smoking may over time cause or worsen a prolapse.
  • Manage your weight– If you are overweight, you will increase the pressure on your pelvic floor and your prolapsed tissue.
  • Avoid constipation and never strain-Repeated straining with constipation will weaken your pelvic floor, increase your risk of prolapse and potentially worsen your prolapse symptoms.
  • Avoid heavy lifting and the wrong kind of exercise-Heavy lifting and inappropriate exercise (see below) will increase your risk of prolapsed tissue and pelvic floor muscle weakness.
  • After prolapse surgery, do all the above to avoid further pelvic floor dysfunction– Previous pelvic floor surgery, including vaginal surgery for prolapse, is likely to increase your risk of further prolapse in the future.
  • Try wearing quality briefs or support underwear-Some women find that support briefs help to reduce prolapse symptoms, especially when they are on their feet or working for long hours.

Safe Exercise with a Prolapse pelvic organ prolapse

The wrong kind of exercise will make your prolapse symptoms worse and may increase the likelihood of recurrent prolapse after prolapse surgery. Having a uterine prolapse or prolapsed bladder does not mean that you cannot exercise. If you have a prolapse or have had pelvic floor surgery, you need to know how to exercise to get the best results AND protect your pelvic floor at the same time.

Avoid high-impact exercises that involve having both feet off the ground at once or stepping heavily, as these exercises increase the likelihood of pelvic floor dysfunction. Choose from the list of appropriate low-impact exercises and read all about those exercises to choose and those to avoid in Inside Out – the essential women’s guide to pelvic support.

Avoid specific exercises that increase downward pressure on your pelvic floor and increase the likelihood of pelvic floor dysfunction. Inside Out describes these exercises, and the exercise classes that may worsen your symptoms and increase the likelihood of repeated prolapse following pelvic floor surgery. If your pelvic floor is weak, avoid abdominal curl or sit-up exercises that will force it downward. Avoid specific Pilates exercises such as Table Top with both of your legs in the air.

Pelvic organ prolapse is a common problem in women and yet many women lack the understanding of best to exercise and protect their prolapse. This pelvic organ prolapse information has been written to inform women and assist prolapse self management.

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We Welcome Your Comments


  1. Hi. I have a slight but worsening prolapse. I am in my 40’s and sexually active. I want to feel confident, but I feel like my vagina is ugly and unattractive. I’m not sure what to think? And I’m worried for the state of my prolapse…what’s going to happen? If I opt for surgery will I be able to enjoy sex again?

  2. hello, will a stair master case machine worsen my prolapse ? thank u

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Noemi I can’t say, it’s best to judge on your symptoms and cease if you notice worsening after stairmaster

  3. Michelle,
    I have watched all your videos and am so grateful for your expertise. One question I still have is whether the stair climber machine at the gym is safe for me since I have a prolapsed bladder. I greatly appreciate your help.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Shannon
      This really depends on your body and how it responds to stair climber. It’s a nice low impact exercise so i don’t envisage it placing a large strain on the pelvic floor. My physio instincts tell me to suggest that you stand upright to maintain good posture when using it rather than leaning forwards. If you notice an increase in symptoms then leave it. Also maybe start out with 5 mins or so and see how your symptoms feel over the next day or so. Hope this helps Shannon and enjoy

  4. I have a uterine prolapse and when working have to sit for about 4 hours. could you recommend what kind of chair I should invest in and which is the best posture to adopt.
    Also, I have many flights of stairs to climb, would you recommend my taking the lift and is climbing stairs bad for you with a prolapse.


    • Michelle Kenway says

      Hi Pauline

      When sitting opt for a firm back support chair – there is no special type of chair required specifically for prolapse other than one that ensures really good upright supported posture.

      This article will give you details on sitting and standing posture for your pelvic floor

      Yes I do think stairs can be an issue, potentially with repeated walking down flights of stairs and stepping heavily.So walk up and take the lift down if you are required to go up and down repeatedly throughout the day.


  5. Hi Michelle, I’m reading your website with great interest as I have moderate prolapse symptoms and am keen to understand what exercise is beneficial. Can I ask you, there is also a lot of info out there saying ‘don’t do kegels’ as at best they’ll do nothing and at worst, they’ll encourage the pelvic organs ‘down’ as opposed to encourage their natural position, and I’d love to hear your comments on this. Many thanks.

    • Michelle Kenway says

      Hi Elizabeth

      Thanks so much for your comment. It is very important that you have raised this for clarification.

      What we know from recent high quality scientific studies into the effectiveness of Kegels for pelvic organ prolapse are two things: in cases of women with mild to moderate prolapse a program of Kegels (pelvic floor exercises) wil improve prolapse symptoms as well as to lift the whole pelvic floor to sit higher within the pelvis i.e. increasing prolapse support. This means that Kegels for prolapse may be very important in post operative prolapse management as well if they can promote pelvic floor support.

      The only time when Kegels will cause the pelvic organs to move down is when the wrong Kegel technique is used. The correct technique is to lift and squeeze the pelvic floor muscles (which in so doing, lift the pelvic organs). If the woman performs the incorrect Kegel technique of pushing or bearing down on the pelvic floor rather than lifting up, then in this situation the pelvic prolapse might be worsened.

      So this really needs to be clear to women – when performed with correct technique, we know Kegels will assist women with mild to moderate prolapse. When performed with a bearing down technique on the pelvic floor then prolapse could forseeably be worsened. This is why women need to ensure they are performing the exercise technique correctly from the outset.

      Let me know if you need further information on this, it is a very important comment Elizabeth and thank you for submitting.

      • Hi Michelle,thanks for the reply and you more or less said what I was thinking. I have a moderate bowel prolapse,bulging into the back of the vagina.My only concern is that whilst I can see that the kegel exercises aim to lift, there must surely be some ‘inward’ draw as well,which could potentially increase the bulging? I am post menopausal and feel that lower oestrogen may also affect the quality/strength of the vaginal wall,influencing the situation.
        Thanks so much for your comments.

        • Michelle Kenway says

          Hi Elizabeth
          You are absolutely correct in that there is some inward squeezing however not just to the vagina (I can see how you would think this would pull the bowel prolapse into the vagina). In actual fact the pelvic floor muscles extent to the rectum, some fibres are continuous with the external anal sphincter before the muscles insert into the coccyx or tail bone. So the indraw is not confined to the vagina – it is more like an inwards lift of the whole area from the pubic bone to the tail bone, hence their real anatomical name ‘levator ani’. I hope this clarifies for you – with a bowel prolapse Kegels are the correct exercise ensuring that the back passage or anus lifts inwards as well rather than just focus on the vagina. Let me know …

  6. Thank you Michelle! Another question, are arm exercises ok to do on the pilates apparatus if the legs are supported (say sitting doing arms)? Again, I am with full hyster and mild bladder prolapse. Thanks and anxiously awaiting my Inside Out package from you!
    Kind Regards

  7. curious about the stationary bike called the Schwinn AirDyne. You sit upright on a full seat (not the narrow spinning seats) and move your arms forward and back while using the legs. You can put all the effort in either the arms or legs or both combined, but other than that there are no gear settings. Would this machine be ok for a mild bladder prolapse (Dr. said no restrictions, but he’s no physio!) Thank you so much for all of your information!
    Kind Regards

    • Michelle Kenway says

      Hi Melly
      Thanks for your question about the Schwinn AirDyne – having looked at this bike, I have not ridden this model so cannot be sure how much resistance is placed through the legs.However having ridden similar types of bikes I would be inclined to favour using the legs rather than placing too much effort through the upper body with pelvic floor weakness. The cycle position is usually not problematic with mild prolapse, just ensure that there is no strain on your pelvic floor when peddling legs. I think you will minimise the potential for strain by keeping the arm activity very light resistance.

      Let me know how you go.

  8. Joanne Gall says

    I have just been diagnosed with severe prolapse & am a gym user.I workout on Xtrainer,bike,treadmill & rowing machine as well as a few weight exeecisers.Are any of these unsafe 2 use now i have prolapse?Will i have 2 discontinue my gym?

    • Michelle Kenway says

      Hi Jo
      Thanks for your question. What you can ultimately do in terms of exercise will depend on how well your pelvic floor muscles and ligaments are supporting your pelvic organs, and this needs to be assessed by a gynaecologist or pelvic floor physio. In general women with mild to moderate prolpase can use bike (seated low gears), treadmill walking (flat) and cross trainer (light resistance) quite comfortably. Many weighted exercises are possible, and others should be avoided. You can read much more infomation about appropriate exercises with a prolapse using the links on this page I hope this gives you somewhere to start Jo

  9. are there any abdominal exercises that are safe to do with a mild prolapse uterus?

  10. Hi Michelle
    I have stage 2 cycstocele and stage 2 rectocele. I have been doing kegels for many months and feel a lot of benefits, however I do feel that the exercises pull the back vaginal wall forward and seem to be making the rectocele bigger. Am I doing the kegels wrong, or should I be doing different exercises as well?

    • Michelle Kenway says

      Hi Sally
      When your pelvic floor muscles contract they lift and squeeze in and around your pelvic openings. As the pelvic floor muscles contract they do pull forward so this may be what you are feeling. In this case check 2 things – make sure you are lifting internally as you contract and that you are not bulging downwards. If you are already feeling better this is a good sign that you are doing things well, however the rectocele shouldn’t get bigger as a result, it should actually lift higher in the pelvis over time. I think they key is to focus on the lift adn ensure against the bulge, does this make sense?

  11. Hi, I have a prolasped womb (it rests on my bowel) can I do rebounding excercise?? I was really looking forward to doing this class but I have been told I possibly cant… :-(

    • Michelle Kenway says

      Hi Louise
      Unfortunately I’m not able to comment on your individual situation as I don’t know your pelvic floor function or the degree of prolapse. What I can say is that rebounding with both feet off the rebounder involves landing with some impact. I suspect that this impact may increase the downwards pressure on the pelvic floor with the landing. Are you planning on doing a rebounding class? I haven’t heard of these, do you have any information that I might follow up for you?

  12. karasalle says

    I have moderate bladder and rectal prolapse. I’ve done kegel’s for years, and have good muscles, but I delivered 2 large babies and had a total hysterectomy years ago. My favorite exercise has always been riding horses, and I’ve also hiked, swam, and done yoga/crunches/side leg lifts/ and push ups. Should I give up some of these? Is it OK to ride if I mostly walk?


    • Michelle Kenway says

      Hi K
      What you can do on an individual basis depends upon your pelvic floor strength, your body weight, your age …many factors come into play. In general terms I would think that riding a walking horse would be a reasonalbly pelvic floor safe activity. I do believe that intense core abdominal exercises including full men’s push ups and crunches are not appropriate with prolapse problems, and some (not all) Yoga exercises should be approached with caution.

  13. Where can I find answers to questions that I submitted?

  14. Hi, I am dealing with prolapse and just found out I have a herniated disc in my back (lumbar region). Will be starting core strengthening therapy and wonder if there is anything I need to avoid or be aware of that my therapist may suggest! Thank you!

    Is it ok to use a mini gym trampoline to bounce on as a form of exercise and fitness.  when I suffer from stress incontinence due to a prolapse, rectoceles i think, and fibroids pressing on the pelvic floor.
    I have heard that rebounding exercices are very good, even to prevent some cancers.
    Thank you
    best wishes

    • Minitramp and prolapse

      Hi Martine

      The amount of pressure on your pelvic floor with a rebounder/mini tramp will depend upon how high you jump, how fast you jog/walk and whether you have both feet off the rebounder at once or not. A low impact version of rebounder would involve at least one foot in contact with the rebounder at all times and using a slow action. There may be the potential for some pelvic floor pressure using a minitramp especially with large fibroids and prolapse but less if used in the manner I have described. Most women find that stationary cycling places far less pressure on the pelvic floor than rebounding type exercises. Walking is also a fantastic form of low impact exercise for you to consider if appropriate.

      Best of luck

  16. Hi my mum was told a year ago she had a pelvic organ prolapse. And she has got to the stage where she can't walk without being in pain all in the lower area. She sometimes can't make it to the toilet quick enough and wets herself sometimes a couple of times a day. They put in a permanent catheter in August but it has made it worse. Now they said she may not benefit from any surgery which doesn't sound right at all. Do you have any advice please .

    • Hi Sue

      Your Mum has a difficult situation with pelvic pain, pelvic prolapse and urinary incontinence- especially now with the failure of her indwelling catheter.

      Has your mum seen a continence nurse advisor for advice or a pelvic floor physiotherapist in the UK? If surgery has failed in this regard then this would be a good approach to take. I am not sure of the availablilty or cost of these services in the UK?


  17. Hello,
    I suspect I may have a prolapse and will be going to my doctor soon, I have a baby who I carry in an ergo baby carrier most days, sometimes for a few hours if I am out and about with my toddler. I carried my older son till he was over 18 months of age, and ideally I would like to do the same, however is this bad for my pelvic floor and if I do have a prolapse?
    Thank you.

    • Prolapse and carrying baby

      Hi Mary
      Yes unfortunately the more load carried whether it is extra physical body weight or carrying heavy loads will increase the load on the pelvic floor. Post natally the pelvic floor is weak and has less capacity to withstand the forces associated with carrying heavy loads and/or carrying a load for a long duration. If the pelvic floor is not fully recovered from the first baby, then the capacity to withstand pressure is even less second time around.

      Ideally to protect your prolapse you would aim to nurse most when sitting or laying down to be more protective of a prolapse.However as all mothers and carers know what is ideal is not always possible with young children. When spending time walking/shopping/exercising using a pram will take the load off the pelvic floor and allow it to recover from pregnancy and childbirth. I do understand the bonding issue here and so it would be best to maximise bonding/nursing time in your unloaded positions and also work diligently on pelvic floor rehabilitation to ensure your full recovery. Also be mindful of pre bracing the pelvic floor muscles before and during lfting your baby (but not constantly when carrying).

  18. Hi
    When you have a prolasped cervix can you do power walking and bicyling?

    • Hi Chris

      When you have a prolapse it is advisable to perfom low impact exercises that minimise pressure on the pelvic floor. These include power walking and cycling with a few qualifications. When walking it is possible to reduce impact further with good footwear, alternating surfaces and never walking carrying hand weights. As far as cycling goes, least pressure on the pelvic floor involves flat surfaces, low gears and remaining in the saddle during cycling. Other tips include breaking your workouts, especially walking into more frequent yet shorter walks, and avoid these when fatigued or unwell as the pelvic floor will be less effective for support.

      Hope this helps Chris