How to Reverse Pelvic Prolapse and Avoid Prolapse Surgery

Are you trying to avoid pelvic prolapse surgery?

Would you like to reverse your prolapse repair?

This Physiotherapy prolapse information teaches you how to:

  • Improve pelvic prolapse without surgery
  • Non-surgical prolapse treatment options 
  • Avoid prolapse worsening

Can Pelvic Prolapse be Reversed?

Yes!

Pelvic prolapse can be treated and improve without surgery in some women.

Prolapse results from stretched and weakened supporting pelvic floor tissues, just like overstretching a piece of elastic.

Pelvic Organs

Your pelvic floor muscles should work to help support your pelvic organs (i.e. bladder, uterus and rectum). Women with prolapse have weak pelvic floor muscles1 so they have decreased internal support.

Recent scientific research2 showed that three months of pelvic floor muscle training reduced the severity of vaginal prolapse in some women with mild to moderate prolapse (i.e. pelvic prolapse sitting above the vaginal entrance rather than beyond).

Proven effective prolapse treatment2 includes:

  • Training the pelvic floor muscles to increase prolapse support
  • Learning The Knack exercise technique to reduce prolapse strain (see video below)
  • Modifying lifestyle factors that worsen prolapse problems (e.g. straining with constipation, heavy lifting and inappropriate general exercise)

This video teaches you how to do ‘The Knack’ technique for prolapse treatment.

In women with more severe prolapse problems (i.e. prolapse protruding below the vaginal entrance) pelvic floor muscle training is less effective in reversing prolapse. These women are still likely to benefit from pelvic exercises, especially if they are undergoing prolapse surgery and are seeking to avoid repeat prolapse.

Can Non-Surgical Treatment Relieve Prolapse Symptoms?

Yes!

The frequency and severity of pelvic prolapse symptoms can be relieved without surgery in some women.

Scientific research has shown that women can reduce how often they experience prolapse symptoms with pelvic floor muscle training2.

Some of the most common prolapse symptoms i.e. vaginal bulging and heaviness that are often the main indicators for prolapse surgery have also been reduced with pelvic floor muscle training.

How Much Pelvic Floor Muscle Training for Results?

Pelvic floor muscle training to reverse the stage of prolapse and relieve vaginal bulging and heaviness involves:

• Performing 3 sets (groups) of daily pelvic floor exercises
• Repeating your exercises 8-12 times in a row
• Contracting your pelvic floor muscles strongly with every exercise

If you are suffering from prolapse problems, pelvic floor exercises can help you take back some control over your body. These muscle training exercises cost you nothing and there are no adverse side effects if they are done correctly.

More Tips for Treating Prolapse Symptoms

losing weight

  • Losing weight especially abdominal fat (if you are overweight)
  • Correcting posture
  • Managing your bowels using correct bowel emptying technique
  • Using a support pessary
  • Managing of chronic chest conditions that cause coughing
  • Modifying adverse lifestyle factors (e.g. using safe lifting techniques)
  • Staying strong and fit with pelvic floor safe exercises

For more details on how to treat these prolapse symptoms listed please refer to further reading and videos (below).

Will my Pelvic Prolapse Worsen?

Unfortunately there is currently no way of predicting whether a woman’s pelvic organ prolapse will worsen over time or how quickly.

There is no one rule fits all when it comes to prolapse worsening.

Some women don’t experience prolapse worsening over time.

Others find that their prolapse worsens to the extent that they require prolapse repair surgery.

Pelvic organ prolapse tends to progress as women increase in age3. This suggests that life-long prolapse management involving pelvic floor muscle training is important for women living with prolapse problems who are seeking to avoid prolapse surgery.

Key Points

  • Pelvic floor muscle training is a scientifically proven effective non-surgical pelvic prolapse treatment for some women in the short-term at least.
  • You may be able to avoid pelvic prolapse surgery with pelvic floor muscle training if you can relieve those prolapse symptoms that are the main indicators for repair surgery.

If you’re not sure about how to proceed with pelvic floor training to manage your pelvic prolapse then why not seek the guidance of a Pelvic Floor Physiotherapist?

Further Reading & Related Videos

» How Pessaries Can Help Prolapse Symptoms And Support

» Safe Lifting Weight Limit With Prolapse or After Hysterectomy

» Pelvic Prolapse Exercises for Fitness? Get on Your Bike and Ride!

» Best Exercise to Lose Weight After Hysterectomy or Prolapse Surgery

Prolapse Exercises Book

This complete exercise guide is especially for women with prolapse and after prolapse surgery seeking to exercise safely, reduce the risk of prolapse worsening and improve prolapse support.

Prolapse Exercises Book

Prolapse Exercises teaches you how to:

  • Avoid unsafe exercises
  • Choose pelvic floor safe exercises
  • Relieve prolapse symptoms
  • Reduce your risk of prolapse worsening
  • Improve prolapse support
  • Increase your strength and fitness
  • Recover after prolapse surgery
  • Return to exercise safely
  • Strengthen your core
  • Lose weight

    Learn More

ABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is an Australian Pelvic Floor Physiotherapist. Michelle lectures to health professionals and promotes community health through her writing, radio segments, online exercise videos and community presentations. She holds dual post graduate physiotherapy qualifications in women’s health and exercise.

1 DeLancey JO, Morgan DM, Fenner DE, etal.(2007) Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstetrics & Gynecology;109:295-302.

2 Brækken, I. H., Majida, M., Engh, M. E., & Bø, K. (2010). Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology, 203(2), 170-e1.

3 Hunskaar S, Burgio K, Clark A, et al. (2005)Epidemiology of POP. In: Abrams P, Cardozo L, Khoury S, Wein A, eds. Incontinence. Plymouth,UK: Health Publication Ltd; 290-8.

We Welcome Your Comments

Comments

  1. Marieke says:

    Hi Michelle

    How long does it normally take for the muscles to strengthen adequately – i.e. for how long and how many sessions do you treat patients?
    Is a subjective improvement in symptoms from the patient’s point of view an adequate indicator of improvement, or which objective measures do you use?

    Kind regards
    Marieke
    (Physiotherapist in Namibia)

    • Michelle Kenway says:

      Hi Marieke

      The time for pelvic floor muscles to strengthen varies from one woman to the next.

      This can depend upon a woman’s:

      * initial pelvic floor muscle strength and function
      * ability to perform pelvic floor exercises using correct technique
      * adherence to home exercises

      The research indicates that women with weak pelvic floor muscles can require 5-6 months of regular pelvic floor exercises to regain pelvic floor strength and that changes start to occur within a couple of weeks of commencing pelvic floor strengthening.

      Subjective improvement in symptoms is one indicator that can be used if you’re not performing vaginal examinations to assess the pelvic floor muscles. Vaginal assessment of pelvic floor muscle strength and grading pelvic floor muscle function is one of the most accurate methods objective methods of quantifying improvement. Ultrasound and EMG are also used in Australia as objective measures of improvement however these methods are not available world-wide. Different cultural practices and norms mean than vaginal assessment of pelvic floor muscles is not carried out routinely in some countries. So I think it really comes down to what measures are available for you to use in your country Marieke.

      I hope this information is helpful.

      All the best
      Michelle

  2. lara boris says:

    How do I get this book

  3. Pelvic floor exercises aren’t good for everyone. I have a prolapse and at the same time my pelvic floor is in spasm, Pelvic Floor Dysfunction. Pelvic floor exercises like Kegels make it worse. I have been seeing a pelvic floor physical therapist to work on relaxing the muscles.

    I cringe every time I see people recommending exercises like these without the warning that for some women, they are harmful.

    • Michelle Kenway Physiotherapist says:

      Hi Mary

      You’re correct! Pelvic floor exercises need to be performed correctly with a contraction and then relaxation of the pelvic floor muscles. Sometimes the pelvic floor muscles can become too tight and spasm which can be painful and debilitating indeed and yes this is a risk for some ladies after pelvic floor surgery. If women with pelvic floor spasm do pelvic floor exercises, they can worsen their pelvic floor spasm. For the general population pelvic floor exercises are very important which is why most women with spasm are then retrained to do their pelvic floor exercises correctly including the relaxation.

      Wishing you all the best for your recovery & thank you for your reminder.

      Michelle

  4. Hi Michelle I had a prolapse once before it was due to constipation, it went away in no time, I have one now and also due to constipation.. I can sure feel my pelvis floor flexing? Is this a good sign and do u think I will recover quickly again?

    • Michelle Kenway Physiotherapist says:

      Hi Kristi

      Once the tissues prolapse they remain so for life – this happens because they are stretched beyond their elastic limits. Your pelvic floor muscles may have provided sufficient support to help you overcome this previously. Whether or not this can happen again depends upon the severity of your prolapse and how well your pelvic floor muscles support your pelvic organs so it will be wise to do pelvic floor exercises regularly life long.

      All the best
      Michelle

  5. Hi I have a Cleo discreet electronic pelvic floor exerciser & haven’t really used it yet. I now have the onset of a rectal prolapse & am wondering if it is safe to use the exerciser? Any advice?x

    • Michelle Kenway Physiotherapist says:

      Hi Chris
      Thanks for your question. My apologies I am not familiar with Cleo and its contraindications. If you read the instructions it should state whether it can be used with prolapse. Pelvic floor strengthening is important in managing rectal prolapse so this is worth following up. Maybe phone the manufacturers or distributors for more information.
      Michelle

  6. I would like a pamphlet on exercises for prolapse

  7. Dear MIchelle,
    Thank for this space and your time… I have a prolapse Grade 3… I am 59 years old. I try once the pessary and not went well.. the doctor said direct to surgery(hysterectomy) .. I don’t like the idea so much.. it is any other actions that I should do? Regards, CN

    • Michelle Kenway Physiotherapist says:

      Hi Charo

      Yes this is when it becomes tricky. The options are pelvic floor exercises and/or trialling different pessaries. It can take some trial and error to get a well fitting pessary that suits. Unfortunately these are the options.

      Michelle

  8. Hi, thank you for all of the information…

    I have a moderately severe prolapse and am waiting for surgery. I have had two back to back vaginal births and have been weight training throughout pregnancy and 6 weeks after with Dr’s ok, having no idea or information that all the push ups, planks, chin ups and heavy weights could potentially cause this issue when my pelvic tissues were already stretched and weakened… very frustrating as I had advised my Dr of the cramping of muscles and discomfort through my pregnancies and was still okayed to continue with my strenuous workout routine.

    Anyways, I’m a police officer and need strength for my line of work, so I appreciate the suggestions for modified exercises as opposed to other websites less then helpful suggestions of just not doing any form of strength training… My concern is that I wear a heavy gun belt and when I’m sitting for 12 hour shifts in my car or at a computer with it on it pushes down and into my bladder and since I’ve been back to work after my maternity for a few weeks my discomfort and symptoms having been getting worse. I really want to keep being a front line officer while I’m waiting for surgery, but I am concerned that my belt may make things worse. Also if things are getting worse, are there any complications that can occur while I’m waiting several months for my surgery? I’m concerned about doing other damage or getting an infection? Thank you for your time!

    • Michelle Kenway Physiotherapist says:

      Hi Jennifer

      Thanks for your comment/question. Has your gynaecologist/obstetrician discussed support pessary with you to help you perform your regular duties? This along with pelvic floor exercises are both feasible to include in your current management plan. Are you able to loosen your belt sitting at your computer to reduce the pressure downwards on your pelvic floor when sitting? If the belt is tight it will increase pressure downwards on your pelvic floor. Finally the risk of vaginal infection is unlikely – this is not usually a problem associated with prolapse. I can’t say whether the prolapse will worsen while you wait for surgery and I don’t think anyone could accurately answer this, it depends on your activities, pelvic floor strength, body weight and more.

      All the best for your surgery Jennifer, I hope this helps a little
      Michelle

  9. Is there much of a difference with a uterin prolapse if the uterus is inverted?

    • Michelle Kenway Physiotherapist says:

      Hi Cindy

      Women with retroverted uterus are more likely to have prolapse problems than normal positioned uterus. When the uterus is retroverted it sits more directly above the vagina making the uterus more likely to descend and prolapse within the vagina.

      Michelle

  10. My uterus just prolapsed a week ago, I’m in my 40’s and don’t want to think about this for the rest of my life. If I choose surgery, does my cervix need to be removed?

    • Michelle Kenway Physiotherapist says:

      Hi Bev
      No your cervix does not necessarily need to be removed if you choose to go with the surgical option. You will unfortunately need to think about this for the rest of your life because prolapse surgery does increase the risk of repeat prolapse. The best way forward is to understand your options for both conservative management and surgical intervention so that you can make a really well informed decision. It’s important to know that the younger you are when you undergo surgery the greater the risk long-term as surgical repair needs to last longer. It will be worthwhile seeing a pelvic floor physiotherapist for long-term management advice so that you know how to protect a pelvic floor and have a strengthened most effectively regardless of whether you have surgery in the future.
      All the best
      Michelle

  11. Virginia says:

    I had a hysterectomy 3 years ago he left my cervix and took my ovaries now I have a prolapse stage 3 the cervix is falling with vagina will excercise help or hurt

    • Michelle Kenway Physiotherapist says:

      Hi Virginia
      It really depends on what type of exercise you choose. Pelvic floor exercises will Kegel exercises are important and if done correctly should not cause any problems. Pelvic floor friendly general exercises such as those described throughout this site are the best type of exercises to perform. It may be worth discussing the possibility of support pessary with your specialist to help you exercise too.
      Michelle

  12. Hi Michelle,
    I am 48 years old and 25 kilos overweight, I am generally healthy and don’t take any medication, I eat healthily, plenty of fresh fruit and veg, wholegrain bread etc. (although portion control and chocolate has been an issue, clearly!) I had two children 15 months apart, weighing 10lb and 9.5lb, the first with episiotomy and forceps, 19 and 17 years ago. I have been overweight ever since. Recently I have been diagnosed with a stage 3 rectal prolapse and a stage 0-1 bladder prolapse. I generally do not suffer with constipation and following your bowel emptying techniques am able to go to the toilet without problems. I have been told I will need surgery by my gastro-enterologist, but he sent me to a urologist to see if it would be worth correcting the cystocele at the same time. After lengthy tests she was debating whether or not this would be necessary as I don’t have a serious bladder problem, and she gave me a lot of information about how my body could reject the polypropylene mesh, or that it could erode surrounding tissue and cause even worse problems. Unsurprisingly this has made me want to avoid surgery at all costs. I am working on losing the weight, I have been doing pelvic floor exercises daily and am going to get you dvd for pelvic safe regular exercise. Do you know if it is possible to manage problems like mine without surgery or is it too severe? I am just so scared and normally take responsibility for my own health where possible, I don’t even like taking a headache tablet if I can avoid it!
    Many thanks, Sam.

    • Michelle Kenway Physiotherapist says:

      Hi Sam

      Great question. I tend to agree with your urologist in that if you can avoid bladder surgery then do so. You’re doing everything right focusing on good emptying techniques, pelvic floor exercises and losing weight. Sam I’m not sure whether you’re referring to true rectal prolapse where the prolapse comes from the anus, or rectocoele (posterior vaginal wall prolapse) which bulges from the vagina as both are often confused. True rectal prolapse often requires surgical intervention when it worsens. In contrast some women find they can manage mild-to-moderate rectocoele quite well without surgery with good conservative therapy. Just a small suggestion on not overloading on too much insoluble fibre which can actually increase constipation. At the end of the day the decision for surgery is yours and it really comes down to how problematic your prolapse is unless it is a severe rectal prolapse in which case surgery is indicated.

      I hope this helps you out!
      All the best
      Michelle

  13. Hi Michelle, its really great that you’ve taken the time to answer everyones questions. I have one of my own. Ive recently been diagnosed with 2nd degree cystocele and 1st degree uterine prolapse, my doctor has prescribed physio for my pelvic floor, however I’m in the process of moving to a different continent with a three year old and a 4 month old… In my search for ways to isolate my muscles and be sure I am using the correct ones, I found a new device called an Elvie, perhaps you cannot comment on particular devices, but in general, are pelvic toning devices possible for someone with a cystocele? or does the device then sit improperly in the body?? any help? Thank you!

    • Michelle Kenway Physiotherapist says:

      Hi Janine
      Pelvic toning devices can be used by most women with mild-moderate prolapse it’s important to sit the device in the correct position. These devices are used lying down passively – it’s then important to start active pelvic floor contractions too with the device and then without.
      All the best

  14. Hi … i am having 3rd degree rectum prolapse. The rectum is coming out from the vaginal opening and not from the anus. Dr. Has recommended surgery for me what should i do now?? I am 34years old. 2kids normal deliveries. 2abortions one with DNC. Now i want one more pregnancy so want to avoid surgery. My problems worsen because of pure exercise monitoring by the physiotherapist. At that time i was having 2nd degree uterus and bladder prolapse. After i started the exercises the rectum came down as well. Now i want to take advise from you for how to control this. Whenever i walk the or do house chores the problem get worse. Dr. Says my bladder and uterus are now better and do not need passery.

    • Michelle Kenway Physiotherapist says:

      Hi Sadia it may have been possible that you were performing the exercises incorrectly as correct pelvic floor exercises shouldn’t worsen your prolapse. Have you discussed this issue with your Physiotherapist? If not I suggest that you do. I would also think that trialling a support pessary in this situation could potentially be a very good option to help you with support for your prolapse and have another child. It could be worth seeking the opinion of another doctor or see a Physiotherapist who does fit pessaries. I’m not sure where you live however in Australia some Pelvic Floor Physiotherapists can fit support pessaries. An important part of management of rectal prolapse will be bowel management as well and you can read more on this with these links which I hope helps you manage your rectal prolapse symptoms better too. All the best!

  15. Jennifer says:

    Hi and how you doing ? I am 21 years old and have a little girl already . Now I’m about 13 weeks and 1 day with my second child. I went in the bathroom to go pee , I saw something weird. I have prolapse for the first time and I’m scared . What should I do or take to make it go away ?

    • Michelle Kenway Physiotherapist says:

      Hi Jennifer
      The first thing to do if you suspect a prolapse is to see your doctor for an accurate diagnosis. If it is a prolapse then the best way of managing during pregnancy is through pelvic floor exercises in addition to managing your bowels, avoiding constipation and straining, reducing heavy lifting and perhaps speaking with your doctor about the possibility of getting a support pessary if required to assist your pelvic floor muscles.

  16. Prolapse disappeared. I feel fine. My children say I may be bleeding internally. That I should go to urgent care????

    • Michelle Kenway Physiotherapist says:

      Hi Bette I’m not sure why your children think this, internal bleeding is not linked to prolapse unless the prolapse protrudes and rubs on undergarments so the skin becomes damaged with very severe prolapse. Hope this helps

  17. Hi, now that the mesh is no longer available because of the terrible stories we have heard, could we not grow some kind of skin or what ever using the patient blood so the body does not reject it and it attache’s to the mussel ? we grow bone and membrane for teeth surgery so why not go down this road ? also i have had a prolapse for 13 years some time i’m ok for weeks and then it just drops , no pain but it does drain me and depending were it is pressing some time it affects my walking, 90% of time I can flush my self empty. Or why can’t i be stitched up ? I do not have sex any more, seen’s my husband had his operation for colon cancer , so I no longer need my opening, could this be done and solve my prolapse.

    • Michelle Kenway Physiotherapist says:

      Hi Maria
      Yes this can be done – the procedure is called a Colpocliesis and it’s relatively simple surgery. It’s ideal for women who no longer wish to have intercourse. The vagina is stitched along the mid line and effectively closed off thereby preventing prolapse. You can google the procedure and talk with your doctor about a referral to a gynaecologist or urogynaecologist that performs this surgery. All the best to you

  18. Is there a correlation between placenta previa and vaginal prolapse?

  19. I had a 9 Pound 7 ounce baby 13 years ago. I noticed my vaginal Arrangement was different after that but couldn’t really pinpoint it. But now I’ve noticed vaginal loosening. After reading and looking at diagrams I believe it’s rectocele. But I noticed upon examination in a mirror I can see it inside the vaginal opening if I push down as if I am trying to poop but I can also tighten my muscles and pull it back in so that it cannot be seen and everything seems to be pulled back into place. Where does this leave me in the Spectrum of how bad this is and how well it could be corrected without surgery? No matter how hard I look I have not been able to find anything that gives you a better idea of what level you’re at based on what you’re able to do with it with your vaginal muscles. Do most prolapses just sit where they sit despite your best efforts or are most of them able to be pulled back into place with your vaginal muscles? And if so is there a way to make it stay without having to constantly Flex?

    • Michelle Kenway Physiotherapist says:

      Hi & thanks for your question
      First and foremost this article on how to know the extent of your understand your prolapse diagnosis may help you a little. To have an accurate diagnosis usually requires an assessment of the prolapse both lying down and in standing by an experienced practitioner. Sometimes the prolapsed tissue can be repositioned within the vagina when the prolapse is not too severe. When more severe the prolapse will protrude to the entrance and/or out of the entrance of the vagina. Using the pelvic floor muscles to reposition the prolapse shouldn’t be done habitually – rather pelvic floor exercises are done to improve the overall support for the pelvic floor and prolapse tissue. Flexing or contracting the pelvic floor muscles without allowing them to relax can actually make prolapse worse because pelvic floor muscle tension and spasm can occur. This condition causes weakness in the pelvic floor and can contribute to prolapse worsening. I hope this explains things a little for you. Seeing a Pelvic Floor Physio for an assessment would be useful to help you know exactly the extent of your prolapse and the condition of your pelvic floor support too.

  20. My prolaspe is so severe the Gyne doctor could not give me a pap smear she couldn’t see my cervic. Help an active 79 year mother of4 children my largest childbirth was for my son 10 1/2 pounds & 8 oz

    • Why do you need a pap at 79? My Dr said around 70 they could be stopped routinely, unless there was a history….. Just wondering.

  21. I have had cervical cancer (22yr ago) I needed a Mytroffanof (instead of a stomo bag 7yr ago) and was left with a prolapsed bowl I am waiting to go to see a surgeon to see if I can get help my poop pushes into my front passage I then have to push it out with my fingers covered with a disposable glove and toilet paper if I make my poop to soft then I have an accident my fingers have now got arthritis and it is getting so painful to push and use my fingers I can get myself into a real panick do you think I can get help I also dread the thought of more major surgery

    • Michelle Kenway Physiotherapist says:

      Yes Ann, it’s not uncommon for women to need to use manual support to assist emptying with a rectocele or posterior vaginal wall prolapse. One of the keys to management is stool consistency. It can be worth trying a product called psyllium husk to keep the stool soft and well formed which can prevent accidents and make emptying easier. Here is comes as a natural husk or in a product called Metamucil. Most women start with a teaspoon per day and if well tolerated increase to 2 teaspoons. This may be worth trying to improve stool consistency and emptying.

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