How to Reduce the Risk of your Prolapse Getting Worse

prolapse getting worseAre you worried about your prolapse getting worse?

Is prolapse worsening inevitable?

Is it possible to avoid prolapse worsening and prolapse surgery?

Read on now for 12 expert Physiotherapy tips that reduce the risk of prolapse worsening.

Is Prolapse Worsening Inevitable?

No, the natural course of prolapse worsening varies from woman to woman.

Some women find that their prolapse rapidly worsens in a short space of time. Others notice little change in their prolapse over many years.

Prolapse worsening isn’t inevitable and it varies from one woman to the next. While pelvic floor problems tend to worsen with increasing age, scientific studies tell us that prolapse progression is unpredictable1.

You can reduce some of the manageable risks of prolapse worsening or recurring after prolapse surgery by following these tips.

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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 weight

How to Reduce the Risk of your Prolapse Getting Worse

Reduce your risk of prolapse worsening

SCROLL DOWN for your free prolapse management tip sheet

Reduce your risk of prolapse worsening with these 12 tips:

1. Regular Pelvic Floor Exercises (Kegels)

Pelvic floor exercises (Kegels) strengthen your pelvic floor muscles. These muscles work with other strong pelvic tissues to keep your pelvic organs in position and prevent them from falling into your vaginal walls (i.e. prolapse).

Research tells us that pelvic floor exercises can improve prolapse symptoms and lift the pelvic floor (and prolapse) to sit higher within the pelvis in some women (with mild to moderate prolapse)2.

2. ‘The Knack’ Exercise Technique

‘The Knack’ is a pelvic floor exercise technique that can counteract downward strain on your prolapse when you cough, sneeze or lift a heavy item.

The Knack’ technique involves lifting and squeezing your pelvic floor muscles using a strong brisk contraction immediately before and during downward pressure on your pelvic floor e.g. immediately before and with a sneeze3.

3. Support Pessary

Types of pessaryA support pessary can help to lift up your prolapse and reduce prolapse symptoms. Support pessaries can help some women manage their prolapse and avoid prolapse surgery.

Some women report that their pelvic floor exercises are much easier when they are wearing a support pessary.

Support pessaries are available in a range of sizes and styles that are suited to managing different types of prolapse.

You can speak with your gynecologist or pelvic floor physiotherapist about whether a support pessary is suitable for you to use.

4. Pelvic Floor Safe Exercises

Keeping your whole body strong and active is a positive step you can take to reducing the load on your pelvic floor with your everyday activities.

If your body is strong you’ll be able to do more physical activity without overloading your pelvic floor (and your prolapse) than you would otherwise.Modified resistance exercises

Choose pelvic floor safe exercises and techniques for keeping your body strong and fit.

Pelvic floor friendly exercises are exercises that reduce the load on your prolapse.

For most women pelvic floor safe exercise involves:

  • Low impact fitness exercises
  • Avoiding intense abdominal core strengthening exercises
  • Appropriate strength exercises and techniques

5. Bowel Management to Avoid Straining

Manage your bowels well to avoid overloading your pelvic floor and straining your prolapse.

Good bowel management for prolapse protection involves:

  • Using the correct bowel emptying position and technique
  • Managing food intolerance/ IBS by working with a health professional
  • Minimizing your risk of constipation and avoid straining
  • Minimizing you risk of diarrhoea and associated straining

6. Body Weight Management

Abdominal body fat

Your abdominal body fat surrounds your abdominal organs and sits directly above your pelvic floor (shown right).

Your pelvic floor supports the load of your abdomen so the greater the load of your abdominal fat, the greater the load on your pelvic floor.

Some women find that losing abdominal body fat reduces their prolapse symptoms markedly.

Reduce your risk of your abdominal fat overloading your pelvic floor by:

  • Losing weight if you’re overweight
  • Avoiding unnecessary weight gain4
  • Understanding that if you are overweight, your pelvic floor is already under load during all of your everyday upright activities and exercises. You will benefit from a careful balance between pelvic floor safe activity, exercises and rest to reduce the load on your pelvic floor.

7. Managing Coughing

When you cough the pressure generated by your strong upper abdominal muscles is transferred downwards onto your pelvic floor. One severe bout of coughing with an acute chest infection can cause prolapse worsening.

Manage your cough by:

  • Working with a health professional to manage your chronic cough e.g. asthma
  • Managing acute chest infections by seeing your doctor (discuss using a cough suppressant to reduce coughing if appropriate)
  • Using ‘The Knack’ every time you cough
  • Not smoking

8. Allergy Treatment

Allergies such as hay fever can cause sneezing, coughing and repeatedly blowing your nose. This can have the effect of worsening prolapse severity.

Managing allergies to protect your prolapse involves:

  • Avoiding known allergens that cause you to experience hay fever
  • Working with your health practitioner to manage existing allergies
  • Using ‘The Knack’ to counteract the pressure of sneezing and blowing your nose

9. Safe Lifting

Avoid heavy liftingHeavy lifting or using the wrong lifting technique can increase the risk of prolapse worsening. Safe lifting is vital for managing your prolapse well.

Safe lifting to protect your prolapse involves:

  • Avoiding heavy lifting that causes you to strain
  • Using the correct lifting technique
  • Lifting from waist height or above where possible
  • Minimizing lifting from ground height
  • Avoiding repetitive lifting

10. Monitoring your Prolapse Symptoms

Do you notice your prolapse symptoms with exercise or particular activities?

Don’t ignore your prolapse symptoms because your body is providing you with important information about activities that your pelvic floor is currently unable to withstand.

Act on your prolapse symptoms by:

  • Modifying activities or exercises that worsen your prolapse symptoms
  • Spreading out your activities during the day
  • Resting to unload your pelvic floor and reduce prolapse symptoms

11. Knowing When Prolapse Risk is Increased

There are times and events in every woman’s life when the pelvic floor works less effectively to support pelvic organs. During these events the risk of prolapse worsening may be increased.

The risk of pelvic floor problems is increased:

  • With menopause and beyond
  • Immediately after pregnancy and childbirth
  • During the breastfeeding months
  • After pelvic surgery
  • With lower back and/or pelvic pain

If you’re living with a prolapse, be mindful of the times in your life when your risk of prolapse worsening is increased. During these times you’ll likely benefit from working to improve your pelvic support (i.e. pelvic floor exercises) and reduce the load on your pelvic floor.

12. Getting Sufficient Rest

Prolapse restingYour pelvic floor will be more vulnerable to strain when you’re fatigued or unwell. Be mindful of the need to protect your prolapse particularly when you’re tired.

If your prolapse is moderate to severe or symptomatic:

  • Balance your activities and exercises with good rest
  • Put your feet up if the opportunity arises during the day
  • Try to avoid prolonged standing or heavy/repetitive lifting

How to Reduce Prolapse Worsening

Reduce your risk of prolapse worsening

Download as PDF

Key Principles for Prolapse Management

In summary, there are 2 key principles for prolapse management:

1. Improving prolapse support
2. Reducing prolapse loading

The tips outlined in this article will help you improve prolapse support and reduce your risk of prolapse overload.

If you can incorporate these principles into your everyday life, you’ll be doing everything you can to manage your prolapse and reduce the risk of your prolapse getting worse.


  1. Gilchrist, A.S., Campbell, W., Steele, H., Brazell, H., Foote, J. and Swift, S. (2013), Outcomes of observation as therapy for pelvic organ prolapse: A study in the natural history of pelvic organ prolapse. Neurourol. Urodyn., 32: 383-386.
  2. Ingeborg Hoff Brækken, Memona Majida, Marie Ellström Engh, Kari Bø, (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, Volume 203, Issue 2, Pages 170.e1-170.e7, ISSN 0002-9378,
  3. Miller, J.M., Sampselle, C., Ashton-Miller, J. et al. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Int Urogynecol J 19, 773–782 (2008).
  4. Kudish BI, Iglesia CB, Sokol RJ, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009;113(1):81-88. doi:10.1097/AOG.0b013e318190a0dd
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We Welcome Your Comments


  1. I’m so terrified during cold and flu season, afraid of getting a cough and worsening everything. It’s turned me into an anxious germaphobe. Does a cough always make it worse or can decent quality of life survive a viral illness with prolapse?

  2. I used to use orbitrek Cycling For 2 years now i feel something comes out of my vegina i feel bulge also when i insert my finger i find myself with something blocks my finger sometimes sudden pain occurs in my vegina n hip right side also pains

  3. Hello!

    Thank you so much for all the information! It is so hard to find out much info about this taboo topic. I had no idea that I should be doing The Knack when I cough!

    I have a question. I had a C-section with our first child, and a vaginal birth with our second. I acquired a stage 1 bladder prolapse with our second child – my first vaginal birth. I was told to push even though I didn’t have a contraction, because the baby’s heart was dropping. This is when I got the stage 1 bladder prolapse, I believe. We would love to have a few more children. Do you know what would be the best way to proceed with the next births? Do you know whether it would be better to have a C-section, or vaginal birth in order to prevent it from getting worse? I don’t have many symptoms as of now, but would like to keep it that way. Thank you very much!!

    • Michelle Kenway Physiotherapist says

      Hi, thanks for your question – yes this is one of those qns I’m asked frequently and can’t answer definitively as there are so many factors involved and your risk factors and condition are unique to your situation. Factors such as your body weight, your pelvic floor support, your bowels, your tissue laxity all come into play.

      The best way to approach this would be to seek an assessment of your pelvic floor & other risk factors with an experienced pelvic floor physio. Being informed about the condition of your pelvic floor and your potential risks with future vaginal deliveries (& pregnancies) will ultimately help you make this difficult decision.

      It makes sense that further vaginal deliveries won’t help the existing prolapse however common thinking is that most of the damage occurs in the first delivery. If you have an understanding Obstetrician this would be worth discussing with him/her too.

      If you have any further qns please feel most welcome to post them.


  4. I am so pleased to have found your site. I hadn’t had problems before having my gall bladder removed but as I have had breathing problems since I was a child I believe the combination of this & my operation have caused my prolapse problem. I am hoping that following your tips & exercises will make it possible to rebuild my pelvic floor strength.
    Thank you for your helpful explanations

    • Michelle Kenway Physiotherapist says

      Hi Tina

      Thanks for your comment – yes breathing problems can contribute to pelvic floor dysfunction. It’s important that the loser abdominal wall and pelvic floor muscles are working as they should in this situation. Unfortunately breathing problems can hamper the strength and coordination of these muscles.

      All the best

  5. Thank you so much for being available to help! I really am truly grateful to have this, and your youtube channel as a resourse. I have a few questions that hopefully you can help me with. I havea prolapsed bladder and would like to find out if using a kickboard in the swimming pool is safe for me to do, and if so, what is the best way to hold the board so there is little to no pressure on my peivic floor? Thank you so very much for your time and assistance.

  6. Thank you Michelle for the proper method for bowel movements. I had an anterior wall surgery for bladder prolapse last Sept. and the dr. told me it’s very important not to strain. Your method is helping me very much. It works better than taking Miralax. I am so grateful to you.

  7. Thank you. I had pro laps operation approx. 2004. I am now 79 years old.

  8. Thank you, thank you! I’ve been trying to keep my prolapse at the original stage. I have been to pelvic floor therapy in Nashville however I didn’t discuss coughing properly with my therapist. Now I have my answer. Your site is a blessing to me. Thanks again, Pamela

  9. christine says

    Once again, Michelle, it seems you are telepathic! Just as concern about potential worsening of prolapse has crept in, you are there “on the button” with a well-timed and helpful email.
    If only you could influence G.Ps and Physios over here, where help and information is scant indeed, making things more scary for women.
    We are indebted to your professionalism and care. Thank you so much.

  10. Good to see all exercises.
    my hysterectomy has been done on 23 Feb 2015 in which one Overy and utras has been removed. My age is 40 years.