Managing pelvic organ prolapse: symptoms, causes and physiotherapy

Created on

14/9/2026

Last updated on

19/10/2026

Written by Hannah Gray, Women's and Men's Health Specialist Physiotherapist.
Medically reviewed by James Walker, Service Development Director & Senior Physiotherapist, on 14/09/26.

Pelvic organ prolapse happens when one or more of the pelvic organs, such as the bladder, the womb or the bowel, moves down from its usual position and presses against the wall of the vagina. It can be uncomfortable and may affect your daily life. Some women experience symptoms, while others have none at all.

Prolapse is very common, and most of it causes no trouble. Some degree of prolapse is found on examination in up to half of women, but far fewer have symptoms from it: studies that define prolapse by symptoms put the figure at 3% to 6% [1]. If you do have symptoms, they can usually be improved.

Women's health physiotherapy can provide evidence-based treatment for a prolapse. At the White House Clinic, our specialist women's health physiotherapists work closely with a multidisciplinary team of clinical professionals to provide personalised care and support, at our Sheffield West and Chesterfield clinics.

What are the common symptoms of a pelvic organ prolapse?

The symptom women most often describe is a vaginal bulge or lump, a feeling of something coming down, or a sensation of heaviness in the genital area. Symptoms vary a great deal from one woman to another, and some women have a prolapse without noticing anything at all.

Symptoms can include:

a vaginal bulge or lump, or the feeling that something is coming down
a sensation of heaviness in the genital area
a dragging feeling in the pelvis
urinary incontinence, or difficulty passing urine
difficulty passing stool
pain during intercourse

Incomplete bowel emptying is another symptom of the condition. Some women describe needing to apply pressure to the vaginal wall or perineum to help empty their bowels. It is rarely mentioned, even to a GP, and it is worth raising.

Bladder symptoms often sit alongside a prolapse, and our article on what bladder symptoms can mean and what can help covers the different types of urinary incontinence and when to seek help.

Risk factors for pelvic organ prolapse

Ageing and giving birth are the most common risk factors for pelvic organ prolapse. The NHS also lists pregnancy and childbirth, being overweight, long-term constipation and straining, persistent coughing, and pelvic surgery such as a hysterectomy [2].

Several other health and lifestyle factors are associated with a higher risk, including:

obesity
constipation and straining
heavy lifting
a chronic cough
smoking, which contributes largely through a persistent cough
pelvic surgery, such as a hysterectomy

What these have in common is pressure. Anything that repeatedly increases the load on the pelvic floor can contribute over time. Where those pressures can be reduced, whether that means managing constipation, treating a long-term cough, stopping smoking or changing how you lift, that is part of what a physiotherapist will look at with you.

How is a pelvic organ prolapse diagnosed?

A prolapse is often diagnosed by GPs, gynaecology consultants or women's health physiotherapists.

Your women's health physiotherapist will begin with an assessment to hear about your symptoms. They will ask how long you have had them, what makes the symptoms worse, and what makes them better.

Your physiotherapist will talk to you about your general health. They may ask whether you have carried pregnancies and given birth, and about your lifestyle, including hobbies and sports.

In some cases, it may be necessary to perform a brief vaginal assessment, which is a helpful way to assess the general health of the vaginal tissue, the anatomy, and pelvic floor muscle strength and function. If it is necessary, it will of course be discussed with you first, and you are welcome to ask questions or to decide not to proceed. This assessment does not involve a speculum and is not generally uncomfortable.

Your physiotherapist will ask you about your treatment goal. Your goal may be, "I don't want my prolapse to worsen" or "I want to try and do everything possible to avoid a prolapse". Or it may be very specific and focused on improving your quality of life. For example, to play tennis comfortably again, or to feel confident that you will have a complete bowel movement every morning.

Treatment for pelvic organ prolapse

Conservative treatment with a specialist women's health physiotherapist is often the first approach to pelvic organ prolapse. This will include pelvic floor muscle training over several months. In a multicentre randomised trial of 447 women, one-to-one pelvic floor muscle training reduced prolapse symptoms at 12 months compared with a lifestyle advice leaflet alone [3].

Your treatment will focus on your prolapse symptoms and your goals. Your physiotherapist will use the information gathered during the assessment to create an individual treatment plan.

For some women, a vaginal pessary, a device fitted into the vagina to support the pelvic organs, can reduce prolapse symptoms and help delay or avoid surgery. Studies report symptom improvement in a high proportion of women who are successfully fitted, though the evidence on long-term pessary care is limited [4]. Pessary fitting is arranged through your GP or gynaecology team.

If conservative treatment is unsuccessful and you continue to experience severe symptoms that affect your quality of life, surgery may be recommended. Most prolapse is managed without it. A UK study following women who had given birth found that by the age of 80, around 1 in 10 had undergone surgery for prolapse [5].

How the White House Clinic can help

Your initial appointment lasts an hour, which gives you space to talk through your symptoms and what they are stopping you doing. That discussion informs a detailed assessment, and the assessment informs a treatment plan built around your goals rather than a set template. It is done sensitively and in complete confidence. Pelvic floor problems can be stressful, and putting you at ease is part of the job.

Specialist women's health physiotherapy is available at our Sheffield West and Chesterfield clinics, and you can read more about the service on our women's health pages. For women's health at Sheffield West, ask to book in with Jackie Gibbon, Specialist Women's Health Physiotherapist; at Chesterfield, ask for Hannah Gray.

If you are unsure which service you need, we would recommend being triaged by our team before arranging an appointment. Call 0114 230 2030 or email info@whitehouse-clinic.co.uk, and one of the team will briefly go over your concerns and identify the best person for you to see. You can also book online.

This article is general information and not a substitute for individual assessment. Book an appointment or call 0114 230 2030 to speak to our team.