Pelvic Organ Prolapse: Non-Surgical Treatment Options Could Work?
Toshiko Takaezu, Gaea (Earth Mother), 1979. Stoneware, hammocks.
Some seasons of womanhood introduce physical changes that can leave us feeling disconnected from our bodies. We often see women who have been told that a "falling", dragging or heavy sensation in their pelvis means an automatic, inevitable surgery. Navigating these changes can feel isolating, but I want to provide place to demystify what is happening.
Today, I am breaking down the myths around Pelvic Organ Prolapse (POP) and exploring how a conservative approach can help you reclaim your body confidence.
What is Pelvic Organ Prolapse and How Common is It?
In clinical terms, POP is the anatomical descent of pelvic organs resulting in protrusion into or beyond the vaginal canal. From a biomechanical standpoint, it is the ultimate manifestation of a progressive lack of support in your pelvic support structures, which involves both your pelvic floor muscles and connective tissue (such as fascia and ligaments).
If you are experiencing this, please know that you are far from alone. POP is incredibly common (unfortunately). Global data from 2021 showed a prevalence rate of 2,769 per 100,000 women, and studies based on physical examinations find evidence of it in 10% to 50% of women. The absolute number of cases is rising as our global population ages, with projections estimating 156 million women will be affected globally by 2036. A huge number, I know.
You can find them happening in 3 ways:
Bladder Prolapse
Anterior Wall Prolapse (Cystocele): This is the most common type of prolapse a physiotherapist sees in the clinic. It occurs when the front (anterior) wall of the vagina and the bladder protrude into the vaginal canal. This is sometimes referred to as a "dropped bladder". Women experiencing this might notice a feeling of pelvic pressure, tissue protruding, frequent urinary tract infections, or difficulty completely emptying their bladder.
Bowel Prolapse
Posterior Wall Prolapse (Rectocele): This occurs when the back (posterior) wall of the vagina and the rectum protrude into the vaginal space. If you are navigating a rectocele, you might experience the inability to fully empty your bowels, discomfort during physical activities, or pain during intercourse. Some women also find they need to manually press on the area to help with bowel movements.
Uterus prolapse
Apical Prolapse (Enterocele): This type involves the descent of the upper portion (apex) of the vaginal wall and the small bowel. It often presents with symptoms very similar to anterior or posterior prolapse and frequently occurs alongside them. We most commonly see this form of prolapse in women who have previously undergone a hysterectomy or other pelvic surgeries. You can even find a 4th one - anal prolapse, which I can write about it on a different post.
I highly suggest you having a look into the Royal College of Obstetricians and Gynaecologists (RCOG) here. They have great pictures there and trustworthy information.
Then why does it happen?
There are a few reasons on why a pelvic organ prolapse happen.
The first thing I want you to know is that, despite they are more common with childbirth, they can happen outside of this seasonal time of a woman’s life. So let’s break this down.
As I mentioned on this blog post, the pelvic floor acts like a little hammock and one of its functions is to hold the pelvic organs inside the pelvic cavity. If they are the floor to these organs as I mentioned, then was holds the ceiling (figuratively speaking)? The connective tissues aka ligaments and fascia. These ligaments and facia connect in some abdomen structures and the hip bones. One theory says that these ligaments ease off their strength and let the organs descend.
A very common reason is a non well conducted labour. Pushing too hard, without allowing space for relaxation through breath and poor guidance on the second stage of labour (delivering time) or even the use of instruments such as forceps and ventouse will create an environment for prolapse. Thinking about the biomechanics, the harder we push or have an instrument to fully pull organs downwards, can bring the pelvic organs down (create a prolapse). Does that mean that a vaginal childbirth is bad? Not at all. We just need correct guidance on that.
Following the same principle, we can think of other situations of a day to day life that will generate the same biomechanics forces to bring the organs down and they are totally away from childbirth. One of them is straining too hard to open your bowels. The forces will conduce the bowel to go down and consequently, other organ prolapses as well with time.
Another day-to-day situation is lifting heavy weights without an appropriate balanced distribution of forces on your whole body. If we push too much on the pelvic floor and pelvis, the same principle applies: the organs will be pushed downwards, making your tissues more likely to ease off and create a prolapse.
Myth-Busting: "You’ll Definitely Need an Operation"
One of the most persistent (and anxiety-inducing) myths about POP is that surgery is the only way forward. This simply isn't true.
Your body is resilient: Longitudinal studies reveal that among symptomatic women who choose to defer treatment, approximately 78% experience no significant anatomical progression over an average of 16 months.
Improvement is possible without surgery: Long-term studies have shown that up to 40% of women experience stable or even improved prolapse over a period of up to 60 months with just monitoring.
The Flor Philosophy: Preparation Before Repair
I reject the "quick fix" model, I often write this here. I don’t think that a mechanical problem just appears followed by “I have to accept it happened because I wanted to have a child“. Current medical guidelines strongly support conservative management as the safest first step, provided the prolapse is not already slated for corrective surgery.
Here are the non-surgical treatments that actually work:
1. Pelvic Floor Muscle Training: There is strong, current evidence establishing that the pelvic floor muscle training is effective in reducing symptoms and improving the stage of prolapse for women with POP stages 1, 2, and 3. It is widely indicated as a safe and effective first-line treatment. By highly targeting the strength, coordination, and endurance of your pelvic floor, it can improve the physical support of your pelvic organs and actively alleviates symptoms like incontinence and pelvic discomfort.
2. Pessaries: A vaginal pessary is a medical device fitted to comfortably support the pelvic organs. Pessary treatments boast a fitting success rate above 90% and offer an incredibly effective non-surgical option for daily management. Recent innovations, such as self-removable pessaries, 3D-printed custom designs, and self-management protocols, have vastly improved patient autonomy and comfort.
3. Lifestyle and Load Management: How you manage physical load, which means how you lift, breathe, and exercise, can create excessive downward pressure on your pelvic floor. You need a holistic guidance to adapt your daily movements so you can stay active, strong, and empowered without exacerbating your symptoms.
When is Surgery Discussed?
While non-surgical options are highly effective, surgery remains a valid and necessary path for certain high-risk situations, or when conservative management simply does not meet a patient's personal goals.
However, it is crucial to understand that surgery can fix anatomy, but it does not automatically restore nerve and muscle function. This is why postoperative rehabilitation, specifically pelvic floor muscle training, is highly recommended to re-establish proper muscle coordination, share the physical load, and ensure long-term continence after an operation.
Whether you are preparing your body to heal naturally or preparing for a surgical repair, we are here to ensure you feel supported, understood, and confident in your journey.
Recent Research & Evidence (2023–2024)
For your reference, here are the recent peer-reviewed studies and clinical guidelines used to inform this post (this can be changed to keep this information up to date):
Pelvic Organ Prolapse: Current Challenges and Future Perspectives (PMC, Oct 2023) - Discusses the 90% success rate of pessaries and the reality that up to 40% of prolapse cases remain stable or improve over 60 months without intervention. Link to Study
Pelvic Floor Muscle Training Following Surgery for Pelvic Organ Prolapse (MDPI, 2024) - Explores the biomechanics of POP and emphasizes that while surgery fixes anatomy, PFMT is vital for restoring actual muscle function. Link to Study
Updates in Pessary Care for Pelvic Organ Prolapse (MDPI, Apr 2024) - Details innovations in pessary designs (like 3D printing and self-removable devices) and their role as a highly effective conservative treatment. Link to Study
W17: IUGA Workshop - How Do We Treat Pelvic Organ Prolapse in 2024? (International Continence Society, 2024) - Clinical guidelines affirming that PFMT should be recommended as the first-line treatment for stages 1, 2, and 3. Link to Study