Physiotherapy for Prolapse

Vaginal prolapse is very common, over half of women over the age of 50 have some degree of prolapse, but many do not have any symptoms.

Prolapse happens when ligament and connective tissues (or ‘fascia’) stretch and no longer support the pelvic organs well. In combination with a weak pelvic floor, the pelvic organs may bulge into the vagina.

Prolapse symptoms

Prolapse is when the bladder, uterus or bowel protrudes into the vagina. Symptoms of prolapse include:

• Vaginal bulging or the feeling of something coming down
• A lump/swelling bulging out of the vagina that you can feel/see
• Pelvic pressure, heaviness or a dragging sensation
• Bleeding/discharge/infection
• Recurring urinary tract infections (UTIs)
• Splinting/digitation - needing to digitally push the prolapse up to be able to urinate or defecate
• Low back ache similar to period pain
• Bladder/bowel dysfunction (including difficulty emptying the bladder/bowel and constipation)
• Difficulty with sexual intercourse (pain or less sensation)

Types of prolapse

• Uterine prolapse - the uterus drops into the vagina
• Cystocele - the bladder bulges into the vagina
• Rectocele - the rectum bulges into the vagina
• Enterocele - the small intestine bulges into the vagina
• Vaginal vault prolapse - the top of the vagina drops down (after hysterectomy)

What causes a prolapse?

The biggest cause of prolapse is pregnancy and birth, however other factors such as family history, lifestyle and certain medical conditions can lead to prolapse. You are more likely to have a vaginal prolapse is you have been through menopause, if you have had more than one baby, if you were pushing for a long time when birthing your baby, you are overweight, you have fibroids or a pelvic tumour or if you have had previous prolapse repair surgery.

Prolapse treatment

Mild cases of prolapse do not require treatment. For symptomatic prolapses, treatment options include pelvic floor muscle exercises (see our section on pelvic floor exercise for prolapse), simple lifestyle modifications, a supportive device (pessary) or you may be recommended surgical treatment.

Physiotherapy and prolapse

Physiotherapists can help with prolapse by teaching pelvic floor exercises (kegels), providing education about changes to lifestyle, good bladder and bowel habits, managing constipation, losing weight and having a pessary fitted. A physio may also use real time ultrasound to facilitate rehabilitation.