Holistic Management of Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the muscles, ligaments and connective tissues supporting the pelvic organs weaken, allowing the organs to fall out of place. It is estimated that as many as 50 percent of women over age 50 have organ prolapse. The degree or amount of prolapse is on a continuum with grade I being mild and grade IV being severe, often requiring surgery. Prolapse of the bladder is known as cystocele. Prolapse of the urethra is known as urethrocele. Prolapse of the upper vagina below the cervix is known as vaginal vault prolapse. Bowel prolapse through the vagina is known as rectocele, whereas a rectal prolapse can occur through the rectum. In many cases, more than one organ has descended.

The risk of developing pelvic organ prolapse increases with faulty breathing patterns, where breath holding increases downward pressure on vulnerable tissues that are healing. This occurs during pregnancy, childbirth (especially in births requiring forceps or a vacuum), chronic constipation, forceful coughing, poor lifting techniques and with decreasing estrogen levels during perimenopause and menopause. Women with hypermobility or Ehler's Danlos Syndrome (EDS) are also at risk. Pelvic organ prolapse is preventable, which is why we recommend pelvic floor therapy if you have any of these risk factors. Weakness of the deep core muscles is present in most individuals with organ prolapse, in addition to pelvic floor dysfunction.

Panic can often arise when a woman notices or feels something unusual outside her body while showering. Prolapse symptoms may include urinary leakage, urgency, or the feeling of an object in the vagina, similar to a marble or a stuck tampon. These symptoms can fluctuate, with some days being better than others. Pelvic floor therapy is a conservative treatment option for grades I to III prolapse. Unfortunately, many women opt for surgery as a first choice, which can increase the risk of developing adhesions and further dysfunction. At our clinic, patients typically attend 4-5 sessions for organ prolapse. If symptoms persist beyond this period, we recommend consulting a surgeon, such as a urogynecologist. However, it is crucial to address any underlying musculoskeletal dysfunction.

Here are some recommendations for both PREVENTING and TREATING pelvic organ prolapse:

1. Refrain from straining and holding your breath, particularly due to constipation. To prevent exertion during elimination, keep your mouth open, as all the sphincters are interconnected. When the oral sphincter is open, the rectal sphincter also opens and relaxes.

2. Exhale with Exertion involves breathing out through your mouth while lifting, whether it's during daily activities like carrying groceries or during exercise with weights. This is one of the reasons we suggest practicing mindful diaphragm breathing every day.

3. Utilize gravity to assist in repositioning your organs while activating the hip rotators and deep core muscles through PELVIC RESTORATION EXERCISES (as demonstrated in person or featured on our Instagram page).

4. Activate your hip rotators to lift the pelvic floor from the sides, akin to drawing up the ends of a hammock. The obturator internus links the hips to the pelvic floor and may pull the pelvic floor downward if there are myofascial trigger points in the muscle.

5. Maintain an active sex life to promote the health of your pelvic floor muscles and assist in repositioning the organs. Additionally, some women find using a tampon during physical activity beneficial, as it serves as a support to prevent the vaginal wall from collapsing.

6. Improve deep core muscle activation. The deep core muscles work synergistically (together) to create atmosphere pressure to hold the organs in place. For example, if you put a straw in a cup of liquid and plug the top, the liquid stays in the straw as you pull it out of the water.

7. Treat diastasis recti, if it occurs, as it is related to pressure management. Visit our BLOG for further details on repairing a midline separation in your abdominal muscles.

8. Be aware of your limitations; seek assistance with carrying heavy items (such as groceries and laundry baskets) until you can lift them without holding your breath, and try to avoid standing for long periods, particularly during menstruation.

9. Manage nervous system dysregulation. Continuously being in a fight or flight state, referred to as sympathetic dominance, leads to improper breathing patterns and unusual tension in the pelvic floor muscles.

We have treated many women with pelvic organ prolapse who have become empowered in their bodies and have been able to avoid surgery for organ prolapse. If prolapse symptoms do not improve after four or five therapy visits, we recommend getting an opinion from a surgeon, such as a urogynecologist. If surgery is the only option, pelvic floor prehab before surgery can help improve surgical outcomes and prevent prolapse from returning. Pelvic floor rehab after surgery is recommended to improve the long-term outcome of surgery. If you have myofascial pelvic pain, limitations in hip mobility or have tried the above recommendations without resolution of symptoms, seeking the help of an expert pelvic floor therapist who specializes in the treatment of organ prolapse is recommended. Specialized physical therapy at Healthy Core can help, whether you already have prolapse or are at risk. Call our office at (330)528-0034 to schedule a FREE consultation with one of our pelvic floor experts. Don't let organ prolapse drag you down.

Disclaimer: the exercises and advice in this blog are not meant to replace individual medical advice or treatment.

written by Janine Laughlin, revised October 2025