Pelvic organ prolapse affects many women, but it remains something people rarely discuss openly. The symptoms can be confusing at first, ranging from a vague sense of heaviness to something more noticeable when you are active or at the end of a long day. Understanding what is happening in your body and knowing that conservative treatment often works well can make a real difference to how you feel about the situation.
Prolapse happens when the muscles and connective tissues supporting the pelvic organs become weakened or stretched. This allows one or more of the pelvic organs (the bladder, uterus, or rectum) to drop down from their usual position. The degree varies considerably. Some women experience only minor symptoms, whilst others notice a bulge or feel something descending into the vaginal canal.
There are several types, named according to which organ is affected. A cystocele involves the bladder, a rectocele involves the rectum, and a uterine prolapse involves the womb. Some women have more than one type at the same time. The severity is often graded from stage one (minimal descent) to stage four (complete prolapse), although these numbers do not always correlate with how bothersome the symptoms feel day to day.
What Are the Early Signs of Pelvic Organ Prolapse?
Early signs include a dragging sensation in the pelvis, a feeling of heaviness or pressure that worsens throughout the day, lower back discomfort, and sometimes a bulge you can feel or see near the vaginal opening. Symptoms often improve when lying down.
Many women describe the sensation as something pressing downwards, particularly after standing for several hours or lifting something heavy. The feeling may disappear completely overnight and return gradually as the day goes on. This pattern is typical.
Other early symptoms can include difficulty emptying your bladder fully, a need to change position when using the toilet, or a sense that something is not quite right internally. Some women notice urinary leakage alongside prolapse symptoms, whilst others experience constipation or difficulty with bowel movements. Not everyone has all of these symptoms, and some people have very few.
It is also possible to have a prolapse without realising it. Mild prolapse may be discovered during a routine examination and cause no symptoms at all. If you do notice something unusual, it does not mean the situation will worsen quickly or that surgery is inevitable. Most cases respond well to pelvic organ prolapse physiotherapy.
Can Pelvic Organ Prolapse Be Treated Without Surgery?
Yes, many women successfully manage prolapse without surgery. Pelvic floor physiotherapy, lifestyle changes, and in some cases a vaginal pessary can significantly reduce symptoms and improve quality of life. Surgery is usually reserved for cases that do not respond to conservative treatment.
Conservative management is often the first approach, especially if symptoms are mild to moderate. Physiotherapy focuses on strengthening or relaxing the pelvic floor muscles depending on what assessment reveals, improving how you manage pressure during daily activities, and addressing any contributing factors such as chronic constipation or poor breathing patterns.
Lifestyle adjustments also matter. Managing your weight if needed, treating a persistent cough, avoiding heavy straining, and learning how to lift safely all reduce downward pressure on the pelvic organs. These changes sound simple, but they often require guidance to get right. A physiotherapist will work with you to identify which factors are relevant in your situation and how to address them practically.
Pessaries are another non-surgical option. These are silicone devices inserted into the vagina to support the prolapsed organ. Your GP or gynaecologist can fit a pessary, and many women find them helpful, particularly if they want to remain active or delay surgery. Physiotherapy and pessary use are not mutually exclusive. You can use both approaches together.
What Does Pelvic Floor Physiotherapy Do for Prolapse?
Pelvic floor physiotherapy for prolapse involves assessing muscle function, teaching appropriate exercises to support the pelvic organs, training you to manage intra-abdominal pressure during movement, and addressing bowel and bladder habits. Treatment is tailored to your symptoms and goals.
The first session usually involves a detailed conversation about your symptoms, medical history, and daily activities. Your physiotherapist will ask about when you notice symptoms most, what makes them better or worse, and what you hope to achieve from treatment. This discussion shapes everything that follows.
Assessment may include observing how you move, breathe, and manage pressure when you cough or lift. An internal vaginal examination is often helpful because it allows the physiotherapist to feel how your pelvic floor muscles are working, but this is always optional and only happens with your informed consent. Some women prefer to start with external assessment and education, and that is absolutely fine.
Treatment might include pelvic floor muscle exercises if your muscles are weak, or relaxation techniques if they are overactive and tight. Many women assume they should simply squeeze their pelvic floor harder, but this is not always the right approach. Overactive muscles can contribute to symptoms too, so assessment is important before starting any exercise programme.
You will also learn how to manage intra-abdominal pressure. This means adjusting how you breathe, lift, and brace during everyday tasks to reduce downward force on the pelvic organs. Small changes to how you get out of bed, pick up shopping, or carry a child can make a noticeable difference over time.
Bowel and bladder advice often forms part of treatment. Straining on the toilet and chronic constipation both worsen prolapse symptoms, so addressing these issues early is worthwhile. Your physiotherapist might discuss fluid intake, fibre, toilet posture, and timing. Again, these seem like minor details, but they add up.
Can Prolapse Get Better With Exercise?
Exercise can improve prolapse symptoms by strengthening the pelvic floor and surrounding muscles, but the type and intensity matter. Supervised pelvic floor exercises often help, whilst high-impact activities may worsen symptoms in some cases. A physiotherapist can guide you towards appropriate exercise.
The idea that exercise might improve prolapse surprises some people, but targeted pelvic floor training has good evidence behind it. Research shows that supervised physiotherapy programmes can reduce the severity of prolapse and improve how women feel about their symptoms. Improvement takes time, usually several months of consistent practice, but many women notice changes within the first few weeks.
General exercise is also important for overall health, mood, and muscle tone. The challenge is finding activities that do not aggravate symptoms. Low-impact options such as walking, swimming, cycling, and yoga are usually well tolerated, although this varies from person to person. You might find that you can do certain exercises comfortably in the morning but feel more symptoms later in the day.
Returning to higher-impact activities such as running or jumping requires a more gradual approach. Some women can return to these activities with good pelvic floor function and pressure management strategies, whilst others find they need to modify their exercise routine longer term. There is no single answer that applies to everyone, which is why individualised assessment helps.
What Exercises Should You Avoid With a Prolapse?
Avoid exercises that significantly increase intra-abdominal pressure without adequate pelvic floor support, such as heavy lifting, high-impact jumping, or straining during core work. However, many activities can be modified rather than avoided completely. Your physiotherapist can help you adapt your routine safely.
The language around what to avoid needs careful handling. Telling someone to stop all lifting, exercise, and strenuous activity is neither realistic nor helpful for most women. Life involves lifting children, carrying shopping, and staying active. The goal is to do these things in a way that minimises symptom aggravation.
Heavy lifting with poor technique, particularly when combined with breath-holding, creates significant downward pressure. Learning how to engage your pelvic floor before lifting, breathing out during the effort, and keeping loads closer to your body all reduce strain. You might also need to reduce the weight temporarily whilst your pelvic floor becomes stronger.
High-impact exercise such as running, jumping, or trampolining can worsen symptoms if your pelvic floor is not ready for that level of demand. This does not mean you can never do these activities again, but it may mean taking a step back, working on foundational strength, and reintroducing impact gradually under guidance.
Certain abdominal exercises can also be problematic. Movements that cause your abdomen to dome outwards or create a visible gap down the midline (diastasis recti) may increase downward pressure on the pelvic organs. Crunches, sit-ups, and some Pilates exercises fall into this category. Alternatives such as modified planks, controlled pelvic tilts, and functional core work are often better choices, but again, this depends on your individual presentation.
Chronic coughing is another factor worth addressing. If you have a persistent cough from asthma, allergies, or smoking, treating the underlying cause reduces the repeated pressure spikes that contribute to prolapse progression. Your physiotherapist can advise you on this or suggest referral to your GP if needed.
When Should You See a Physiotherapist for Prolapse?
See a physiotherapist if you notice symptoms of prolapse, even if they are mild. Early intervention often leads to better outcomes. You should also seek help if symptoms worsen, if you experience pain or bleeding, or if prolapse is affecting your daily activities and quality of life.
Many women wait months or even years before seeking help, often because they feel embarrassed or assume nothing can be done. Starting physiotherapy early gives you the best chance of managing symptoms conservatively and may prevent progression in some cases.
You do not need to see your GP first before booking physiotherapy privately, although some women prefer to discuss symptoms with their doctor initially. Private physiotherapy allows you to access specialist assessment and treatment without waiting, which can be particularly valuable if symptoms are affecting your work, exercise, or daily comfort.
If you are in Central London, accessing women’s health physiotherapy in London is straightforward. Clinics near Tottenham Court Road, such as those in Bloomsbury, offer specialist pelvic health services with physiotherapists trained specifically in this area. You can usually book an initial assessment within a week or two.
There are some situations where you should see your GP before or alongside physiotherapy. If you have unexplained vaginal bleeding, sudden severe symptoms, significant pain, or if you notice a large bulge that appeared quickly, medical assessment is important to rule out other conditions. Your physiotherapist will also refer you onwards if they identify anything during assessment that needs further investigation.
What Happens During a Prolapse Physio Assessment in London?
Booking a prolapse physio in London usually starts with an initial assessment lasting around 45 to 60 minutes. Your physiotherapist will want to understand your symptoms in detail, including when they started, what makes them better or worse, and how they are affecting your life. Be prepared to discuss your bowel and bladder habits, any previous pregnancies or surgeries, and your current activity levels.
The conversation is private and confidential. Many women feel anxious before their first appointment, but most find the discussion easier than expected. Pelvic health physiotherapists talk about these issues every day and approach them in a calm, matter-of-fact way.
Physical assessment usually includes observing your posture, breathing pattern, and how you move. Your physiotherapist might ask you to perform a squat, lift something, or cough so they can see how your body manages pressure. This external assessment provides useful information even without an internal examination.
An internal vaginal examination allows your physiotherapist to assess pelvic floor muscle tone, strength, coordination, and the degree of prolapse. However, this is always your choice. You can decline an internal examination and still receive helpful assessment and treatment. If you do consent, your physiotherapist will explain exactly what will happen, and you can ask them to stop at any point.
After assessment, your physiotherapist will explain their findings and discuss a treatment plan with you. This might include specific exercises to practise at home, advice on pressure management and daily activities, bowel and bladder strategies, and a plan for follow-up appointments. Treatment is usually spread over several weeks to months, with the frequency of appointments reducing as you become more confident with self-management.
How Long Does Physiotherapy Take to Help Prolapse Symptoms?
Timelines vary considerably depending on the severity of prolapse, how long you have had symptoms, your general health, and how consistently you can practise your exercises. Some women notice subtle improvements within a few weeks, whilst others take several months to see significant change.
Pelvic floor muscle training typically requires daily practice for at least eight to twelve weeks before you see measurable strength gains. This is similar to any other muscle training programme. You would not expect to see major changes in your arms or legs after one week of exercise, and the same applies to your pelvic floor.
Symptom improvement may happen before measurable strength change, particularly if you make adjustments to pressure management, bowel habits, or activity modification. Many women find that understanding what aggravates their symptoms and learning how to manage daily tasks differently provides fairly quick relief.
Realistic expectations matter. Physiotherapy will not make a stage three prolapse disappear completely, but it can often reduce it to a stage where symptoms are minimal and do not interfere with your life. For some women, this is enough. For others, physiotherapy serves as a bridge whilst they decide whether surgery is right for them, or it helps them prepare for surgery and recover better afterwards.
Your physiotherapist will reassess your progress regularly and adjust your treatment plan as needed. If symptoms are not improving after a reasonable period of consistent effort, or if they are worsening despite treatment, your physiotherapist may suggest discussing other options with your GP or requesting a referral to a gynaecologist.
Finding Specialist Prolapse Physio in Central London
If you are searching for prolapse physio treatment in London, location and specialist expertise both matter. Pelvic health physiotherapy is a postgraduate specialisation, so you want someone with specific training in this area rather than a general physiotherapist.
Clinics in Bloomsbury and near Tottenham Court Road offer convenient access if you work or live in Central London. Being able to book appointments that fit around your schedule, without long waiting times, makes it easier to commit to a course of treatment.
At PhysioReform, the team includes physiotherapists with advanced training in women’s health and pelvic floor dysfunction. The clinic is located in Central London, close to Tottenham Court Road station, making it accessible whether you are travelling from within London or further afield. You can book an initial assessment online and usually be seen within a week or two.
The approach at the clinic focuses on thorough assessment, clear explanation of what is happening and why, and collaborative treatment planning. If you have questions about whether physiotherapy is right for you, or if you want to discuss your symptoms before booking, the team can provide advice by phone or email.
For more information about how physiotherapy can help with prolapse and other pelvic floor conditions, you might find it useful to read about what to expect from a pelvic health physiotherapy session in Central London. If you also experience bladder leakage alongside prolapse symptoms, the clinic offers specialist assessment and treatment for urinary incontinence.
Pregnancy and childbirth are common contributors to prolapse, so if you are pregnant or postnatal and experiencing symptoms, pre and postnatal physiotherapy can address prolapse alongside other pregnancy-related concerns.
Book Your Assessment
If you are experiencing symptoms of pelvic organ prolapse, speaking to a specialist physiotherapist is a good first step. Early assessment and treatment often lead to better outcomes, and most cases can be managed successfully without surgery.
You can book an appointment online or contact the clinic to discuss your symptoms and find out how physiotherapy might help.
External References
For further reading on pelvic organ prolapse, the NHS provides detailed information about symptoms, causes, and treatment options. The Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) professional network also offers patient information resources on pelvic health topics.