Managing Pelvic Organ Prolapse Without Surgery: What Are Your Options?
Pelvic organ prolapse (POP) is more common than many women realise. Whether you've noticed a feeling of vaginal heaviness, difficulty fully emptying your bladder or bowel, or your doctor has mentioned it during a check-up, being told you have a prolapse can feel confronting. You might wonder what it means long term, and what your treatment options are.
Fortunately, not all prolapses require surgery. In many cases, symptoms can be managed effectively with conservative (non-surgical) treatment, especially when guided by a pelvic health physiotherapist. These approaches focus on symptom relief, improving function, and helping you feel comfortable and supported in your daily life.
Understanding Prolapse
POP occurs when one or more of the pelvic organs, such as the bladder, uterus, or bowel descend from their usual position and bulge into the vaginal space. This is often due to weakened or stretched pelvic floor muscles and connective tissue, commonly after childbirth or with ageing, but also influenced by factors such as chronic straining, repeated heavy lifting, or connective tissue differences.
Some women feel a distinct bulge or dragging sensation, others report lower back ache or incomplete emptying of the bladder or bowel. And some women may not notice any symptoms at all, prolapse is sometimes picked up during a routine pelvic examination.
Conservative Management Options
There are several conservative strategies that can make a meaningful difference for women experiencing prolapse symptoms. These approaches can reduce discomfort, support your pelvic structures, and help you continue to move and live well. There is strong evidence to support the role of conservative management in the treatment of lower grade prolapse.
1. Pelvic Floor Muscle Training
Strengthening your pelvic floor muscles is one of the most researched and effective ways to manage prolapse conservatively. These muscles form a supportive sling for your pelvic organs and play a crucial role in bladder and bowel control.
In physiotherapy, we assess not just the strength of these muscles, but also how well they coordinate and respond to daily tasks like lifting, coughing, and exercising. Many women unknowingly overuse or underuse their pelvic floor muscles, and this imbalance can worsen symptoms. A tailored program can improve both muscle control and pelvic support over time.
2. Pessary Fitting and Support
A vaginal pessary is a silicone device inserted into the vagina to help support the pelvic organs and reduce symptoms like bulging or pressure. When fitted correctly, a pessary can provide immediate relief and allow you to stay active without aggravating symptoms.
Pessaries come in different shapes and sizes, and an individual fitting is essential. I offer pessary fitting as part of my practice, alongside education on how to care for and use the device safely. Some women use a pessary long term; others use it during certain activities or phases of life. It can be a flexible, low-risk option for managing prolapse day-to-day. Pessary fitting is best performed as part of a multi disciplinary team approach. Involvement from your GP and/ or gynaecologist is encouraged.
3. Adjusting Everyday Activities
Many women with POP find that symptoms are worse after prolonged standing, heavy lifting, or high-impact exercise. Making small, consistent changes to how you move and function can ease pressure on the pelvic floor:
Support your pelvic floor during coughing, sneezing, and lifting
Avoid straining on the toilet, healthy bowel habits are key
Break up long periods of standing with short rest periods lying down
Engage in low-impact activities such as walking, swimming or Pilates
It’s important not to stop exercising. Talk to your physiotherapist about how you can modify your exercise so it feels good and suits where your body is at.
With support, most women can continue moving and exercising in ways that feel safe and enjoyable.
4. Whole-Body Pelvic Health Support
Pelvic floor rehabilitation is about more than just exercises. In the clinic, I assess posture, breathing patterns, core and glute strength, and even how you move through day-to-day tasks. These elements all influence pelvic load and pressure. We also look at your goals, whether that’s returning to work, running around with your kids, or simply feeling more in control of your symptoms. Your care plan is built around you, not just your diagnosis.
When Should You Seek Help?
If you’re noticing signs of prolapse, or if you’ve been diagnosed and want to explore non-surgical options, a pelvic health physiotherapy assessment is a valuable first step. We’ll work through a thorough examination, talk about what’s most important to you, and develop a plan that’s both realistic and evidence-based. If you are concerned I would recommend touching base with your GP/ gynaecologist. In some cases conservative management is not enough and we need to involve specialist clinicians.
