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Two Keys To Managing Prolapse

Hi friends!  If you deal with pelvic organ prolapse, you know the feeling of pressure, heaviness, and maybe even the bulging that happens when you’ve been active.  But what if we told you it doesn’t have to be that way?  What if we told you that you could live a happy and active lifestyle while managing your prolapse?  It’s true!  Let’s talk about the two keys to managing prolapse symptoms.


Let’s first start by talking about what prolapse is.  Pelvic organ prolapse is the descent of the bladder, cervix, or rectum into the vaginal canal due to insufficient support.


To understand POP, it's helpful to know more about your pelvic floor muscles.   Everyone (yes, you too men!) has layers of muscle that support their pelvic organs. Pelvic floor muscles start at the pubic bone in the front and stretch to the tailbone in the back, functioning like an internal hammock at the base of the pelvis. Pelvic floor muscles are designed to stretch, support, and rebound under stress.


In females, this hammock cradles the bladder, the uterus, and the rectum.

Pelvic organ prolapse happens when the forces from above (gravity, intraabdominal pressure, etc.) exceed the forces from below (pelvic floor muscles, fascial support, etc.). If these muscles are damaged or weakened, they may be unable to support the organs--resulting in the collapse of these organs into or through the vaginal canal walls. (Strauhal, 2016)


The two keys to managing prolapse symptoms are: managing pressure from above and optimizing support from below.


Managing Pressure From Above

Intra-abdominal pressure is the scientific term for the amount of pressure that is in our abdomen. The pressure inside our abdomen changes throughout the day with movements, changing positions, breathing, coughing and sneezing, and contracting our abdominal muscles (Bo, 2020).  Managing intra-abdominal pressure is crucial to allow to pelvic floor muscles to do their job well (Bo, 2020).  To help manage this pressure, the abdominal muscles need to be able to contract at the same time as the pelvic floor (Leitner, 2018).  Not managing this pressure well can lead to the leakage of urine or worsening of prolapse symptoms.


We can use our breath to help manage intra-abdominal pressure, and prevent excess pressure on the pelvic organs, by breathing out as we lift or exert ourselves. We want to avoid breathing in as we perform strenuous activities like lifting.  Breathing in, engages the diaphragm muscle, and when we engage both the abdominal muscles and diaphragm at the same time greatly increases intra-abdominal pressure (Hodges, 1985). This means that if we brace the stomach muscles and breath in at the same time we can significantly increase the intra-abdominal pressure. Breathing out will cause less of an increase in this pressure, allowing the pelvic floor to manage leakage and support our organs better.  Use breathing and the core brace to help with both day-to-day activities (like lifting a laundry basket) and with exercise.

Optimizing Support from Below

Our pelvic floor muscles play are responsible for giving up support from below.   As you contract your PFM (do a Kegel), the pelvic floor muscles squeeze and lift, providing support to those organs.  When we engage the pelvic floor muscles, we help to provide a counter pressure to the increase in our intra-abdominal pressure (or the pressure from above).  Watch the video below to learn how to properly engage the pelvic floor muscles.


With prolapse, sometimes the muscles aren’t strong enough or don’t have good endurance to help optimize the support from below, especially when we are very active all day long.  Supports can be a great addition to pelvic floor muscle training when dealing with prolapse. These supports can be internal (inserted into the vagina) or external (on the outside of the vagina).


Internal supports can seem scary and overwhelming, but they are a great conservative, non-surgical option. Extra internal support gives many individuals the freedom they need to do the things they want. The internal supports are inserted into the vagina to stop the pelvic organs from falling down into the vaginal canal.  There are several other internal support options that do not require a fitting by a healthcare professional. These can include: Poise Impressa, tampons, and sea sponges.  Always be sure to follow manufacturer’s guidelines on any products that you use.

 External supports help to alleviate symptoms of prolapse. These supports may also be called perineal support and provide an extra support or “lift” around the vagina to the area called “the perineum.” Perineal supports can help with symptoms of prolapse as well as varicose veins. While perineal supports can’t stop the organs from falling inside the vaginal canal, they can help to stop them from prolapsing outside of the vagina. External supports can be a game changer for many individuals. Some of our favorite supports are the Cabea belly band and the Prenatal Cradle.  If you don’t want to purchase an external support, wearing tight clothing like leggings or compression shorts can help to provide some of the same relief.

 Remember that you can live the life you want even if you have pelvic organ prolapse!   Speak with your providers about seeing a pelvic floor physical therapist or occupational therapist to help get you back on your feet.


Ready to learn more about pelvic health? Here are some helpful resources:


For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual reso­­­­­urces.  At myPFM Academy you’ll find courses like: 

  • Special Considerations for Hysterectomy and Prolapse Repair with Melissa Stendahl, PT, DPT

  • Pessaries: What Pelvic Floor Therapists Need to Know with Dr. Amanda Olson, PT, DPT, PRPC

  • Pelvic PT Evaluation of the Pelvic Floor Muscles with Dr. Samantha Richter, PT, DPT, WCS


Written by Emily Reul, PT, DPT



  1. Bo K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Med.2020;50(3):471-484.

  2. Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89(3):967-76.

  3. Leitner M, et al.  Evaluation of pelvic floor kinematics in continent and incontinence women during running: an exploratory study.  Neurourol Urodyn. 2018;37(2):609-618.

  4. Strauhal MJ, Swenson C, Rosenman A. Pelvic organ prolapse. Our Bodies Our Selves. Published August 3, 2016. Accessed November 3, 2019.


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