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Women's Health

Vaginal Prolapse

Vaginal prolapse occurs when one or more pelvic organs move downwards due to reduced support from the pelvic floor muscles and connective tissues, causing pressure or a feeling of heaviness.

Understanding Vaginal Prolapse and How Pelvic Health Physiotherapy Can Help

Vaginal prolapse is a common condition where one or more of the pelvic organs move downwards and create pressure or a feeling of heaviness within the vagina. It occurs when the muscles, ligaments, and connective tissues that support the pelvic organs become less effective at providing support.

Prolapse can affect women at any stage of life, although it is more common after pregnancy and childbirth, during menopause, or following changes that place increased pressure on the pelvic floor.

Although prolapse can feel worrying, it is important to understand that it is a very common and manageable condition. Many women improve their symptoms significantly with the right advice, lifestyle changes, and targeted pelvic health physiotherapy.

What is vaginal prolapse?

The pelvic floor muscles and supporting tissues help keep the bladder, bowel, uterus, and vaginal walls in their normal position.

A prolapse occurs when these supporting structures become weakened or stretched, allowing an organ to move lower than usual.

Types of prolapse include:

Anterior vaginal wall prolapse (cystocele)

This involves the bladder pushing into the front wall of the vagina.

Posterior vaginal wall prolapse (rectocele)

This occurs when the rectum pushes against the back wall of the vagina.

Uterine prolapse

This occurs when the uterus moves downwards towards or into the vaginal canal.

Vaginal vault prolapse

This may occur after a hysterectomy, when the top of the vagina loses some of its normal support.

Common symptoms of vaginal prolapse

Symptoms vary significantly between women. Some may have a prolapse with very few symptoms, while others experience noticeable changes.

Common symptoms include:

  • A feeling of heaviness, pressure, or dragging in the vagina
  • A sensation of something “coming down”
  • A visible or noticeable bulge
  • Discomfort with prolonged standing or activity
  • Difficulty emptying the bladder or bowel
  • Urinary leakage or urgency
  • Discomfort during sexual activity
  • Reduced confidence with exercise

Symptoms often worsen towards the end of the day or after activities that increase pressure through the abdomen.

What causes vaginal prolapse?

Prolapse usually develops due to a combination of factors rather than one single cause.

Risk factors include:

  • Pregnancy and vaginal childbirth
  • Pelvic floor muscle weakness
  • Menopause and reduced oestrogen levels
  • Age-related changes in connective tissue
  • Chronic constipation and straining
  • Long-term coughing
  • Heavy lifting or repeated high-impact activity
  • Previous pelvic surgery

It is also important to recognise that prolapse can affect active women and those who have never had children.

How is vaginal prolapse diagnosed?

A diagnosis is usually made through a clinical assessment by a healthcare professional.

A pelvic health physiotherapist will discuss:

  • Your symptoms and concerns
  • Your birth and medical history
  • Your exercise and activity levels
  • How prolapse affects your daily life

Assessment may include:

  • Pelvic floor muscle assessment (with your consent)
  • Checking strength, endurance, and coordination of the pelvic floor muscles
  • Understanding how your symptoms change with movement and activity

Your physiotherapist can work alongside your GP or gynaecologist where further assessment or treatment is required.

How can pelvic health physiotherapy help?

Pelvic health physiotherapy is an important part of conservative management for vaginal prolapse.

Treatment may include:

Pelvic floor muscle training

A personalised pelvic floor programme can help improve:

  • Muscle strength
  • Support around the pelvic organs
  • Coordination during movement and pressure changes

Research shows that targeted pelvic floor training can improve symptoms for many women with mild to moderate prolapse.

Lifestyle and activity advice

Your physiotherapist can help you understand how to manage pressure on the pelvic floor, including advice around:

  • Lifting techniques
  • Exercise modification
  • Managing constipation
  • Returning safely to higher-impact activities

The aim is not to avoid activity but to help you move confidently and safely.

Support with pessary management

Some women benefit from a vaginal pessary, a device fitted inside the vagina to provide additional support.

A pelvic health physiotherapist can provide advice alongside medical management where appropriate.

Do I need surgery for prolapse?

Not everyone with a prolapse requires surgery. Treatment depends on:

  • The severity of symptoms
  • How much it affects your life
  • Your personal goals
  • Your response to conservative treatment

Some women manage their symptoms successfully with physiotherapy, lifestyle changes, or pessary support. Others may require surgical advice from a specialist gynaecologist.

Living well with vaginal prolapse

A prolapse diagnosis can feel concerning, but many women continue to exercise, work, and enjoy an active lifestyle with the right support.

A specialist pelvic health physiotherapist can provide a confidential, one-to-one assessment to help you understand your symptoms and develop a treatment plan that fits your lifestyle.

Whether you are experiencing symptoms, returning to exercise after childbirth, or looking for advice before symptoms worsen, personalised guidance can help you feel more confident.

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