Feeling pressure or heaviness in your vagina—or noticing a bulge where you weren’t expecting one—can be scary.
One of the first thoughts many women have is:
Is something falling out? Do I need to call my doctor?
These symptoms can occur with pelvic organ prolapse, a condition in which one or more pelvic organs descend toward or into the vagina as the supporting muscles and connective tissues change.
Pelvic organ prolapse is relatively common, particularly after pregnancy and childbirth, and not everyone who has prolapse experiences bothersome symptoms.
If you think you may have prolapse, the important thing is to understand what’s happening, determine whether your symptoms need medical evaluation, and learn what treatment options are available.
What Does Pelvic Organ Prolapse Feel Like?
Pelvic organ prolapse doesn’t feel exactly the same for everyone.
Common symptoms may include:
- Pelvic or vaginal pressure
- Vaginal heaviness
- Feeling like something is “falling” or dropping
- Seeing or feeling a bulge near the vaginal opening
- Symptoms that become more noticeable after standing for long periods
- Increased symptoms later in the day
- Discomfort during certain exercises or activities
- Difficulty emptying the bladder or bowel
- Needing to change position to urinate or have a bowel movement
Some women have anatomical prolapse without significant symptoms at all.
Is Pelvic Organ Prolapse an Emergency?
Pelvic organ prolapse itself isn’t usually a medical emergency.
However, new pelvic symptoms shouldn’t automatically be assumed to be prolapse.
Contact a medical provider promptly if you experience severe or rapidly worsening pelvic or abdominal pain, significant or unexplained vaginal bleeding, fever, inability to urinate, or other sudden or concerning symptoms.
If you’re otherwise feeling well but notice pelvic pressure, heaviness, or a vaginal bulge, scheduling an evaluation with a gynecologist, urogynecologist, or qualified pelvic health provider can help determine what’s going on.
Do I Need to Stop Exercising or Lifting?
Not automatically.
Women with prolapse are sometimes given broad recommendations such as:
“Don’t lift anything heavy.”
“Don’t squat.”
“Stop running.”
“Don’t lift more than ___ pounds.”
There may be situations where temporarily modifying an activity makes sense, particularly if it significantly increases your symptoms. But generic restrictions don’t tell us how your body responds to movement.
A pelvic floor physical therapist can evaluate how you breathe, move, lift, and manage pressure during activities that reproduce your symptoms.
Instead of assuming an activity is permanently off-limits, the goal is to determine whether modifications in technique, load, breathing, strength, or pressure management may help you participate more comfortably.
What Does a Pelvic Floor PT Evaluate for Prolapse?
A pelvic floor physical therapy assessment looks at more than whether prolapse is present.
Depending on your symptoms and individual situation, your physical therapist may assess:
- Pelvic floor muscle strength and coordination
- Ability to contract and relax the pelvic floor
- Breathing and abdominal pressure management
- Bowel habits and straining
- Lifting and exercise mechanics
- Activities that increase pelvic pressure or heaviness
- Your movement patterns while standing and performing functional activities
An internal pelvic floor examination may also be recommended when appropriate and with your consent.
Understanding when and how your symptoms occur helps your physical therapist develop a treatment plan specific to your body and goals.
Should I See My Gynecologist or a Pelvic Floor Physical Therapist?
Often, the answer can be both.
A gynecologist or urogynecologist can medically evaluate your symptoms, determine the type and extent of prolapse, rule out other conditions, and discuss medical treatment options when appropriate.
A pelvic floor physical therapist approaches the problem from a different perspective.
Physical therapy can evaluate how your pelvic floor, breathing, movement, bowel habits, exercise technique, and pressure-management strategies may be contributing to your symptoms.
These providers can work together rather than functioning as either/or options.
You don’t necessarily have to wait until every medical appointment is complete to discuss whether pelvic floor rehabilitation is appropriate, but new or concerning symptoms should receive appropriate medical evaluation.
Can Pelvic Floor Physical Therapy Help Prolapse?
For many women, pelvic floor physical therapy can be an important part of conservative prolapse management.
Treatment isn’t simply doing Kegels.
Depending on what your evaluation finds, pelvic floor PT may include:
- Pelvic floor muscle training
- Improving muscle coordination
- Breathing and pressure-management strategies
- Bowel and toileting mechanics
- Reducing unnecessary straining
- Modifying activities that reproduce symptoms
- Gradually returning to exercise
- Improving lifting mechanics
- Education about managing symptoms during daily activities
The appropriate treatment depends on what is actually contributing to your symptoms.
Does Having Prolapse Mean I’ll Need Surgery?
No.
Pelvic organ prolapse does not automatically mean surgery.
Treatment decisions depend on several factors, including the type and extent of prolapse, your symptoms, your health, how prolapse affects your quality of life, and your personal goals.
Options may include observation, pelvic floor physical therapy, a vaginal pessary, lifestyle or bowel-management strategies, and surgery.
For women wondering whether prolapse stage determines the need for surgery, we’ve written a separate guide explaining pelvic organ prolapse physical therapy vs. surgery and how treatment decisions are made.
What Should I Do If I Think I Have Prolapse?
First, don’t panic.
Pelvic pressure or a vaginal bulge deserves evaluation, but noticing these symptoms does not automatically mean you need surgery or have to stop exercising.
A good next step is determining exactly what you’re experiencing and how it affects your daily life.
Consider writing down:
- When you notice the pressure or heaviness
- Whether symptoms change throughout the day
- Activities that make symptoms better or worse
- Any bladder or bowel changes
- Whether you see or feel a vaginal bulge
- How symptoms affect exercise, work, intimacy, or everyday activities
That information can be extremely useful during both your medical and pelvic floor physical therapy evaluations.
Frequently Asked Questions
What are the first signs of pelvic organ prolapse?
Common early symptoms include vaginal heaviness, pelvic pressure, a sensation that something is dropping, or noticing a vaginal bulge. Some women also experience bladder or bowel symptoms.
Can pelvic organ prolapse happen after childbirth?
Pregnancy and vaginal childbirth are recognized risk factors for pelvic organ prolapse because they can affect the muscles and connective tissues supporting the pelvic organs.
Does prolapse always get worse?
Not necessarily. Prolapse and its symptoms can change over time, and progression isn’t identical for everyone. Your individual risk factors and symptoms should be evaluated rather than assuming prolapse will inevitably worsen.
Can I exercise if I have pelvic organ prolapse?
Many women with prolapse remain physically active. Whether a particular exercise needs to be modified depends on your symptoms and individual response. Pelvic floor PT can help assess how you manage movement, load, breathing, and pressure.
Should I see a gynecologist or pelvic floor physical therapist for prolapse?
Both may play important roles. A gynecologist or urogynecologist provides medical evaluation and treatment options, while a pelvic floor physical therapist evaluates muscle function, movement, pressure management, bowel and bladder factors, and strategies for remaining active.
You Have Options for Pelvic Organ Prolapse
Finding or feeling a vaginal bulge can be alarming, but a prolapse diagnosis doesn’t automatically mean surgery or giving up the activities you enjoy.
The first step is understanding what’s happening.
Medical evaluation and pelvic floor physical therapy can provide different—and complementary—information about your symptoms.
Once you understand the type of prolapse, how it affects you, and what factors may be contributing to your symptoms, you can make a much more informed decision about what comes next.
If pelvic pressure, vaginal heaviness or prolapse symptoms are affecting your daily life, learn more about our pelvic organ prolapse treatment in Las Vegas.