What is Pelvic Organ Prolapse?

I am really excited to bring you yet another post about your pelvic floor.  If you haven’t read my post about what exactly Pelvic Physical Therapy is, I highly encourage you to read that post first and come back here.

Below you will learn all about Pelvic Organ Prolapse. What it is, the symptoms, and ways to feel better.

Ana is a Pelvic Physical Therapist located in North Carolina, and I am so excited to have her guest posting here on A Peach in the Queen City.

She is passionate about helping women not live with these things we have been living with for so long. Because like I tell you all the time, none of these things are normal.  You do NOT have to live with this.

Could you have Pelvic Organ Prolapse?

After delivery, it takes some time for your bladder and uterus to get back to the positions they were in to begin with.

However, if significant time has passed and you find yourself saying the statements below, it is time to seek a Pelvic Physical Therapist.

“I feel like I’m falling out!”

“It feels like when a tampon is not inserted properly and is just at the opening.”

“I can’t wear a tampon because there’s something pushing it out.”

“I can see (or feel) something bulging down there and it’s rubbing against my underwear!”.

These are all phrases I hear women say when they have Pelvic Organ Prolapse (POP).

They are usually concerned and are noticing an impact in their daily lives—they feel that they can’t exercise to their full potential, they’re noticing changes in their bowel and bladder patterns, or they are noticing sex doesn’t feel the same or is uncomfortable.

It can be an unnerving and scary time for woman!

Who is Ana? 

Hi! My name is Ana Karim and I’m a pelvic physical therapist in Charlotte, NC.  I have been a physical therapist for over 20 years with a specialized focus in women’s health for almost 7 years!

When I found my niche in women’s health, it was like I finally reached my “home” in my practice.  I often tell women that my greatest joy is telling women, “you are not crazy!” and “I can help!”.

Women’s health issues are beginning to be addressed more in our country and around the world, BUT, we still have a long way to go!  I’m honored to be part of the growing number of providers who want to be a part of the solution.

Last year I started my own practice, Queen City Pelvic PT, where I offer personalized care to my clients.

As we delve into the “ins and outs” of prolapse, please know that the following is for information and educational purposes only.

Please see a physical therapist or physician for full evaluation and treatment that is right for you.  Hopefully the information I share will equip you with knowledge you can discuss with your healthcare provider!

What is Pelvic Organ Prolapse?

So, back to prolapse.  What is it? Why does it happen? Who do I see about it? What can be done to address it?

Pelvic organ prolapse, or POP, is what happens when the pelvic floor muscles and connective tissue weaken or tear.

Because of this lack of support, organs found in the pelvic cavity can descend or drop into the vaginal vault (canal).  Think hernia—but in the vagina.

It’s not that the organ is actually breaking through the vaginal canal and falling out.  It’s that the organ is pushing on the wall of the vaginal canal and creating a bulge.

That bulge can happen in the front which would indicate that the bladder is “falling” in.  That is termed a cystocele.

If the bulge is happening in the back part of the vagina, it’s the rectum and that is termed rectocele.

The uterus and the vaginal vault (if you’ve had a hysterectomy) can also prolapse and are termed uterine prolapse and vaginal vault prolapse, respectively.

If the small intestines bulge into the vagina, it’s called an enterocele.

Why does Pelvic Organ Prolapse Happen?

Prolapse can happen for several reasons:

  • Pregnancy and childbirth: Pelvic Organ Prolapse occurs in one in three women who give birth. Carrying a baby and vaginal delivery can damage the pelvic floor muscles, nerves, and connective tissue (ligaments and supportive tissue).  If the baby is large, a woman pushes for more than two hours, or has a quick and abrupt delivery, or has had multiple babies, the prevalence of Pelvic Organ Prolapse can increase
  • Aging and Menopause: With menopause comes loss of estrogen which impacts the strength and resilience of vaginal tissue. Along with other changes in aging, the pelvic floor muscles can weaken and not provide enough support.
  • Genetics: Genes, in part, help determine the strength of the connective tissue, so if your mother had Pelvic Organ Prolapse, you are more likely to also develop Pelvic Organ Prolapse if other factors are at play.
  • Lifestyle and health conditions: Activities and health conditions that involve repeated straining can cause or exacerbate Pelvic Organ Prolapse. They include obesity, chronic coughing, constipation, poor form and technique with exercising or heavy lifting.  Repeated straining, especially if you are holding your breath or closing the airway can increase intraabdominal pressure which then puts pressure downward through the pelvic cavity.

Diagnosing Pelvic Organ Prolapse

If you suspect you have Pelvic Organ Prolapse or are not sure, your gynecologist can do an initial examination.

There are specialized physicians called Urogynecologists who will do a more thorough examination especially if you are also having bowel and bladder issues.

Urogynecologists are also the specialists who, if needed, will be the best practitioners to see if surgical intervention is needed.

In many states of our country, including NC where I practice, you can see a Pelvic Physical Therapist for evaluation and treatment without a physician’s referral.   If your situation is more serious, a Pelvic Physical Therapist will refer you to a specialist for further evaluation.

There is standard measure to determine the severity of a prolapse.

Physicians use what is called the Pelvic Organ Prolapse-Q test which takes different measurements along different points of your anatomy.

Therapists use a manual and visual exam and may use a specific measuring stick to measure the descent of the pelvic floor.  There are 5 grades to classify Pelvic Organ Prolapse:

  • 0 No prolapse
  • 1 more than 1 centimeter above level of the hymen
  • 2 between 1cm and 1 cm below hymen
  • 3 more than 1 cm below the hymen but no further than 2 cm
  • 4 complete protrusion at least 2 cm outside of the vaginal opening

How to Treat Pelvic Organ Prolapse?

Finally, how is pelvic organ prolapse addressed or treated? There are a variety of interventions which   include:

Pelvic Physical Therapy

With therapy, my focus is on teaching you how to correctly locate the pelvic floor muscles and develop a personalized program for strengthening them (Kegels). It’s not a one- size-Kegel-fits-all scenario.

A therapist can assess where your starting point is and then progress you as needed to build more tone and support for those pelvic organs.

I also focus a significant amount of treatment on teaching women how to manage constipation, use good toileting mechanics, learn correct lifting techniques, and exercise using good form and techniques that correctly manage pressure through the pelvic cavity.

Studies have shown that in mild cases of Pelvic Organ Prolapse conservative treatment with Pelvic Physical Therapy significantly improves symptoms associated with Pelvic Organ Prolapse.

We can’t fix the laxity of the vaginal walls, but we help you improve the support and tone of the pelvic floor muscles which in turn, reduces some symptoms and prevents further progression of Pelvic Organ Prolapse.


This is a silicone made vaginal device that lifts and supports the vaginal walls.  There are a myriad of options, shapes and sizes.  It requires individualized fitting and your best option there is to see a urologist or urogynecologist.


In cases where physical therapy or pessary use is not helpful in reducing discomfort and improving functional limitations, surgical intervention may be necessary.

You’ll want to see a Urogynecologist and seek clear information about the type of surgery recommended.

Take the time you need to ask questions and fully understand the procedures recommended.

Of course, as with any surgery, there is recovery time and precautions and restrictions (like lifting) are placed for a certain amount of time.

Even if you were to have surgery, Pelvic Physical Therapy before and after are important as you still need good, strong pelvic floor muscles to offer pelvic support.

I hope this article has been helpful and useful.  For more information you can go to the American Urogynecologic Society website.

Although Pelvic Organ Prolapse is common, it does not mean this is something you should live with.  

If you think you might have Pelvic Organ Prolapse, contact your Gynecologist right away to set up the referral process if it is required in your state or by your insurance. 

Ana Karim, PT, PYT

A passion for helping others led me down the path of healthcare into a career that allows me to provide my clients with high quality and skilled Physical Therapy.  As a graduate of UNC-Chapel Hill’s Physical Therapy program, I have over 20 years of clinical experience. I have worked in a variety of health care settings, serving men and women across the age spectrum.  Specializing in pelvic health has allowed me to bring a holistic approach to my work.  I combine my clinical skills, pastoral care skills, certification as a Professional Yoga Therapist (PYT) to treat each individual with the expertise, care and compassion they deserve.

I’m also happy to answer questions and guide you in the right direction to meet your needs.  You can reach me via email at queencitypelvicpt@gmail.com .

Visit my website at Queen City Pelvic PT

Follow me on Instagram: @queencitypelvic and Facebook: Queen City Pelvic PT

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