What to expect from pelvic floor physiotherapy for pelvic organ prolapse

Pelvic organ prolapse happens when support for the bladder, bowel or uterus changes and a pelvic organ moves downwards. Symptoms may include heaviness, a vaginal bulge, urinary changes, bowel difficulty or discomfort with activity. A clinician considers your symptoms and examination findings together; the sensation of a bulge does not by itself show how much support has changed.

Expect questions about childbirth, menopause, surgery, constipation, coughing, exercise and the activities you want to resume. The physiotherapist may assess breathing, posture and pelvic floor contraction and release. An internal examination can help assess support, but it requires your consent and can be postponed or declined.

Your programme may teach a coordinated pelvic floor squeeze before a cough or lift, followed by full release. It can include endurance and quick contractions, breathing without straining, bowel habits, lifting technique and graded exercise. If constipation or repeated straining is present, addressing it is part of protecting pelvic support.

Practise the prescribed technique in the positions chosen for you. Do not repeatedly tighten if that creates pain or a sense of pressure. A pessary or medical review may also be discussed when symptoms remain troublesome; physiotherapy is one part of prolapse care.

Arrange review if a bulge is new, changing, bleeding, ulcerated or difficult to push back, or if urinary or bowel emptying becomes harder. Seek urgent help if you cannot pass urine, have severe pelvic pain, heavy bleeding or feel faint. Sudden symptoms after childbirth also need prompt contact with your maternity or medical team.

Ask which organ support is affected, whether a pessary or specialist review is appropriate, how to lift safely, and how to measure progress without focusing only on the bulge sensation.