Prolapse Happens. Let's Talk About It.
- Marnie Hansen
- Jun 6
- 9 min read
Why Your Pelvic Floor Might Be Asking For Help (And Why Kegels Aren't Always The Go-To). Tips on Pelvic Organ Prolapse Treatment And More.
Blog Post Written by Dr. Marnie Hansen, DC for Salt Lake Spine & Pelvis
Let's talk about something that almost nobody talks about (or even thinks to talk about) until it happens to them:
Pelvic organ prolapse.
Not exactly your typical casual dinner table conversation, right? Yet I see it in my office all the time. Some of the most common things I hear that get my diagnostic brain thinking of prolapse are:
"I feel pressure down there."
Or:
"It feels like something is falling out."
Or my personal favorite (and a sensation I have experienced myself):
"This is embarrassing, but I swear there's a tampon stuck inside me."
And honestly? These are classic prolapse symptoms.
The good news (maybe? I have thoughts on this, but I will save for another post...) is that prolapse is incredibly common. The even better news is that there are many things we can do to help improve symptoms, support your healing, and help you feel strong and confident in your body again.
Let's dive in, shall we?
What Is Pelvic Organ Prolapse?
Imagine your pelvic floor as a hammock. Your bladder, uterus, and rectum all sit on top of that hammock all day long (in a way... technically they are suspended by fascia and the base of the organs are supported by the hammock, but hang with me here...). When the muscles, fascia, and connective tissues that support those organs become overstretched, weakened, or overloaded, one or more organs will descend downward, into the vaginal canal.
This is called a pelvic organ prolapse.
Depending on which organ is involved, it may be called:
Cystocele – bladder prolapse
Rectocele – rectal prolapse into the vaginal wall
Uterine prolapse – the uterus descends downward into the vaginal canal
Vaginal vault prolapse – often after hysterectomy
In the more severe cases, tissues and organs may actually protrude outside the vaginal opening. I've had patients tell me about this experience that they have had, and it can be quite shocking and traumatic for them. Yet many women have mild prolapse and don't even know it.
The Different Grades of Prolapse
Prolapse is typically graded based on how far the organ or organs have descended toward, into or through the vaginal canal. There are technical measurements that go far beyond this short and sweet summary, but for ease of reading, I will give you the basic overview of how prolapse is classified:
Grade 1
Mild descent into the vaginal canal.
Often, there are only a few symptoms, if any at all. This grade can be very common. Many women don't realize they have it.
Grade 2
The organ or organs (typically the uterus) have dropped closer to the vaginal opening.
Symptoms can become more noticeable, but again, not always obvious.
Grade 3
The organ (typically the uterus; the cervix is often identified first) begins to protrude outside the vaginal opening. Again, symptoms may or may not be present, and patients often report that this is not painful.
Grade 4
The organ (typically the uterus) is significantly (or completely) outside the vaginal opening. This is the most severe category.
Now here's the important thing that I want to stress:
The grade does not always match the symptoms.
I've seen women with mild prolapse who complain of severe pelvic floor pain (think perineal region, tissues and muscles between the sit-bones or even vulva area, typically). I've also seen women with more moderate to severe prolapse who didn't even know what was happening. Your experience matters more than the grading scale of course, but it's always good for preventive purposes to know where your organs sit.
What Does Prolapse Feel Like?
Women describe prolapse in all sorts of ways.
Common symptoms include:
Vaginal or vulvar pressure
Heaviness in the pelvis
Feeling like something is falling out
A bulge at the vaginal opening
Feeling like a "golf ball" is "down there"
Low back pain
Difficulty emptying the bladder
Difficulty emptying the bowels
Urinary leakage
Increased urgency or frequency
Pelvic discomfort after standing or sitting for long periods
Many women notice symptoms worsen:
At the end of the day
During exercise or exertion
After prolonged sitting or standing
During constipation (usually after straining)
After heavy lifting
Sound familiar? You're not alone.
Isn't Prolapse Just a Postpartum Thing?
Nope. Pregnancy and childbirth certainly increase risk, but they are not the whole story. And not always the cause. I've worked with numerous women who have never had children and still developed prolapse.
Why?
Because prolapse is largely a pressure-management issue (multiplied by a tissue support issue, if you want the complete equation!).
Things that can contribute include:
Chronic constipation
Repeated straining
Chronic coughing
Heavy lifting
Poor breathing mechanics
Abdominal or pelvic surgeries
Menopause-related tissue changes
Hypermobility
Abdominal obesity or an increase in visceral fat (yup, this is a known contributor)
High-impact sports
Long periods of sitting
Postural dysfunction
And yes... The old injuries matter too. As a former professional snowboarding competitor, I spent plenty of time (unintentionally) crashing and falling on my rear end and tailbone. Years later, as I was working in a busy clinic, adjusting 30-40 patients a day while standing in awkward positions, I began to notice pressure in my pelvic floor that turned into sharp pains over time.
In order to get the job done and help people in pain, I continued to strain too much with my adjusting technique, not realizing that I was adding unnecessary and unguarded stress and strain to my pelvic floor. I wasn't bracing with all the adjusting and thrusts, and I was seeing too many people in my busy clinic. Those repetitive loads added up for me over time, and my pelvic floor started talking, before it began screaming.
My body kept the score, so to speak, and this is a perfect example of old injuries and cumulative stressors adding up over time.
Does this mean you shouldn't be lifting heavy things, or avoid straining or stressing the pelvic floor? Not necessarily...
Here's the Part Most People Get Wrong
When women hear "pelvic floor problem," they often think:
"I need more Kegels."
Well, do they really? Maybe, yes. Maybe, no. This is where things get interesting.
Many women with prolapse actually have a pelvic floor that is already tight, overworked, guarding and gripping all day long.
Think of a clenched fist. Can it generate much strength? Not really. To create true strength, muscles must first be able to lengthen and relax.
Think: Lengthen to strengthen.
That's why pelvic floor therapy often starts with:
Breathing
Mobility
Relaxation
Pressure management
Lengthening and relaxing the pelvic floor
Before we focus heavily on strengthening. In fact, all of these techniques aide in the strengthening of the pelvic floor. In many cases, lengthening creates the foundation for strengthening.
So, by taking the proper steps to first relax an over-tightened pelvic floor, you can lay the foundation for appropriate strengthening. This may require a trained eye and professional guidance to walk you through it; however, in many instances.
How Is Prolapse Diagnosed?
A prolapse diagnosis typically involves:
Medical Examination
Your provider may perform a pelvic exam and ask you to bear down slightly while they assess the movement of the pelvic organs. Imaging isn't required for diagnosis, but it can be helpful in fully assessing where the pelvic organs sit in the pelvic bowl and the integrity of their function. Especially if you are having trouble emptying your bladder or bowels.
I personally had an MRI Defecography ordered for me by my physician to examine my pelvic organs more closely. This was unpleasant to perform, but gave me significant insight into the cystocele, rectocele, and moderate grade of prolapse I was experiencing from years of downward pressure to the pelvis from my occupation. It gave me answers and a roadmap to begin my own therapy with. So, further investigation via imaging could be a helpful topic to discuss with your provider.
Functional Assessment
This is one of my favorite parts of the exam.
I want to know:
How do you breathe?
How do you sit?
How do you stand or walk?
How do you lift?
What happens when you cough?
How is your posture?
Because prolapse is rarely just a pelvic floor issue. It's also a postural issue. Which means it's a whole body biomechanical issue. Think: diaphragm, core, ribs, spine, hips, and pelvic floor, and how they all work together as a pressure and movement ecosystem. When one part struggles, the other parts get the memo and will compensate.
Four Things You Can Start Doing Today
1. Learn Diaphragmatic Breathing
In my humble opinion, breathing is one of the most powerful pelvic floor exercises available. And, it's free! There are many techniques out there, but my favorite place to start with diaphragmatic breathing is Box Breathing. Here we go...
As you inhale:
Ribs expand
Diaphragm lowers
The pelvic floor gently lengthens
As you exhale:
Core engages
The pelvic floor and breathing diaphragm gently recoil upward
Try 5 minutes daily. Find a count that works for you. For example: Breathe in for a slow count of 3, hold your breath for a count of 3 (letting your diaphragm stretch and your pelvic floor relax), slowly breathe out for a count of 3, then hold for 3. This creates a "box" or complete cycle with four corners (in, hold, out, hold), hence the name Box Breathing.
For additional pelvic floor awareness and engagement, try breathing into a balloon to feel how the pelvic floor and diaphragm contract and engage as you blow the air out. This is the feeling you want to aim for when practicing any diaphragmatic breathing technique. Your pelvic floor will thank you for adding this exercise to your daily routine.
2. Stop Hovering Over Public Toilets
I know, I know. Gross. Nobody wants to sit on a public toilet. But hovering keeps the pelvic floor contracted. That makes it harder to fully empty the bladder or bowels.
Sit when possible. Relax. Breathe. Let your body do what it was designed to do. Then get up when you are done, don't linger. The downward pressure encourages prolapse.
3. Exhale During Effort
This is a game-changer. When lifting groceries, picking up kids, getting out of a chair, or climbing stairs:
Exhale on exertion while engaging the pelvic floor.
Think of lifting the pelvic floor upward and inward, supporting your organs with a small contraction as you do this. This reduces downward pressure and supports the pelvic floor in the long run.
Many women accidentally hold their breath and push downward instead. Become mindful of this practice, and notice how it changes and protects your pelvis!
4. Take Frequent Movement Breaks
Your pelvic floor loves movement! So, if you sit for long hours during the day, simply set a regular timer, and:
Stand up every 30-60 minutes.
Walk.
Stretch.
Move your hips. Do some hula-hooping or pelvic tilts. Cat/cows. Turn on some of your favorite music and dance, if you can... make it fun.
Your bladder, back, and pelvic floor will all benefit from moving those buns.
The Secret Weapon: "The Knack"
One technique pelvic floor therapists love is called The Knack.
Before coughing, sneezing, laughing, or lifting:
Gently engage the pelvic floor.
Think:
"Lift and support."
Then perform the movement.
It takes diligent focus and persistent practice, so have patience with yourself on this one. Getting "the knack" for this practice can significantly reduce leakage and pressure symptoms over time.
My Take as a Pelvic Floor and Women's Health Specialist
One of the biggest myths I encounter is that prolapse means surgery is inevitable.
For some women, surgery can be very helpful. For many others, conservative care alone can make a tremendous difference.
I've seen women improve through:
Pelvic floor therapy
Breathing retraining
Postural correction
Core rehabilitation
Yoga
Better bowel habits
Lifestyle modifications
The earlier we identify and address the problem, the more options we usually have in avoiding surgical interventions. This all starts with simply getting checked, and starting the conversation.
Want to Learn More?
This is actually one of the reasons I created my Pelvic Floor Yoga & Mobility Class at Salt Lake Spine & Pelvis!
In my class, we focus on:
Breathing mechanics
Pelvic floor mobility
Core support
Hip mobility
Posture
Nervous system regulation
Building strength without excessive pressure
No awkwardness.
No judgment.
No need to know yoga.
Just practical tools to help your body work the way it was designed to.
I created this class for myself first, as I worked through my own prolapse symptoms. Then I began prescribing the exercises to my patients as I saw how well they worked on myself. Now, I teach this class for the general public to learn more about their own pelvic floor health. It's a great introduction to pelvic floor therapy if you are not sure where to start.
Final Thoughts
If you've been feeling pressure, heaviness, leakage, or the sensation that something just isn't quite right "down there," don't ignore it. Prolapse is common. And it is manageable.
Most importantly, if you are experiencing symptoms, there is a lot you can do about it. Symptom expression is simply your body's way of saying:
"Hey, I've been carrying a lot. Can we work together a little differently?"
And that's a conversation worth listening to!
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