The word “prolapse” refers to when an organ or part of the body moves to a different position.

Pelvic organ prolapse is a condition in which one or more pelvic organs have descended from their typical position(s) and push against other organs, or move into free space such as the vaginal canal or rectum.

This condition can cause a variety of uncomfortable symptoms depending on the type and severity of prolapse.

Pelvic organ prolapse can be treated and managed with nonsurgical options, but may require surgical corrections depending on the severity.

In general terms, a partial slippage or movement of an organ is called a partial prolapse. When an entire organ shifts significantly, it is referred to as a complete prolapse.

Providers often use a grading system that classifies the severity of prolapse into different levels, which allows them to track any changes or movements of the prolapsed tissue and determine the best form of treatment.

This classification is very important, as the severity and symptoms of prolapse can vary widely.

Individuals with pelvic organ prolapse may not have any symptoms, but those who do may experience any of the following:

• A feeling of fullness or pressure
• Pelvic pain
• Being able to see or feel a bulge at the opening of the vagina or anus
• Painful sex
• Bowel difficulties, such as incomplete emptying or requiring physical assistance to allow stool to pass
• Urination difficulties such as frequent urination or incomplete bladder emptying
• Being unable to utilize insertable menstrual products

Typically, this condition affects those born with a vagina most often. However, it also can happen to those with a penis, as well as those who have undergone genital reconstruction surgery.

Below, we’ll specify the types of pelvic organ prolapse that may occur depending on the genitals you have:

*Hive Therapy and Wellness understands that gender is a spectrum and welcomes patients of all gender identities.

We understand that those who identify with gender non-conforming or genderqueer identities may also choose to undergo genital reconstruction surgery (GRS). The language used on this page when referring to different types of GRS is only used for ease of understanding.

Prolapse For Those With a Vagina:

There are many types of prolapse possible for a person born with a vagina or who has undergone male to female genital reconstruction.

The pelvic organs often affected include the bladder, uterus, rectum, or small intestines.

These organs tend to push against the walls of the vaginal canal or rectum as a result of prolapse, because both the rectum and vaginal canal are like tubes which hold empty space. Once an organ begins to fall, it is likely to push against the walls of these “tubes.”

Therefore, the types of prolapse experienced by these individuals can include any of the following:

Cystocele (Bladder Prolapse): Occurs when the muscles and connective tissues (fascia, ligaments, and tendons) that hold the bladder weaken and lengthen, causing the bladder to fall against the front or anterior vaginal wall.

Urethrocele: This happens when the support of the urethra is lost, causing the urethra to move towards the front or anterior wall of the vagina. This often will occur in conjunction with a cystocele.

Urethral Prolapse: The inner lining of the urethra moves down and protrudes outside of the body through the urethral opening.

Rectocele (Rectal Prolapse into the Vagina): The rectum is the final segment of your large intestine. This is the last place where stool travels before exiting the anus.

With a rectocele, the muscles and connective tissues that hold the rectum in place weaken and lengthen, causing the rectum to fall or bulge into the posterior or back vaginal wall.

Rectal Prolapse: Refers to when the final segment of your large intestine (the rectum) slides down into the anal canal and, in some cases, bulges outside of the body.

Uterine Prolapse: This type of prolapse occurs when the surrounding muscles, fascia, and ligaments can no longer hold and support the uterus and cervix. As a result, the uterus and cervix move down into the vaginal canal.

Depending on the degree of downward movement, the uterus and cervix may protrude out of the vaginal opening.

Vaginal Vault Prolapse: Similar to a uterine prolapse; however, this occurs in individuals who have had a hysterectomy (with or without cervical sparing) or individuals with a neovagina.

The top portion of the vaginal canal loses its support and descends into the vaginal canal, and in some cases will move into or outside of the vaginal opening.

Enterocele (Small Intestine Prolapse): This occurs when the small intestine drops down into the pelvic cavity; if severe enough, this can create a bulge into the vagina.

Neovaginal Prolapse: This is a complication of male to female genital reconstruction, which occurs when the newly formed vagina falls down into the vaginal canal or protrudes from the vaginal opening.

This condition may occur any time after the reconstruction surgery (even years later). This can also be considered vaginal vault prolapse.

Prolapse For Those With a Penis:

There are fewer types of pelvic organ prolapse for those born with a penis or who have undergone female to male genital reconstruction, due to the anatomical makeup of the pelvic structures.

Additionally, the types of prolapse possible can depend on the type of genital reconstruction chosen, as there are a wide range of procedures that may affect different pelvic organs and tissues.

Some examples of prolapse that could occur in these individuals include:

Urethral Prolapse: The inner lining of the urethra moves down and outside of the body through the urethral opening.

Rectal prolapse: The rectum is the lowest part of your large intestines. When its support structures such as the ligaments, fascia, and muscles weaken and lengthen, the rectum will move down into the anal canal.

In some instances, the rectum will move past the anus and bulge outside of the body.

Enterocele (Small Intestine Prolapse): This occurs when the small intestine drops into the pelvic cavity. The small intestine may push into the perineum, bladder, or rectum in severe cases.

Start Healing with Hive

One of the primary contributors to pelvic organ prolapse—regardless of body type—is pelvic floor dysfunction. The pelvic floor is a group of muscles, ligaments, and connective tissues that support your pelvic organs and respond to the dynamic demands of daily life.

These muscles must coordinate effectively to contract and relax for functions such as urination, bowel movements, and sexual activity.

When the pelvic floor becomes weak, overly tight, poorly coordinated, or overstretched, its ability to support the organs within the pelvis is reduced.

As a result, one or more pelvic organs—such as the bladder, rectum, uterus, urethra, or intestines—can descend from their typical position and press into nearby structures, leading to prolapse.

This lack of muscular and structural support is often gradual and influenced by a variety of factors, but at its core, prolapse reflects a breakdown in the pelvic floor’s ability to maintain internal support.

Pelvic floor dysfunction can look different for everyone. There are many causes of pelvic floor dysfunction which can lead to prolapse, and these causes depend on the person, the genitals they are born with, and many other factors.

Some factors that can contribute to pelvic floor dysfunction include the following:

Behaviors and Pelvic Floor Control

Lacking the ability and awareness to engage and relax your pelvic floor muscles at the appropriate times can cause them to become impaired.

Individuals may unintentionally negatively affect the health of their pelvic floor and their control over these essential muscles by practicing and engaging in faulty habits throughout their day. This can include aspects such as:

• Chronic straining: Frequently straining during bowel movements or trying to empty your bladder more quickly. 
• Poor posture and body mechanics: Consistently slouching or engaging in poor movement patterns.
• Improper breathing during lifting: Improper breathing coupled with poor core coordination can negatively impact intra-abdominal pressure.
• High-impact activities without proper pelvic support: Running, jumping and other high-impact movements without adequate pelvic floor muscle strength and control.
• Leaving pelvic floor dysfunction untreated: Dysfunctional movements can cause issues with strength, flexibility, and coordination over time.

Genetic Factors

Having a family history or genetic abnormality that results in a connective tissue disorder may increase an individual’s risk of experiencing prolapse.

Previous Surgery or Injury

Having a previous pregnancy, surgery, or injury to the pelvis can weaken the pelvic floor. Some examples can include hysterectomies, endometriosis surgeries, or birth injuries.

Childbirth can vary from person to person, but in most cases affects the pelvic floor to some extent. This can include cases such as:

• Vaginal deliveries
• C-section deliveries that occurred after an attempted vaginal delivery
• Delivery that resulted in perineal trauma (tears or episiotomy)

Any of these examples can also affect the nerves that allow for pelvic floor function and sensation, thus impairing pelvic floor health and strength.

Aging

The pelvic floor is perfectly capable of maintaining health and function, even into advanced age, with proper care and maintenance.

However, many individuals do not engage in long-term preventative health, and therefore may experience a loss of strength and elasticity in their pelvic floor muscles as a result. 

Additionally, the significant decrease in estrogen that occurs when aging affects tissue health, which can contribute to a loss of muscle mass.

The body begins to lose the support and suppleness of its tissues with time, and your posture also begins to change.

All of these different aspects of aging, combined with poor long-term lifestyle choices and a lack of preventative care, can result in pelvic floor dysfunction that contributes to prolapse.

Body Type

Individuals who are assigned female at birth are more prone to prolapse, due to many factors such as anatomy, the effects of pregnancy or childbirth, hormones, and an increased intra-abdominal pressure.

Pelvic floor physical therapy is a great way for individuals who have experienced prolapse to manage their symptoms, improve pelvic floor function, prevent further progression, and enhance their quality of life.

Although pelvic floor physical therapy cannot reverse prolapse, it can significantly decrease or even eliminate symptoms of prolapse.

Additionally, it is a great form of management and preventative treatment for early to moderate stages of prolapse, and can provide essential support and healing for those who choose to undergo surgery to correct their prolapse.

In most cases, individuals will want to try other forms of treatment for pelvic organ prolapse before surgery.

The first line of treatment is usually physical therapy, and if this treatment alone is unable to relieve symptoms, other interventions such as hormone management or use of a pessary will be considered next (pessaries are only applicable to individuals with a vagina).

A pessary is an insertable tool that helps hold up pelvic organs while an individual still engages in physical therapy treatment to improve their pelvic floor function.

If these non-surgical options still are unable to provide sufficient relief or the prolapse becomes too severe, surgery may become a viable option. Even then, pelvic floor physical therapy plays a necessary supportive role.

Recovery After Prolapse Surgery

In some cases, surgical interventions may become necessary for late-stage or severe prolapse in order to return the organs back to their typical position and relieve symptoms.

However, simply returning the organs to their original location doesn’t fix the root of the problem: pelvic floor dysfunction.

Even after surgical corrections, it will be essential to improve the strength, coordination, and range of motion of the pelvic floor to prevent the recurrence of prolapse and to solve the dysfunctions caused by the condition.

Therefore, your pelvic floor therapist will create a treatment plan to improve the health of your pelvic floor and relieve dysfunctions of the bladder, bowels, and more. Other specific goals of pelvic floor therapy after prolapse surgery include:

• Managing pain and swelling post-surgery
• Addressing scar tissue
• Restoring normal movement
• Decreasing the chances of relapse

Improving pelvic floor health and reducing the chances of relapse will involve much of the same pelvic floor training and preventative strategies necessary for early to moderate stages of prolapse, which we’ll discuss next.

Improving Pelvic Floor Health and Preventing Progression

Your physical therapist will start by assessing your pelvic floor strength, flexibility and coordination, and identifying the severity of your pelvic floor dysfunction.

They’ll observe your movement mechanics and postures, which can affect the health of your pelvic floor. This can include discussing your daily activities to identify other potential causes of pelvic floor dysfunction and prolapse.

They will then curate a treatment plan to improve the health of your pelvic floor and related causes of prolapse. This treatment plan will help reduce your symptoms and prevent your prolapse from worsening or recurring.

Over time, it will not only improve your comfort and confidence in daily activities but also allow you to exercise and fully engage in the activities you enjoy!

The main target of this treatment plan will be the pelvic floor, the system of muscles that holds and supports all of your pelvic organs.

It allows for many important functions, so improving the health of this group of organs will also relieve bladder, bowel, and sexual dysfunctions.

Therefore, your pelvic floor therapist will utilize treatments like neuromuscular re-education and biofeedback to retrain your pelvic floor and improve your coordination of these important muscles.

Being able to control these muscles is the first step to reducing tension and gaining strength!

Once you can effectively contract and relax these muscles, your pelvic floor therapist will guide you through strengthening exercises that will help your pelvic floor be strong and more supportive of your pelvic organs.

Having your pelvic floor therapist guide you through this is necessary in order to prevent straining and overactivation.

These exercises will not only help build strength, but also endurance, which will be essential for long-term pelvic floor health and organ support.

The pelvic floor is very important for supporting your organs, as are other parts of your body such as your hips, low back, and abdominals—which play supportive roles.

They work alongside your pelvic floor, and therefore may also need attention during your treatment to ensure proper posture, muscle balance, and coordination!

While improving the current condition of your body is important, it is also important to learn strategies to prevent further dysfunction and progression of prolapse.

Therefore, part of your pelvic floor training will address how you activate your pelvic floor during certain activities and exercises, which will be essential to prevent the progression of your prolapse.

It may be necessary to modify certain exercises in order to reduce pelvic floor strain.

Your pelvic floor therapist will also correct any harmful postures, movements, or bathroom habits that you currently engage in—which can put pressure or tension on the pelvis.

As mentioned earlier, some individuals may need to utilize an insertable tool called a pessary to help hold up pelvic organs.

Your pelvic floor therapist can collaborate with your other health providers in order to ensure safe usage of this device during movements and exercises.

In fact, the physical therapists at Hive are willing to collaborate with any other health professional, if it proves necessary for your needs!

Prolapse is different for every individual, and therefore treatment can look different, too. Hive Therapy and Wellness curates comprehensive treatment plans for every patient based on their unique needs.

Depending on your individual case, you can expect any of the following treatments to be included in your care plan: 

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback