What Is Pelvic Organ Prolapse (POP)?

Pelvic Organ Prolapse can sound a bit intimidating, but it’s actually incredibly common. It happens when the pelvic organs, like your bladder, uterus, or bowel shift from their usual position and begin to bulge into the vaginal wall. This is often linked to pregnancy and birth, but not always. Hormonal changes, ageing, long-term constipation, repetitive heavy lifting, or simply genetics can all play a part too.

So, what exactly is prolapse?

Pelvic organ prolapse (often shortened to POP) is when one or more of the pelvic organs drop down from their normal position and press against the walls of the vagina. This usually happens because the muscles and connective tissues that support those organs have weakened or become stretched.

Symptoms can vary, but many people describe:

• A heavy, dragging or full sensation in the pelvis or vagina

• Feeling or seeing a bulge

• Trouble completely emptying the bladder or bowels

• Leaking urine

• Discomfort during sex

• Or just the sense that something feels “off” down there

Not everyone has symptoms though, and that’s why getting a proper assessment with a pelvic health physio is so important.

The different types of prolapse

There are several kinds of prolapse, depending on which organ is affected:

A urethrocele is when the urethra shifts downward.
A cystocele is when the bladder prolapses into the front wall of the vagina.
A uterovaginal prolapse involves the uterus, cervix, and top part of the vagina.
An enterocele is when the small bowel drops into the space between the vagina and rectum.
A rectocele is when the rectum pushes into the back wall of the vagina.

You might have just one type, or sometimes a combination.

Prolapse grades – how it’s measured

Prolapse is also described in grades (or stages), based on how far the organ is dropping.

Grade 0 means there’s no prolapse.
Grade 1 means the organ has dropped but is still more than 1cm above the vaginal opening (hymen).
Grade 2 means the organ is sitting right at, or just within 1cm of, the vaginal opening.
Grade 3 means it’s protruding slightly beyond the vaginal opening.
Grade 4 is the most advanced, with the organ fully bulging out.

These grades are part of a system called the POP-Q, it sounds complicated, but really it just helps your physio or healthcare provider describe what’s going on clearly and track any changes over time.

Common symptoms

The HSE lists some of the most common symptoms of prolapse as:

• A feeling of pressure, heaviness or fullness in your pelvic area

• A bulge or lump at the vaginal opening

• Backache or discomfort

• Issues with peeing – like difficulty starting, a slow stream, or not fully emptying

• Bowel movement troubles – like needing to press around the vagina to help things along

• Urinary leakage

• Discomfort or pain during sex

Again, symptoms can vary from person to person and not everyone experiences them the same way.

What can help?

The good news? There are loads of options for managing and improving prolapse, and it doesn’t always mean surgery. Here’s what might help:

• Pelvic floor strengthening exercises – done properly and consistently, ideally with guidance from a pelvic health physio.

• Reducing bodyweight, if advised, to lessen pressure on your pelvic floor.

• Improving bowel habits – managing constipation and avoiding straining is key.

• Finishing breastfeeding – for some, lower oestrogen during lactation can impact symptoms. This doesn’t mean you need to stop, but it can help explain symptoms in the meantime.

• Topical hormonal therapy – oestrogen creams or pessaries prescribed by your GP.

• Support pessaries – small silicone devices placed in the vagina to help support the organs.

• Surgery – considered if other approaches haven’t worked, and depending on your symptoms and goals.

Managing my own prolapse – my top 5 tips

Yep, I’ve got a prolapse too. And here’s how I’m managing mine, in case it helps you:

1. Work with a pelvic health physio
This is a non-negotiable. An internal assessment can help you find your personal starting point and figure out what your body needs right now, not just a generic list of exercises.

2. Do my pelvic floor "homework"
But not just lying-down kegels. I work on strength, endurance, responsiveness and relaxation - in different positions and throughout my training sessions.

3. Be aware of my overall “load”
Training isn’t the only pressure on your pelvic floor. How you carry your baby, lift your toddler, how your bowels are functioning, if you’re coughing a lot – it all plays a role. This isn’t to scare you, just to help you understand the big picture.

4. Keep strength training
My pelvic floor is part of my whole body, so staying strong throughout makes a massive difference. I follow a total-body progressive strength plan that helps me stay active and functional in everyday mum life.

5. Use a pessary for extra support
I’ve been using the Restifem pessary and it’s been a total game-changer. It helps reduce daily symptoms and gives me a bit of reassurance while I work on getting stronger.

Final thoughts

Prolapse is common, but it’s not the end of your training, or your sense of strength and self. With the right support, smart training choices, and a bit of patience, you can feel like you again.

Everyone’s journey is different, so what works for one person might not suit someone else. That’s why working with a pelvic health physio, and a coach who understands postnatal bodies, can make all the difference.