Understanding Pelvic Organ Prolapse – Feeling of “insides”falling out

As a pelvic floor physical therapist, I work with many patients who come to me feeling overwhelmed, even frightened, by the symptoms of Pelvic Organ Prolapse (POP). The words I hear most often are:

“It feels like my insides are falling out.”

POP can feel alarming, but it’s important to know: you are not alone, you are not broken, and there are highly effective treatment options available.

What Is Pelvic Organ Prolapse?

Pelvic Organ Prolapse happens when the support structures of the pelvic floor—the muscles and connective tissues that hold up the bladder, uterus, rectum, and intestines—become weakened, stretched, or damaged. As a result, one or more organs may descend into the vaginal canal or, in advanced cases, protrude beyond it (Weber & Abrams, 2020, Lancet)

Think of your core like a soda can:

• The diaphragm at the top

• Abdominal and back muscles around the sides

• Pelvic floor muscles forming the base

If one side weakens, pressure escapes, often in the form of a prolapse, hernia, or disc bulge.

Risk Factors

Research shows that nearly 50% of women who give birth vaginally experience some degree of prolapse in their lifetime (Nygaard et al., 2008, JAMA)

Some of the most common contributors include:

• Childbirth injuries (especially prolonged pushing, vacuum or forceps delivery)

• Menopause and hormonal changes

• Pelvic floor injuries or previous surgery

• Chronic constipation and straining

• Chronic coughing (asthma, smoking, COPD)

• Obesity and increased abdominal pressure

• Improper heavy lifting mechanics

• Genetic predisposition to weaker connective tissue

  
  

Common Symptoms of POP

Patients often describe:

• A bulge near or beyond the vaginal opening

• Heaviness or pressure in the pelvis, worse at the end of the day or with activity

• Difficulty emptying the bladder or bowels

• Urinary leakage, urgency, or frequency

• Needing to press inside the vagina to have a bowel movement or urinate

• Pain or leakage during intimacy

• Lower back or pelvic discomfort

Every patient’s experience is unique—some have very mild symptoms, while others find prolapse severely limiting their quality of life.

Why Pelvic Floor PT Should Be First-Line Care

As a pelvic floor PT, I want every patient to know: pelvic floor therapy is considered first-line, evidence-based treatment for prolapse.

A Cochrane Review found that pelvic floor muscle training significantly improves prolapse symptoms and quality of life, especially in the early to moderate stages (Hagen & Stark, 2011, Cochrane Review)

Through PT, we can:

• Strengthen weak pelvic floor muscles to better support organs.

• Relax overactive muscles that cause pressure and discomfort.

• Retrain the “core canister” (diaphragm, abs, back, and pelvic floor working together).

• Teach safe strategies for lifting, exercising, and bowel/bladder habits.

I’ve seen patients reduce or completely eliminate heaviness, leakage, and discomfort by retraining their pelvic floor.

Where Does Surgery Fit In?

Sometimes, surgery is necessary—especially for more advanced prolapse. Teh decision of surgery also depends on how much your quality of life is affecting and how the prognosis looks. It depends on age, and comorbidities. But even if you are getting the surgery, I tell patients to think of prolapse surgery the same way you’d think about knee or shoulder surgery:

You wouldn’t have orthopedic surgery without prehab (strengthening beforehand) and rehab (restoring function after).

The same principle applies here:

• Before surgery: PT strengthens the pelvic floor and optimizes your pressure system, improving surgical outcomes.

• After surgery: PT helps restore balance, prevent recurrence, and ensure safe return to daily life.

This combination gives patients the best chance of long-term success.

A Patient Story

One of my patients came in months after giving birth, saying she felt a bulge and heaviness every time she lifted her baby or carried groceries. She was told surgery was her “only option.” Instead, we started with pelvic floor therapy. Over 12 weeks, she regained strength, retrained her breathing, and learned new movement strategies. Her symptoms improved so much that she no longer felt like surgery was urgent.

This is not unusual—many women can significantly reduce prolapse symptoms with PT alone. For those who still choose surgery, they go into it stronger, better prepared, and more confident.

Takeaway

Pelvic Organ Prolapse is common, but it’s not something you have to simply “live with.” Whether your prolapse is mild or more advanced, pelvic floor physical therapy should always be your first step.

Even if surgery is part of your journey, PT is your best ally for prehab and rehab, ensuring the best outcomes and helping you return to the activities you love.

Next Step

If you’ve noticed pelvic heaviness, a bulge, or urinary and bowel changes, don’t wait until symptoms worsen.

Click below to schedule a consultation and take the first step toward relief, confidence, and better pelvic health.

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