What is pelvic organ prolapse?

Pelvic organ prolapse (POP) happens when the pelvic organs (like the bladder, uterus, or bowel) move down a little from their usual position and start to press into the vaginal walls.

This can happen when the tissues that normally support everything (your connective tissues and/ or vaginal walls) become stretched, weakened, or possibly injured over time.

It’s more common than most people realise, and it can happen at any age. Yep, POP is not just for old ladies anymore!

Why does it happen?

There isn’t just one cause. For most people, it’s a combination of things over time.

Common contributing factors include: pregnancy and childbirth (especially vaginal or assisted births), larger or multiple babies, ageing and hormonal changes through perimenopause and menopause, genetics, chronic constipation or ongoing straining, chronic coughing, regular heavy lifting or high physical loads, higher body weight, and connective tissue differences.

But it’s really important to say this clearly: you can have several of these risk factors and never develop prolapse. And sometimes people with very few risk factors still do. Its not clear cut.

What does it actually feel like?

This is the part most people aren’t prepared for, because it doesn’t always feel how they expect.

Some people notice:

• a heavy or “dragging” feeling in the vagina or pelvis

• a sense that something is sitting lower or “not quite right”

• pressure that is worse later in the day, or after being on your feet

• feeling like a tampon is sitting differently or not quite comfortable

• needing to rush to the toilet, or feeling like bladder or bowel emptying isn’t quite complete

• symptoms that flare after lifting, exercise, or even just a busy day

• sometimes lower back or hip discomfort that doesn’t quite settle with usual treatment

And for some people, there are no symptoms at all, it’s only picked up on examination.

Is surgery the only option?

No.

Surgery can absolutely be the right option for some people, but it’s not the only pathway, and it’s not always the first step.

A lot can be done with conservative management, depending on your symptoms and goals. First you have to be assessed by an trained and experienced pelvic physiotherapist, GP, or gynaecologist.

What I look at in an assessment

When you come in, I’m not just looking at one thing. I’m trying to understand how everything is working together for you. That includes how your pelvic organs behave when you cough or push, how things feel in standing and real-life positions, pelvic floor muscle function, breathing and pressure management, tissue health and hormonal influences, lifestyle factors, and most importantly how much this is actually bothering you in your day-to-day life. Because that “level of bother” matters just as much as what I find clinically!

What treatment might involve

Treatment is never one-size-fits-all. It depends on you. It might include pelvic floor muscle training, bladder and bowel strategies, pressure management, exercise guidance, lifestyle changes, education around vaginal oestrogen (in collaboration with your GP), and sometimes support like a vaginal pessary.

A pessary is a soft silicone device that sits inside the vagina and helps support the pelvic organs. Think of it like a sports bra for your pelvic organs. It’s fitted by an experienced and trained clinician like a pelvic physiotherapist or a gynaecologist , and for many people it can make a big difference to comfort and function.

It can help people stay active, return to exercise, manage symptoms in postpartum recovery, or support them through perimenopause and beyond. But it’s not for everyone, and it’s not always a perfect fit. Part of my role is helping you figure out whether it’s actually helpful for your body and your lifestyle.

The important part

There’s no “one way” prolapse looks or feels.

Some women are really affected by it day to day, and others barely notice it. Both are valid, and both deserve attention based on your symptoms and your goals not just what shows up on a scan or exam.

If something feels off, heavy, or just not quite right, it’s worth getting it checked out.

For more information, please feel free to contact me.

Yours in pessary fitting and POP management,

Dr Camille Rains Physiotherapist

Novella Health -Whitsundays

Supporting women’s health & hormones, pelvic rehab, and nurturing fertility through physiotherapy