You Were Told You Have Prolapse.

Most postpartum prolapse improves significantly on its own. Research shows that up to 78% of pelvic floor support issues resolve between 8 weeks and 1 year after delivery. Stage I prolapse is now considered normal anatomical variation by many experts, not a diagnosis. And Stages II and III respond well to physical therapy, pessary support, and pressure management strategies. If you were recently told you have prolapse, your situation is almost certainly not as dire as it sounds.

A lot of people get really freaked out when they hear that they have been diagnosed with prolapse. I see it all the time. A woman comes to me in tears because her OB told her at her six-week checkup that she prolapsed during delivery. She thinks her body is broken, that it will never be the same again.

And that is almost never true.

The Five Types of Vaginal Prolapse

Before we talk about what your diagnosis actually means, let me explain what we are dealing with. There are five types of vaginal prolapse:

• Cystocele — your bladder prolapsing into your vaginal wall. This is the most common type.
• Rectocele — your rectum prolapsing into your vaginal wall.
• Urethrocele — your urethra descending and coming further down.
• Uterine prolapse — your uterus descending into the vaginal canal.
• Enterocele — your small intestine bulging into the vaginal wall. This is most common after hysterectomy, when the support at the top of the vagina is weakened.

Each type has different causes and may require different treatment approaches. An anterior prolapse (cystocele) is very different from a posterior prolapse (rectocele). This is one reason why blanket advice like “just do your Kegels” often misses the mark. You need to know what type you have before you know how to address it. Learn more about how we treat prolapse.

Why Your 6-Week Diagnosis Is Probably Wrong

After you have a baby, first and second stage prolapse is common. Extremely common. One large study from Southwest China found that over 63% of women had Stage I prolapse at their postpartum checkup. Another study found Stage II or worse in over half of women at 6 weeks.

But here is the part nobody tells you: the vast majority of that is going to heal on its own.

Research tracking primiparous women from 8 weeks to 1 year postpartum found that worse pelvic floor support resolved in 78% of cases without any surgical intervention. Your body just needed time to heal.

So when a provider diagnoses you with prolapse at your six-week appointment, they are diagnosing you at the absolute worst point of your recovery. It is like telling someone who sprained their ankle yesterday that they will never walk normally again. The tissue has not had time to heal. The muscles have not had time to recover. The hormones have not had time to stabilize.

People should not even be diagnosing women with prolapse in those early stages, because so many of them are going to heal that the diagnosis just adds unnecessary fear. And that fear can be paralyzing. I have had patients who avoided exercising, avoided picking up their children, avoided intimacy for months because of a six-week diagnosis that would have resolved on its own.

Stage 1 Is Not Prolapse Anymore

This is the part that changes everything for a lot of women.

Enough research has been done showing that people without any symptoms, people who have never had a baby, do not have any issues, will have the amount of movement that was typically classified as Stage I prolapse. In other words, Stage I is a normal amount of pelvic organ movement.

Harmanli (2014) published a paper asking directly: “POP-Q Stage I prolapse: is it time to alter our terminology?” Dietz (2016) confirmed through ultrasound studies that Stage I anterior and posterior descent is “likely within the normal range.”

Here is what makes this so significant: when assessed using the POP-Q scale, up to 50% of all women show Stage I findings on exam. But only 3-6% report symptoms. That is a massive gap between what is “diagnosed” and what actually causes problems.

There are a lot of women out there who were classified with “prolapse” when they actually had a normal amount of movement. Especially after having a baby. And that diagnosis does not have a time period associated with it. A Stage I amount of movement is normal no matter how old you are, how far postpartum you are, or whether you have never been postpartum at all.

Stages 2 and 3: Treatable With Physical Therapy

For women with Stage II and Stage III prolapse that persists beyond the early postpartum period, the evidence strongly supports physical therapy. A systematic review of 11 randomized controlled trials found high-level evidence supporting pelvic floor muscle training as a first-line treatment for prolapse.

The important thing with prolapse is determining what is causing it, because it is really a pressure management issue.

• Some people get prolapse from chronic constipation — bearing down repeatedly pushes organs downward.
• Some people get it from heavy lifting with poor pressure management.
• Having a baby is a very common cause, but if that is the only factor, recovery is often straightforward.

If the only thing that caused your prolapse was having a baby, now it is about adding support from the bottom. Whether that means pelvic floor muscle strengthening, a pessary, or a support garment depends on where you are in your healing and how significant the prolapse is.

But if something ongoing is causing the prolapse, like the way you lift or chronic constipation, we need to address those things. Otherwise you are just going to keep stressing that system by adding extra pressure that pushes down on those organs.

Pessaries: The Ankle Brace for Your Pelvic Floor

A pessary is something I am really excited about as a treatment option. Think of it like a splint for your vaginal wall.

When you sprain an ankle, you wear an ankle brace while it is still healing and while you are gaining internal support from your ligaments and muscles. A pessary is similar. It adds external support when the ligaments are not strong enough yet.

There are different shapes and sizes of pessary, so getting one fitted specifically for you by someone who is trained in fitting pessaries can be really helpful in managing your symptoms. You wear it during activities that cause your symptoms, like exercising, running, gardening, or even just walking around. It depends on your body and what you are feeling.

Pessary fitting by physical therapists is relatively new in the United States, but in countries like Australia, PTs have been fitting pessaries for 10 to 15 years. The research is promising. Some studies show that prolapse can actually get smaller after wearing a pessary for 3 months to a year. We do not have enough long-term research to definitively say that wearing a pessary will permanently resolve prolapse, but the evidence is encouraging.

There is also good research coming out about wearing support garments during pregnancy and in those first six to eight weeks postpartum that can lessen the symptoms of prolapse, that heaviness or bulgy feeling, as well as helping everything heal in a supported position.

Exercise Does Not Make Prolapse Worse

One of the biggest fears women have after a prolapse diagnosis is that exercise will make things worse. This is not supported by the research.

Siff et al. (2020) found that exercise does not enlarge the levator hiatus, the opening in your pelvic floor. Gluppe et al. (2023) conducted a randomized controlled trial showing that curl-ups improve abdominal strength without worsening pelvic floor disorders.

Avoiding exercise entirely because you are afraid of your prolapse can actually make things worse. Muscles that are not used get weaker. And weaker muscles mean less support for your organs. Here is what you actually need to know about postpartum exercise.

The key is not avoidance. The key is learning to manage pressure during activity. That means learning how to breathe, how to brace, and how to coordinate your core and pelvic floor during movement. That is exactly what we teach in your first visit.

The Real Story: A Patient Who Cancelled Her Surgery

I had a patient who worked at a packing company, lifting heavy boxes all day. She had been scheduled for a hysterectomy because of her prolapse. After one to two months of physical therapy focused on lifting form, breath coordination, bowel habits, and external support, she cancelled her surgery. Her symptoms were gone.

That is not a miracle. That is what happens when someone actually assesses what is causing the pressure, and addresses it. Not everyone can avoid surgery. Stage IV prolapse typically requires surgical intervention. But for Stages II and III, physical therapy should always be tried first.

When to Actually Seek Help

Not every prolapse needs treatment. If you are early postpartum and were told you have a Stage I or mild Stage II prolapse, give your body time. The odds are strongly in your favor that things will improve.

But you should seek assessment if:

• You feel persistent heaviness or pressure in your vagina that is not improving
• You can see or feel something bulging at the vaginal opening
• Symptoms are limiting your daily activities or exercise
• Your symptoms are not improving over time
• You are avoiding activities you love because of fear or symptoms

Most clients invest between a few sessions to several months depending on their goals. At least half of every session is education, because I want you to understand your body well enough that you do not need me forever. Schedule a free consultation and let us figure out exactly where you stand.

By Dr. Danaya Kauwe, PT, DPT, PRPC, Cert-DN — Board-Certified Pelvic Rehabilitation Practitioner serving Utah Valley with in-home pelvic floor physical therapy. Clinical insights informed by the WHTA Advanced SUI/POP course presented by Taryn Hallam.