Pelvic Organ Prolapse: Rehab Pilates

Pelvic organ prolapse

Pelvic organ prolapse is the drooping of any of the pelvic floor organs, leading to them protruding out of an orifice. The uterus, bladder, or vaginal walls can prolapse out of the vagina, or the rectum out of the anal opening. Urinary incontinence can occur as a symptom of pelvic organ prolapse.

When it comes to men, pelvic floor organ prolapse is less common than it is for women, with an occasional herniation of the bladder or the rectum. However, a vast number of women tend to have some degree of pelvic organ prolapse but it is not discussed enough.

Some of the major causes are pregnancy, labor, and childbirth. Other causes can be obesity, constipation, chronic cough, hysterectomy, or any other surgery or illness of the pelvic floor organs. Heavy occupational work is an added risk factor and can lead to the pelvic floor collapsing and the organs protruding out.


Identifying this condition first needs an analysis of the symptoms, followed by an internal examination by a pelvic floor expert. Symptoms usually depend on which organ is dropping out. When it comes to the urethra or bladder, there might be urinary incontinence. When it is the rectum, there might be constipation and dissatisfaction even after having excreted. If is it the vagina, there will be difficulty in performing intercourse or even spotting or bleeding besides the regular cycle.

With any form of pelvic organ prolapse, low back pain is a usual suspect. Prolapse could be static or could increase when coughing. And frequent infections could occur in the pelvic floor region.

Any form of prolapse requires complete medical intervention and a thorough check-up. And along with that, you need to work on pelvic floor health and your core muscle health.

Case Study

Maya (name changed) came to us post a surgical repair of prolapse. She had had two full-term normal deliveries. In both cases, her babies were large and she had required assistance in delivery. It had led to a uterine prolapse, which was diagnosed only 10 years after the first actual occurrence during the first delivery.

Even post the surgery, she had constant infections and pelvic pain. Added to this, she had a history of asthma and her lungs lacked proper expansion capability. As a culmination of all of this, she had low back pain and was unable to do even simple yoga exercises.

Being a CA by profession, she spent most of her day sitting. Her body was so used to the sedentary lifestyle and low demands, that if she went for a walk also, it became excessive for her. She was recommended Pilates to improve her mobility.

When we assessed her, she had lost tone in her abdominal muscles and also had diastasis rectus (which we will address in the next blog). There were stretch marks and a bulging belly. There were tight knots in her trapezius muscles as well.

Her urinary incontinence had increased post the second delivery and was aggravated by coughing, sneezing, and constipation. All these symptoms had vanished after the surgery. Unfortunately, they reappeared after a year. She always felt that her bladder wasn’t completely empty and had difficulty in sexual intercourse.

An X-ray and MRI indicated left lumbar scoliosis as well as disc protrusions in the cervical and lumbar region, which is basically a slipped disc.

Rehab Pilates for Pelvic Floor Prolapse

Moushumi Kuvawala, a physiotherapist and pelvic floor expert performed an external and internal examination of her pelvic floor. There was a lot of tightness and the pelvic floor recruitment was weak.

She was put on a specialised Pelvic Floor program. We started by teaching her how to relax the pelvic floor muscles. Breathing exercises and release work for the pelvic floor were part of the first stage.

Then it was important for her to learn how to recruit the pelvic floor correctly. The pelvic floor muscles are constantly in a feed-forward loop. It is a knack to pre-activate the pelvic floor in anticipation of activity.

Gradually, we moved on to the general Pilates exercises to build up her routine to deal with low back pain and cervical pain. Strengthening the muscles around the pelvic floor in the lumbar region is essential to support the organs in the pelvic region. Later, we worked on building the muscles up for function, strength, and endurance.


Awareness is the first step to cure. If you are facing any of these symptoms, don’t shy away from discussing them with your doctor or our experts. It is more common than you think and it is important to address it before it worsens.

Watch the video below for some of the exercises we used in Maya’s program

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