Dietz (2015) describes Pelvic organ prolapses (POP) as the downward displacement of the pelvic organs which results in herniation of the organs into or through the vagina or the anal canal away from their normal anatomical position.

Symptoms of POP include:

  • sensation of a bulge into the vagina
  • heaviness within the pelvis
  • pain with bladder and bowel clearance
  • dysfunction and sexual function
    (Hagen and Ranee 2012)

Different types of prolapses

  1. Cystocele (Anterior prolapse) where the bladder protrudes into the vagina
  2. Uterine prolapse where the uterus protrudes into the vaginal canal
  3. Rectocele (Posterior compartment prolapse) where the rectum protrudes into the vaginal canal
  4. Enterocele where the colon or the small bowel herniates through the vaginal canal

POP is a common condition which affects women over the age of 50 years. According to Hagen et al (2014), 46%-50% of childbearing women over 50 years, experience POP on examination. Severe POP in elderly women significantly reduces quality of life and thus surgery is required (Hagen et al 2013).

Indications of pelvic organ prolapse

Risk factors for Pelvic Organ Prolapse

• Increasing age due to a lack of oestrogen and other factors
• Menopause
• Previous hysterectomies
• Pregnancy
• Familial history of prolapse especially along the maternal line
• Obesity
• Constipation and forcing voiding of bowel
• Ligament laxity
• Increase in intra-abdominal pressure from heavy lifting
• Vaginal delivery
• Obstructed defecation
(Hagen et al 2014) (Dietz 2015)

Stages of POP (Pelvic Organ Prolapse Quantification (POP-Q)

Stage 0: No prolapse demonstrated,
Stage I: Most distal portion of the prolapse is more than 1cm above the level of the hymen,
Stage II: The most distal portion of the prolapse is situated between 1cm above the hymen and 1cm below the hymen.
Stage III: The most distal portion of the prolapse is more than 1cm beyond the plane of the hymen but everted (turned outwareds) at least 2cm less than the total vaginal length.
Stage IV: Complete eversion, or eversion at least within 2cm of the total length of the lower genital tract is demonstrated.
(Definitions taken from the ICS website).

Stages of Pelvic Organ Prolapse

Role of physiotherapy in POP

• PFM training, especially in stage I-II prolapse to activate and strengthen pelvic floor.
• Lifestyle changes (ie. weight-loss programmes to counteract obesity, reducing activities which increase intra-abdominal pressure such as heavy lifting or running, and preventing constipation with dietary changes and increased fluid intake).
• Physiotherapists can also provide advice on postures for defecation, advice on the effects of smoking and voiding without straining.
(Hagen and Ranee 2012)

Pelvic organ exercise on a mat
Pelvic organ exercise on a ball

Should you suffer with symptoms of Pelvic organ prolapse or have been diagnosed with POP, please feel free to contact a physiotherapist at your nearest Lamberti Physiotherapy branch for a comprehensive assessment, treatment, and exercise programme. Lauren Angus at our Paulshof and Sandton branches has a special interest in Woman’s Health and can assist with an internal examination if required.


  1. Dietz HP 2015 Pelvic organ prolapse – a review. Australian Family Physicians 44(7): 446-452.
  2. Doaee M, Moradi-Lakeh M, Nourmohammadi A, Razavi-Ratki SK, Nojomi M 2013 Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. International Urogynecology Journal 25: 153-163 [in press]: DOI 10.1007/s00192-013-2141-8.
  3. Hagen S, Ranee T 2012 Conservative management of pelvic organ prolapse. Obstetrics, Gynaecology and Reproductive Medicine 22 (5): 118–122 [in press]: DOI: 10.1016/j.ogrm.2012.02.003.
  4. Hagen S, Stark D, Glazener C, Dickson S, Barry S, Elders A, Frawley H, Galea MP, Logan J, McDonald A, McPherson G, Moore KH, Norrie J, Walker A, Wilson D 2014 Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Then Lancet 383: 796-806.
  5. International Continence Society (ICS) website: https://www.ics.org. Last accessed 15/03/2023.
  6. Li C, Gong Y, Wang B 2015 The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. International Urogynecology Journal 27: 981-992 [in press]: DOI 10.1007/s00192-015-2846-y.