Pelvic Organ Prolapse (POP)

What is pelvic organ prolapse?

Pelvic organ prolapse (POP) refers to the downward descent of the vaginal walls, uterus, or vaginal vault. It is not merely an anatomical condition. The symptoms can affect daily activities, physical function, self-image, and, in many cases, sexual health as well.

How common is pelvic organ prolapse?

Nearly half of women over the age of 40 experience some degree of pelvic organ prolapse. Despite this, the condition often remains hidden, mainly due to feelings of embarrassment or shame.

What symptoms can pelvic organ prolapse cause?

  • Sensation of a vaginal bulge or foreign body
  • Pulling or dragging lower abdominal pain
  • Low back pain
  • Urinary and bowel symptoms
  • Urinary incontinence

The severity of symptoms does not necessarily correlate with the stage of the prolapse.

Risk factors

  • Number of childbirths (especially vaginal deliveries)
  • Age
  • Overweight and obesity
  • Increased injury to the pelvic floor muscles (levator ani)
  • Menopause
  • Chronically increased intra-abdominal pressure
  • General connective tissue laxity
  • Previous pelvic surgeries

Did you know?

Pelvic floor muscle training before childbirth does not prevent pelvic organ prolapse, BUT it can reduce the risk of urinary incontinence and severe (grade III–IV) perineal tears.

Pelvic floor muscle training before and after pelvic surgery does not reduce the risk of prolapse recurrence, BUT it may improve incontinence, sexual function, and pain.

When is a urogynecological examination recommended?

The management of pelvic organ prolapse always requires a urogynecological assessment.

Conservative treatment options for POP

  1. Patient education and lifestyle modification

As physiotherapists, we teach proper lifting techniques, help manage constipation, and show you how to protect your pelvic floor muscles during everyday strain (such as coughing or sneezing).

  1. Individualized pelvic floor muscle training (PFMT)

Individualized pelvic floor muscle training has been proven to improve functional symptoms and may delay the need for surgery.

  • Stage I–II: At least 4 months of intensive, physiotherapist-guided training is recommended.
  • Stage III: Exercise therapy may still be beneficial, but its effectiveness decreases.
  1. Pessary therapy

In Hungary, pessary therapy is considered a medical competency and can be effectively combined with PFMT to provide mechanical support.

Additional treatment options: When can technology help?

Electrical stimulation

Electrical stimulation is recommended only when muscle strength is very weak (grade 0–1). Its goal is to activate the neuromuscular connection. Once active muscle contraction appears, the focus should shift to exercise therapy.

Important: If muscle strength is already good, electrical stimulation may even be harmful.

As physiotherapists, we help adjust the settings of electrical stimulation devices and reassess pelvic floor muscle strength, which determines whether continued use of the device is necessary.

Biofeedback

Biofeedback is a visual learning tool that helps patients accurately perceive muscle contraction and relaxation. It is especially recommended when the pelvic floor muscles are overactive/tight, or when muscle strength is weak to moderate (grade 2–3).

Primarily, therapist-guided EMG-based biofeedback is recommended instead of home-use consumer devices.

Our principles

  • Patient-centered care: We do not treat a diagnosis — we treat you.
  • Evidence-based therapy: We always follow the latest international guidelines.
  • Realistic goals: We provide honest guidance about what can realistically be achieved with physiotherapy and when medical consultation is necessary.

More information is available on the website of the International Urogynecological Association: