Pelvic Organ Prolapse After Birth - Hope, Healing and What Really Works

Pelvic organ prolapse (POP) is far more common after childbirth than many mums realise, but the good news is most mild to moderate cases improve significantly - and often resolve - with the right conservative treatment in the first 12-18 months.

If you're experiencing a heavy dragging sensation, a bulge, or bladder/bowel changes postpartum, you're not alone and you're not broken.

This guide, based on our popular Pelvic Organ Prolapse video, gives you clear, practical steps to support your recovery.

Pelvic organ prolapse is downward descent of female pelvic organs. These organs include the bladder, uterus or post-hysterectomy vaginal cuff and the small or large bowel, resulting in protrusion of the vagina, uterus, or both.

Most postpartum prolapse is stage 1 or 2 and highly responsive to conservative treatment in the first 12-18 months.

Up to 80-90 % of women with mild-moderate POP become symptom-free or nearly symptom-free without surgery when they do the right things early.

What is Pelvic Organ Prolapse - Why Does It Happen After Birth?

Pelvic organ prolapse occurs when the bladder, uterus, or bowel descend and bulge into the vaginal wall due to stretched or weakened pelvic floor muscles and supporting tissues.

Vaginal birth is the leading cause, but risk factors also include:

1. Multiple vaginal deliveries
2. Instrumental birth or large baby
3. Family history/genetics
4. Higher BMI
5. Chronic constipation or straining

Up to 50% of women who have given birth have some degree of prolapse, yet only 1 in 5 need medical treatment. Most postpartum cases are Stage 1-2 and respond very well to non-surgical management.

Common Signs and Symptoms of Postpartum Prolapse

Look out for these common symptoms:

1. Feeling of heaviness, pressure, or 'something coming down' in the vagina

2. Visible or palpable bulge at the vaginal opening

3. Incomplete bladder emptying or weak urine stream

4. Recurring UTIs

5. Difficulty emptying bowels

6. Discomfort during sex

7. Lower back or pelvic ache that worsens by the end of the day

Early detection is key. Always see your doctor or pelvic health physiotherapist for a proper assessment.

Your Pelvic Floor

Your pelvic floor muscles play a role in holding up your pelvic organs from below. If your pelvic floor muscles are weak, then your pelvic organs might not be held in their right place. And as a result, they may bulge or sag down into the vagina.

The most consistent risk factors include:

1. Vaginal childbirth
2. Advancing age
3. Increasing body-mass index

Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms. However, with the exception of vaginal bulging, none is specific to prolapse.

If you are experiencing any symptoms please seek medical advice as you will likely need a pelvic examination and medical history check.

Step-by-Step Postpartum Prolapse Recovery Plan

Timeframe: 0-6 weeks postpartum

Focus on healing. Rest, gentle walking only, diaphragmatic breathing, and pelvic floor relaxation. Avoid heavy lifting and constipation.

Goal and Actions:
1. Rest and heal the perineum/C-section
2. NO formal exercise except gentle walking
3. Start diaphragmatic breathing and pelvic-floor relaxation (most important!)
4. Avoid constipation (stool softeners OK)
5. No lifting - baby in car seat

Why It Matters: Prevents worsening while tissues are still very soft from relaxin

Timeframe: 6-12 weeks

See a pelvic floor physiotherapist for an internal exam. Learn correct activation + full relaxation. Begin gentle deep core (transversus abdominis) coordination and scar massage.

Goal and Actions:

1. See a pelvic-floor physiotherapist for internal exam

2. Learn correct pelvic-floor contractions and full relaxation

3. Start gentle TA (deep core) and pelvic-floor coordination exercises

4. Begin scar massage (C-section or perineal)

Why It Matters: This is the window when tissues heal strongest - best chance for full recovery

Timeframe: 3-12 months

Follow a daily prolapse-safe exercise program with proper pressure management. Gradual return to movement, weight loss if needed (every 5kg lost can significantly reduce symptoms), and consistent pelvic floor training.

Goal and Actions:

Daily specific prolapse-safe program
1. Gradual return to exercise with proper pressure management
2. Weight loss if BMI >27 (every 5 kg lost = big symptom relief)

Why It Matters: Maximum tissue remodeling happens in first year

Timeframe: After 12 months

Goal and Actions:

1. Re-assess with physio / urogyn
2. If still symptomatic to pessary trial or surgery discussion

Why It Matters: Most spontaneous improvement plateaus by 12-18 months

Factors for a Higher Risk of Prolapse

There is a strong genetic component so prolapse tends to run in families. It is more likely after menopause or if you are overweight.

Prolapse can also happen in young women right after childbirth.

About 50% all women who have had a child have some level of prolapse. Of this, only one in five women need to seek medical help.

Prolapse can also happen in women who haven't had a baby, mainly if they cough, strain on the toilet or lift heavy loads.

Did you know that even after surgery to repair prolapse, one in three women will prolapse again?

Types of Prolapse

Pelvic organs may bulge:

1. into the front wall of the vagina (cystocele)

2. through the back vaginal wall (rectocele ;or ;enterocele) or;

3. the uterus may drop down into the vagina (uterine prolapse). More than one of the pelvic organs may bulge into the vagina.

During the early stages you may not notice the signs of prolapse. This is where it is important to have your routine pap smear test as your doctor will be able to see it when you have this test.

Signs of a Prolapse You May Notice

If the prolapse bulges right outside your body, you may feel sore and bleed as the prolapse rubs on your underwear.

1. your bladder is not emptying completely
2. you have a weak urine stream
3. a heavy sensation in the vagina
4. something coming down' or a lump in the vagina
5. sexual problems
6. a lump bulging out of your vagina
7. recurring urinary tract infections
8. difficulty emptying your bowel.

Causes

By now, you will probably know that 'childbirth' is the main cause of a prolapse. This occurs because as the baby passes through the vagina, it can stretch and tear the supporting tissues and your pelvic floor muscles.

The more vaginal births you have, the more likely you are to have a prolapse.

1. constipation
2. persistent coughing
3. lifting heavy weights

Prolapse-Safe Lifestyle Habits That Make a Big Difference

1. Always 'Blow before you go - exhale on effort when lifting baby, car seat, or pram

2. Optimise toilet posture: lean forward, elbows on knees, relax and bulge gently

3. Avoid straining - treat constipation early

4. No heavy lifting (>8-10kg) in the first 6-12 months

5. Stay hydrated and eat fibre-rich foods

6. Maintain healthy weight

Prevention & Long-Term Pelvic Floor Strength

The best defence is strong, functional pelvic floor muscles throughout pregnancy and beyond. Consistent, correct training (not just Kegels) combined with deep core work and pressure management can dramatically reduce risk and support recovery.

At PregActive, our postpartum recovery programs are specifically designed to help mums safely rebuild core and pelvic floor strength while managing or preventing prolapse symptoms.

You can heal. You can get stronger. Thousands of mums have used these strategies to return to exercise, lift their babies comfortably, and feel confident in their bodies again. Start your recovery today with the right guidance.

Listen to our full video, join the PregActive community, and take control of your postpartum healing journey. Your body has done incredible things — now it’s time to support it back to strength.

Because a prolapse is due to weak pelvic tissues and pelvic floor muscles, you should keep your pelvic floor muscles strong. Now you know why I include a pelvic floor exercises in your workouts every week of your pregnancy!

Treatment of Prolapse

1. Surgery for Prolapse

Surgery can be done to repair torn or stretched support tissues and ligaments. There are different surgical options including:

1. vaginal approach
2. abdominal approach
3. laparoscopic (keyhole)
4. robotic

2. Non-surgical Options

1.Strengthening your pelvic floor muscles.

2. Making necessary lifestyle changes - diet, fluid intake, exercising, losing weight.

3. Avoid straining on the toilet.

Lifestyle Habits

1. Never hold your breath when lifting baby, car seat, toddler, groceries → always 'blow before you go'.

2. Toilet posture every time: lean forward, elbows on knees, gentle bulge at end of poo (no straining).

3. No heavy lifting (>8-10 kg / 18-22 lb) for at least 6-12 months.

4. Treat cough/allergies and constipation aggressively.

5. Lose pregnancy weight gradually (especially if you gained >15 kg / 35 lb).

Takeaway

Prolapse is common for mamas. The key is for you to do your pelvic floor exercises throughout your pregnancy and continue doing them after childbirth. My online program has helped thousands of mamas - let me help you!