Feeling Heaviness or Fullness? Understanding Pelvic Organ Prolapse and the Role of Physical Therapy

Have you ever experienced a sensation of heaviness, pressure, or fullness in your pelvic area, especially when standing, running, or squatting? While such feelings are common, they are not a normal part of aging or postpartum recovery. These symptoms could be a sign of pelvic organ prolapse (POP)—a condition that affects millions of women but often goes unrecognized and undertreated.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the muscles and connective tissues supporting the pelvic organs weaken, allowing the bladder, uterus, rectum, or small intestine to descend into or even outside of the vaginal canal. This can lead to discomfort, bladder or bowel issues, sexual dysfunction, and a visible or palpable bulge in the vaginal area.

Types of Pelvic Organ Prolapse:

• Cystocele (anterior wall prolapse) – bladder drops into the vaginal wall

• Rectocele (posterior wall prolapse) – rectum bulges forward into the vaginal wall

• Uterine prolapse – uterus descends downward

• Enterocele – small intestine drops into the pelvic cavity

• Vaginal vault prolapse – top of the vagina collapses, especially after hysterectomy

Why Does It Happen?

POP results from a loss of support in the pelvic floor, often due to:

• Vaginal childbirth (especially with large babies, prolonged labor, or forceps use)

• Repeated straining from constipation

• Chronic coughing or respiratory issues

• Poor pressure management during exercise or lifting

• Hormonal changes during menopause

• Genetics or connective tissue disorders

• Obesity or sedentary lifestyle

Symptoms to Watch For:

• Heaviness or dragging sensation in the pelvis

• A bulge or feeling of something "falling out"

• Urinary incontinence or retention

• Difficulty with bowel movements

• Pain during intercourse

• Pelvic discomfort after standing or activity

  
  

The Role of Pelvic Floor Physical Therapy (PFPT)

While surgery is a valid option in some cases, many women aren’t informed that pelvic floor physical therapy is a first-line treatment—and in many cases, it’s highly effective. PFPT focuses on strengthening the pelvic floor, improving muscle coordination, and addressing posture and breathing strategies to manage intra-abdominal pressure.

What Does Therapy Look Like?

Your treatment may include:

• Internal and external assessments of pelvic muscle strength and coordination

• Tailored exercises to support and lift the pelvic organs

• Breathwork and pressure management for safe lifting and movement

• Manual therapy to release muscle tension or scar tissue

• Lifestyle coaching around constipation, hydration, movement, and posture

Backed by Research

Two high-quality studies published in the last decade support the effectiveness of PFPT:

• Braekken et al. (2015) found that targeted pelvic floor muscle training significantly reduced prolapse symptoms in women with Stage I and II POP (PubMed).

• Bo et al. (2019) emphasized PFPT’s role in improving quality of life, muscle coordination, and symptom severity in women with pelvic floor dysfunction (PubMed).

Common Myths About Pelvic Organ Prolapse

1. "If I have prolapse, I need surgery."

Not necessarily. Many mild to moderate prolapses respond well to conservative treatments. PFPT can often reduce symptoms significantly—without surgical risk or downtime.

2. "Prolapse only happens to older women."

While age and menopause can contribute to POP, young and postpartum women can also develop it, especially if they've experienced childbirth trauma or high athletic demands on their core.

3. "Kegels are the only answer."

Kegels can help—but only if they're done correctly, and they’re not always appropriate. Some women actually have overactive or tight pelvic floor muscles and need relaxation, not more contraction.

4. "If I don’t feel a bulge, it’s not prolapse."

Not all prolapse is visible or felt externally. Symptoms like heaviness, incomplete emptying, or pelvic discomfort may still indicate internal descent.

5. "I should avoid all exercise."

Quite the opposite—guided movement is essential. A skilled pelvic PT will help you safely return to fitness with core and pressure strategies that support, not strain, your pelvic floor.

Real Patient Stories

Case 1: The Active Mom

A 34-year-old mother of two came to therapy reporting a deep pelvic heaviness and pressure that worsened during long walks and when picking up her toddler. She had been told by a physician that her bladder was "a little low" but was not given treatment options. After eight weeks of pelvic floor therapy focused on breathwork, pressure management, pelvic muscle coordination, and lifting strategies, she was able to return to full activity without symptoms—and without surgery.

Case 2: The Lifelong Lifter

A 52-year-old CrossFit enthusiast began to experience leakage and heaviness during deadlifts. She feared she’d have to stop training altogether. Her PFPT evaluation revealed poor pressure control and overuse of her abdominal bracing strategy. With pelvic floor retraining, cueing modifications, and breathing drills, she returned to lifting confidently. She now incorporates PFPT-informed techniques into all her workouts.

Case 3: Post-Hysterectomy Setback

A 60-year-old woman who had undergone a hysterectomy five years prior came in reporting renewed pelvic pressure and urinary frequency. She was disheartened to learn she had developed vaginal vault prolapse—something she hadn't been warned about post-surgery. Through pelvic PT and use of a supportive pessary in collaboration with her urogynecologist, she now manages her symptoms conservatively and avoids further surgical interventions.

Final Thoughts

Pelvic organ prolapse is real, common, and treatable—without jumping straight to surgery. The body has an incredible capacity for healing, especially with the right support. Pelvic floor physical therapy can not only reduce symptoms, but also help prevent worsening over time.

Whether you’re postpartum, peri-menopausal, an athlete, or just noticing changes in your body, don’t ignore feelings of heaviness, pressure, or discomfort. You are not broken—and you are not alone.

Looking for Support?

At Top Notch Physical Therapy, we specialize in helping women navigate pelvic floor challenges with movement-based, individualized care. All sessions are 1:1 with a Doctor of Physical Therapy in a supportive and private setting.

📍 Located in San Luis Obispo📞 805-600-3525🌐 www.yourtopnotchpt.com📱 Instagram: @yourtopnotchpt

You don’t have to wait for surgery to start feeling better. Let’s work together to restore strength, confidence, and freedom.