Prolapse Physiotherapy in Clapham

Prolapse feels different from one woman to the next, and some women have no symptoms at all. Common signs include:

• A feeling of heaviness, pressure or dragging in the vagina or pelvis, often worse at the end of the day or after standing for a long time
• A bulge, or a sense of “something coming down”, that you can feel or see
• Discomfort during exercise, lifting or sex
• Bladder changes, such as leaking, a weak flow or feeling you haven’t fully emptied
• Bowel changes, such as difficulty emptying or needing to press to help a bowel movement

Symptoms are often milder first thing in the morning and when lying down.

Prolapse is described by which organ has moved. Many women have more than one type.

Bladder prolapse (cystocele)

The front wall of the vagina loses support and the bladder bulges into it. It’s the most common type and often comes with bladder symptoms such as leaking, frequency or difficulty emptying.

Bowel prolapse (rectocele)

The back wall of the vagina loses support and the rectum bulges into it. It can make it harder to empty your bowels fully.

Womb prolapse (uterine prolapse)

The uterus drops down into the vagina. After a hysterectomy, the top of the vagina (the vault) can drop in a similar way.

How prolapse is graded

Prolapse is graded by how far it has descended, from stage 1 (mild) to stage 4 (severe). Physiotherapy is the recommended first option for stage 1 and 2 prolapse, and Olivia will explain what she finds and what it means for you.

Prolapse happens when the muscles and tissues that support the pelvic organs are stretched or weakened. Often more than one factor is involved.

Pregnancy and birth

Pregnancy and vaginal delivery, especially a long labour, a large baby or an assisted delivery, put a lot of strain on the pelvic floor. Some women notice symptoms soon after birth, others years later. Postnatal physiotherapy can help at any stage.

Perimenopause and menopause

Falling oestrogen levels affect the strength and elasticity of the pelvic tissues, so symptoms can appear or get worse during perimenopause and menopause.

Straining and heavy lifting

Long-term constipation, a persistent cough and regular heavy lifting all increase pressure on the pelvic floor over time.

Weight and general health

Carrying extra weight adds load to the pelvic floor. Some women also have naturally more flexible connective tissue, which can make prolapse more likely.

Supervised pelvic floor muscle training is the recommended first treatment for mild to moderate prolapse. It won’t always reverse a prolapse, but it can improve support, ease symptoms and help stop it getting worse. Your plan is tailored to you, but may include:

• Pelvic floor muscle training: a progressive programme to build strength, endurance and the habit of tightening before you cough, lift or bend
• Lifting and everyday activity: how to lift, carry and move in a way that protects your pelvic floor
• Bowel and bladder habits: preventing constipation and straining, and healthy toileting positions
• Return to exercise: a graded plan for running, gym or sport
• Pessary advice: a vaginal pessary can support a prolapse alongside physiotherapy, and Olivia can advise whether it’s worth discussing with your GP or gynaecologist

Your first appointment lasts 60 minutes and takes place in a private, judgement-free room at our Clapham clinic. Olivia will:

• Talk through your symptoms, pregnancies and births, bladder and bowel habits, activity levels and goals
• Assess your posture, breathing and core
• With your consent, carry out an internal examination to assess the type and stage of your prolapse and how well your pelvic floor is working. It’s always optional and fully explained beforehand
• Explain what she has found and agree a treatment plan with you

NICE guidance recommends at least 16 weeks of supervised pelvic floor muscle training as a first option for women with stage 1 or 2 prolapse. Many women notice symptoms easing within the first few weeks, but muscles take time to strengthen, so sticking with your programme matters. Most women have a series of follow-up appointments over this period, and Olivia will review your progress at each one.

A prolapse doesn’t mean you have to stop exercising. Staying active is good for your pelvic floor and your overall health, but some activities may need adapting while you build strength.

High-impact exercise such as running, jumping and heavy lifting can increase symptoms for some women. Rather than giving up what you love, Olivia will help you understand your limits, adjust your training and build back up gradually.

Physiotherapy is safe to start straight away for most women with prolapse. Speak to your GP if you have bleeding or discharge from the bulge, a bulge that can’t be pushed back, difficulty passing urine or opening your bowels, or pain that’s getting worse. Olivia will also refer you on if anything in your assessment needs medical review.