Pelvic Organ Prolapse: who to see and what helps

Pelvic Organ Prolapse · Kitchener, Waterloo & Cambridge

Pelvic organ prolapse is when the womb, bladder or bowel bulges into the vagina. It is common in women over 50, and a prolapse that is not bothering you may not need treatment. For stage 1 or 2 prolapse with symptoms, the UK’s national guideline says to consider at least 16 weeks of supervised pelvic floor muscle training as a first option. At CARESPACE the first visit is with a pelvic health physiotherapist.

What pelvic organ prolapse is

The pelvic floor muscles hold the womb, bladder and bowel in place. When they weaken, one or more of those organs can drop and press into the vagina. Prolapse can affect anyone with a vagina. It sometimes causes no symptoms at all and is found during a test for something else, such as cervical screening. Clinicians grade it from 1 to 4, with 4 the most severe.

Symptoms of pelvic organ prolapse

• A feeling of heaviness, discomfort or pressure in the lower tummy or vagina
• Feeling or seeing a bulge or lump inside, or coming out of, the vagina
• Pain, discomfort or numbness during sex
• Problems passing stool, such as constipation
• Problems peeing, such as feeling that your bladder is not emptying fully
• Needing to go to the toilet more often
• Leaking a small amount of urine when you cough, sneeze or exercise

That last symptom has its own page: urinary incontinence can come with a prolapse or without one.

What causes pelvic organ prolapse

• Pregnancy and childbirth
• Getting older, particularly after menopause
• Being overweight
• Long-term constipation and straining
• A persistent cough
• Pelvic surgery, such as a hysterectomy
• Joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndromes, which can make prolapse more likely

How pelvic organ prolapse is diagnosed

By a physical examination, done by a physician, nurse practitioner or gynaecologist. Specialists record how far the organs have dropped using a staging system called POP-Q. Scans are not routinely needed to document a prolapse that an examination has already found. If the examination does not explain your symptoms, it may be repeated standing or squatting, or at another time.

When to get medical help

The NHS lists no emergency signs for prolapse itself. Its advice is to see a doctor, which here means a physician or nurse practitioner, if you have a lump in or around your vagina or any other symptom of prolapse. Pelvic pain is a different matter, and these signs apply to anyone.

Call 911 or go to an emergency department if you have pelvic pain that is severe, getting worse, or hurts when you move or touch the area, or pelvic pain together with feeling faint, dizzy or lightheaded or passing out, pain in the tip of your shoulder, difficulty breathing, heavy bleeding from the vagina, or sudden confusion. Do not drive yourself. These are the signs the NHS, the UK’s health service, lists for emergency care.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner the same day, or go to an urgent care clinic or an emergency department, if you have pelvic pain and any of these: difficulty peeing or passing stool; blood in your urine or stool; unusual discharge, fluid or bleeding from the vagina; pain when you pee, or needing to pee more than usual; a very high temperature, or feeling hot, cold or shivery; vomiting and diarrhoea, or feeling sick; or you are or might be pregnant. If you are 20 weeks pregnant or more, contact your midwife or your hospital’s birthing unit.

What the evidence says about treating pelvic organ prolapse

• Doing nothing is a legitimate option. The UK guideline (NICE) says to discuss three routes: no treatment, non-surgical treatment and surgery.
• Supervised pelvic floor muscle training is a first option for stage 1 or 2 prolapse with symptoms. The recommendation is to consider a supervised program of at least 16 weeks, and to keep the exercises going afterwards if it helps. “Consider” is the more cautious of NICE’s two words: it is used where the evidence of benefit is less certain, and “offer” where the recommendation is strong.
• What the trials show. A Cochrane review found four trials, with 857 women, that compared pelvic floor muscle training with no treatment. All three that measured prolapse symptoms found more improvement with training, and in two trials training raised the chance of an improvement in prolapse stage by 17%. Four of the review’s six trials were small, two had a moderate to high risk of bias, and its searches date from 2010.
• Lifestyle advice is sensible but barely tested. Advice to consider covers losing weight if body mass index is over 30, minimising heavy lifting, and preventing or treating constipation. The Cochrane review found no trials of lifestyle changes as a treatment for prolapse.
• A pessary can be used alone or with training. In the one trial that compared them, with 260 women, a pessary plus pelvic floor muscle training probably led to more women noticing improvement than training alone, and may have slightly increased abnormal vaginal bleeding. Canada’s gynaecology society reports that most women can be fitted successfully.
• Surgery is for when the rest has not worked or is not wanted. It should be offered to women whose symptoms have not improved with non-surgical treatment, or who have declined it.

What a doctor may offer

Pessaries, hormone treatment and surgery are medical care, arranged through a nurse practitioner, physician or gynaecologist.

• A vaginal pessary. A plastic or silicone device placed in the vagina to support the pelvic organs. More than one fitting may be needed to find one that suits. Known complications are vaginal discharge, bleeding, difficulty removing the pessary and the pessary coming out, and it should be removed at least once every six months to prevent serious complications. Major complications have been seen only when pessaries were neglected.
• Vaginal estrogen, as a cream, tablet or ring, which can be considered for menopause-related symptoms before a pessary is started.
• Surgery to lift and support the pelvic organs, for severe prolapse.

How each CARESPACE service treats pelvic organ prolapse

Pelvic Health Physiotherapy

The training to consider first is a supervised program, not a sheet of exercises, and supervising it is a pelvic health physiotherapist’s work. They can assess how your pelvic floor muscles are working, build the program, and progress it across 16 weeks or more. They can also go through the lifestyle points with you: how you lift, and how to avoid straining with constipation. Whether to have an internal examination is always your choice.

About pelvic health physiotherapy →

Nurse Practitioner

A Nurse Practitioner can examine you, confirm whether you have a prolapse and how far it has progressed, talk through the three routes, prescribe vaginal estrogen where it fits, and arrange a pessary fitting or a referral to a gynaecologist.

See our Nurse Practitioners →

Other services people ask about

Kinesiology and personal training. No trial we found tests a general exercise program for prolapse. The advice in our sources is to minimise heavy lifting and to avoid activities that put a lot of strain on the pelvic floor, such as running and trampolining, while keeping up gentle exercise like walking. If you train with a kinesiologist or personal trainer, tell them about the prolapse and bring your physiotherapist’s advice. Nutrition. Weight and constipation are two of the lifestyle points above, and both are things a Registered Dietitian can help with.

Where most people start

Book with a pelvic health physiotherapist, who assesses and treats at the first visit. If you can feel or see a bulge and nobody has examined it yet, see a physician or nurse practitioner as well.

How your team works together

Prolapse is mainly looked after by one practitioner, your pelvic health physiotherapist. The medical options, a pessary, vaginal estrogen or surgery, run through a nurse practitioner or physician, and a pessary can be combined with the exercises.

Browse by service: physiotherapists and nurse practitioners.

What to expect at your first visit

1. A private conversation. What you feel and when, your bladder and bowel habits, pregnancies and births, and what you lift at work or at the gym.
2. A check for anything that needs a physician or nurse practitioner first.
3. An assessment of your pelvic floor, explained step by step, with an internal examination only if you choose one.
4. The start of your program, and a plan for the weeks ahead.

What you can do at home

• Do regular pelvic floor exercises.
• Keep to a healthy weight.
• Eat more fibre, drink plenty of water and walk regularly to avoid constipation.
• Avoid activities that put a lot of strain on the pelvic floor, such as heavy lifting, running and trampolining. If your job involves lifting, as a lot of warehouse and plant work in Waterloo Region does, raise it at your first visit.
• Do not smoke. Stopping makes a persistent cough less likely.

Outlook

Expect to give supervised training at least 16 weeks, and to keep exercising afterwards if it has helped. Our sources give no figure for how often prolapse returns or progresses. A prolapse that causes no symptoms may never need treatment.

Pelvic organ prolapse treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Can a prolapse be treated without surgery?

It can be. Supervised pelvic floor muscle training is a first option for stage 1 or 2 prolapse with symptoms, and a pessary can be used alone or alongside it. Surgery is offered when those have not helped or are not wanted.

How long do pelvic floor exercises take to help a prolapse?

A supervised program runs for at least 16 weeks. Our sources do not say how soon symptoms ease.

Can I run or lift weights with a prolapse?

The advice is to avoid activities that put a lot of strain on the pelvic floor; heavy lifting, running and trampolining are the ones named. Gentle exercise such as walking is encouraged. Our sources do not say when it is safe to go back to those activities, so ask your pelvic health physiotherapist about your own case.

What is a pessary, and who fits one?

A plastic or silicone device that sits in the vagina and supports the pelvic organs. Fitting is arranged through a nurse practitioner, physician or gynaecologist, and it can take more than one try to find the right one.

Will the physiotherapist need to examine me internally?

Only if you agree to it. At CARESPACE that decision is always yours.

Where can I see someone about a prolapse in Kitchener, Waterloo or Cambridge?

Physiotherapy is offered in all three cities, and the pelvic health physiotherapy page lists who provides it. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• National Institute for Health and Care Excellence (UK). Urinary incontinence and pelvic organ prolapse in women: management (NG123). 2019. The meaning of “offer” and “consider” is from Making decisions using NICE guidelines.
• Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews (CD003882). Dated 2021, Issue 6 on Cochrane’s page; the review’s searches run to May 2010.
• Bugge C, Adams EJ, Gopinath D, et al. Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, 2020.
• Harvey MA, Lemieux MC, Robert M, Schulz JA. Guideline No. 411: Vaginal Pessary Use. Society of Obstetricians and Gynaecologists of Canada. Journal of Obstetrics and Gynaecology Canada, 2021. Read as the published summary.
• NHS (UK). Pelvic organ prolapse, reviewed July 2025, and Pelvic pain, reviewed November 2025.

Related conditions

Urinary Incontinence · Pelvic Pain · Postpartum Recovery · Menopause · Constipation

Ready to book?

Book online with a pelvic health physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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