“Nobody told me this could happen after giving birth..” — Let’s Talk Prolapse
It’s Prolapse Awareness Month, and it’s a diagnosis we see often at our Highland Park, Los Angeles clinic.
Prolapse is a unique condition. It happens when an organ—most commonly the bladder, uterus, or rectum—herniates into the vaginal canal. This often results from pushing or straining, and we frequently see it after childbirth or in individuals with chronic constipation or if the individual is constantly bearing down. It’s important to spread awareness about prolapse because many people don’t know it exists or that it can happen to them. When someone is postpartum and experiencing vaginal heaviness, prolapse is one of the key things our pelvic therapists assess for. Honestly, it’s still disheartening when someone comes in, we discover they have a prolapse, and they had no idea this was even a possibility.
As a pelvic therapy clinic, we want to highlight what prolapse is, how it can occur, and how conservative treatment can make a real difference. Oftentimes, people think they can no longer exercise or lift heavy things because they have a prolapse. Others believe surgery is the only option to manage their symptoms. However, that’s not always the case. We know that seeing or feeling something unusual vaginally can be scary. So, this isn’t meant to alarm—it’s meant to inform, to let you know what’s going on and what can be done about it.
With that, let us introduce you to a patient—let’s call her Annabelle. (Name changed for privacy.) I’m Dr. Rachel, DPT, and I’ve had the privilege of working with her for quite some time. She initially came in with stress urinary incontinence (SUI) while pregnant with her first child. We treated it successfully during and after pregnancy. She returned during her second pregnancy, when SUI reappeared in her third trimester but resolved before birth. After the vaginal delivery of her second child, her goal was to return to exercise safely and quickly. While she was no longer leaking, she reported feeling a vaginal "presence," especially after long walks or physical activity.
As her pelvic therapist, I evaluated several things:
Pelvic floor muscle status: Were her muscles hypertonic (too tight) or hypotonic (no tone)?
Muscle coordination: Could she contract and relax her pelvic floor effectively?
Neurological input: Was there any irritation coming from within the pelvis or higher up the spine?
Connective tissue integrity: How was her fascia in her abdominopelvis?
Prolapse status: Did she have a pelvic organ prolapse? (We assess both lying down and standing.)
Here’s what we found:
Her pelvic floor muscles were on the lower tone side—not overly tight.
She had difficulty recruiting both her pelvic floor and abdominal muscles.
Fascia and connective tissue were within normal limits, though we worked on releasing the fascia along her abdomen and into her back to support mild diastasis recti.
There was no neural irritation.
She presented with a stage 1 prolapse when supine—technically still within normal limits during bearing down.
Side note: It’s estimated that about 50% of women in their early 20s have a stage 1 prolapse. This shows that organ descent at this level is often normal, especially if there are no symptoms.
However, Annabelle was feeling that “presence” after long walks. So, we assessed her prolapse standing, where it was still stage 1 and asymptomatic. Initially, she was bearing down more than 75% of the time during abdominal contractions—even while lying down. We then asked her to perform some gym exercises, observed how often she was bearing down, and reassessed the prolapse standing. While technically still stage 1, we saw slightly more movement. When asked to bear down while standing—like she would during workouts—her prolapse increased to stage 2 (still above the vestibule). At that point, we had clarity on the best direction for treatment.
From that initial evaluation, we focused heavily on:
Pressure management
Pelvic floor and abdominal strength
Muscle coordination and endurance
Function across different positions: supine, sitting, and standing
We also discussed pessary use—a small device inserted vaginally to support organ position—if her symptoms didn’t improve. But Annabelle was highly motivated to improve her muscle control and strength. Within just a few sessions, she reduced her bearing down to under 25% of the time and saw marked improvements in strength and control. After about 8 visits, she no longer reported any vaginal heaviness or prolapse sensation.
Where is she now? Her diastasis is resolved, her linea alba is firm, and she has excellent pressure regulation. She does not deal with constipation and has never needed to push or strain with bowel movements. She can participate in HIIT workouts with little to no bearing down, do overhead movements without symptoms, and walk over 3 miles without any prolapse-related sensations.
The takeaway: A vaginal bulging or heaviness sensation can have many causes—from muscle coordination issues to true prolapse or even nerve involvement. Sometimes a pessary is helpful. Sometimes it’s about motor control. Here at The Pelvic Model, we’re up to date on conservative management, and we have a fun, supportive space with real equipment to help patients feel strong again. And even if exercise isn’t your thing, we tailor everything to your individual needs.
We hope this was informative for Prolapse Awareness Month. If you’re feeling unsure about what’s normal, we’re here to help.
