Understanding Pelvic Organ Prolapse: Beyond Tightness and Towards Recovery
Pelvic Organ Prolapse (POP) can be one of the most confronting pelvic floor symptoms. It often arrives with fear, confusion, and a sense of disconnect from your body. But understanding what’s really happening beneath the surface can help you feel more empowered and less alone—and lay the foundation for meaningful recovery.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse happens when one or more pelvic organs shift from their optimal position and press into the vaginal wall or descend through the anus. This descent occurs because the support structures—fascia, ligaments, muscles, and connective tissue—have become overstretched, weakened, or disrupted.
Types of Prolapse and Where They Occur
Pelvic organ prolapse isn't just one thing—it can involve different organs, tissues, and support structures:
Cystocele (anterior vaginal wall prolapse): The bladder pushes into the front wall of the vagina. This is one of the most common types, often experienced as a bulge or pressure.
Rectocele (posterior vaginal wall prolapse): The rectum bulges into the back wall of the vagina. This may cause a sensation of incomplete emptying or the need to press on the perineum to pass stool.
Uterine prolapse: The uterus descends into the vaginal canal or, in more severe cases, protrudes outside of it.
Enterocele: The small intestine herniates into the space between the vagina and rectum, often following hysterectomy or loss of upper vaginal support.
Vaginal vault prolapse: This occurs after hysterectomy, when the top of the vaginal canal loses support and collapses inward.
Rectal prolapse: A full-thickness portion of the rectal wall protrudes through the anus. This is distinct from rectocele and often linked to chronic straining, nerve dysfunction, or pelvic floor weakness.
Urethral prolapse: The inner lining of the urethra protrudes out of the external urethral opening. It may look like a small red donut and is more common in postmenopausal women and young girls.
Perineal descent (or bulging): The perineum—the area between the vagina and anus—drops lower than usual, especially during straining or standing. It may cause pain, a feeling of instability, or difficulty with bowel movements.
Common Symptoms
A sensation of heaviness, dragging, or bulging in the pelvis or vagina
Feeling like something is "falling out"
Difficulty emptying the bladder or bowels
Discomfort during sex
Lower back ache
Visible or palpable bulge
Mucus leakage or rectal bleeding (rectal prolapse)
Urethral irritation or spotting (urethral prolapse)
What Causes Prolapse?
Prolapse is rarely due to a single cause. Often, it's the result of multiple influences on the body's pressure system and connective tissue resilience:
Childbirth: Especially vaginal deliveries, forceps use, large babies, or long pushing phases.
Chronic straining: From constipation, heavy lifting, or persistent coughing.
Hypermobility syndromes: Such as Ehlers-Danlos, which compromise connective tissue integrity.
Trauma (physical or emotional): Habitual holding or tension patterns can create long-term pelvic bracing.
Disordered eating (e.g. bulimia): Repeated vomiting increases intra-abdominal pressure and pelvic strain.
Surgical trauma: Hysterectomies or pelvic repairs can disrupt fascial integrity or nerve signalling.
Kegels, the Knack, and the Squeezy App: Helpful or Harmful?
Kegels
Kegels are voluntary contractions of the pelvic floor. When taught well—including the relaxation phase—they can improve coordination and circulation. But in many cases of prolapse, the pelvic floor may already be overactive. Adding more contraction without length or breath may worsen symptoms.
The Knack
This technique involves squeezing the pelvic floor just before a pressure event like coughing or sneezing. It’s a short-term strategy for managing leaks or bulge sensations but does little to restore long-term pressure management or tissue health.
Squeezy App
Created by the NHS, Squeezy helps users track pelvic floor exercises. It focuses on consistent squeezing. While this may suit some, it can miss the nuance of breath, posture, fascial release, and full-range coordination.
The Myth of the Tight Pelvic Floor
A tight muscle isn’t a strong one. True pelvic health relies on dynamic strength—the ability to contract and relax, adapt and respond. A constantly braced pelvic floor can:
Increase intra-pelvic pressure
Limit blood and lymph flow
Create friction between fascial layers and organs
Aggravate nerve compression
In prolapse cases, chasing tightness can make symptoms worse.
Your Pelvic Floor Is Part of a Bigger System
The pelvic floor is connected to and influenced by multiple muscle groups and fascial chains:
Adductors: Connect through the obturator internus to the pelvic wall
Glutes: Stabilise the sacrum and influence pelvic outlet
Back extensors (QL, multifidus): Support lumbar and sacral orientation
Psoas: Fascially linked to pelvic and respiratory diaphragm
Abdominals (RA, TA, obliques): Key to intra-abdominal pressure regulation and pelvic positioning
Lats: Connect to the glutes through thoracolumbar fascia, affecting load distribution
A well-functioning pelvic floor relies on integration with these chains, not isolation from them.
"Fascia loves movement. It’s nourished by it." – Eric Franklin
Fascia Needs Movement
The pelvic organs are suspended in fascia. Without movement, this tissue can become dry, sticky, and restrictive. Movement keeps fascia hydrated and supple, which:
Allows organs to move without friction
Supports blood and nerve flow
Reduces pulling sensations
"Scars are not inert; they influence the whole system." – Joanne Elphinston
Scar Tissue and Adhesions
Scars from birth tears, surgeries, or past trauma can create adhesions—fibrous bands that pull and distort nearby tissue. These can lead to discomfort, nerve irritation, and organ tethering.
Biomechanics expert Joanne Elphinston has described how scar tissue doesn’t just sit passively—it can exert a tensional pull through the fascial system. Rather than the organs simply “falling out,” they may be drawn downward toward the site of old scars, such as an episiotomy, perineal tear, or coccyx injury. These anchored areas can distort the organ's natural suspension, altering load distribution and exacerbating prolapse symptoms.
Movement educator Katy Bowman similarly highlights how adhesions and immobility can anchor and drag tissues out of alignment. In her work, she explores how the body’s natural movement patterns help keep scar tissue remodelled and functional. Without this movement, adhesions can bind organs in place, influencing pelvic pressure and altering load transfer across the whole system.
Avoiding movement for fear of worsening prolapse can make this worse. Gentle, informed movement is essential to healing.
"You are how you move." – Katy Bowman
There Is Hope
Every breath you take shifts pressure through your system. When we learn to manage that pressure—through 360 costal breathing, whole-body breathing, postural alignment, and progressive movement—we restore reflexive pelvic support.
Practices like Hypopressives pair breath with progressive poses and movement patterns like rocking and slow, active engagement. designed to gently challenge and retrain the system, building coordination, fascial adaptability, and deep core responsiveness.
This isn’t about getting "tight." It’s about creating an adaptable, strong, and responsive system that allows you to return to what you love—without fear.
"Hope is being able to see that there is light despite all of the darkness." – Desmond Tutu
Try This: Gentle Actions to Support Healing
Here are three simple yet powerful practices you can explore to begin reconnecting with your pelvic floor and fascia:
1. Try 360° Costal Breathing
Place your hands gently around the lower part of your ribcage—fingers in front, thumbs at the back. Inhale through your nose and feel your ribs expand out to the sides, back and front like an umbrella opening. Exhale slowly and feel the ribs close gently inward. The aim is to direct breath around the ribcage, not down into the belly. While your abdominals will move slightly, they are not the primary drivers of this breath—they follow the lead of the ribcage and diaphragm. Think of the abdominals expanding like a corset all the way around—front, back, and sides—opening with the inhale and naturally contracting with the exhale, in rhythm with the movement of the ribs.
2. A Katy Bowman-Inspired Movement: Calf Stretch at the Wall
Tight calves can affect pelvic position and overall alignment.
Stand facing a wall, place the ball of one foot up on a rolled towel or yoga mat, heel on the ground.
Keep both legs straight and hips square.
Slowly walk the other foot away from the wall until you feel a stretch in the back of the calf.
Hold for 1–2 minutes per side. Try to keep your torso stacked over your pelvis and don’t let your pelvis tuck under.
3. Feldenkrais-Inspired Embodiment: Pelvic Clock Imagery
Lie on your back with knees bent and feet flat. Imagine a clock face on your pelvis:
12 o’clock at your navel
6 o’clock at your pubic bone
3 o’clock on your left hip
9 o’clock on your right hip
Gently tip your pelvis toward each of these numbers, creating small, slow movements—no forcing, just awareness. Keep both knees facing the ceiling throughout to avoid momentum or compensation from the legs.
This practice, rooted in Feldenkrais methodology, brings awareness and subtle control back to the pelvic area and can be very calming for the nervous system.
4. Franklin Method Embodiment: Imaginary Ischial Wings
Sit comfortably on a firm surface. Imagine your sit bones (ischial tuberosities) as wide, flexible wings. As you breathe in, imagine them gently widening and softening. As you breathe out, feel them grounding and drawing slightly inward, like wings folding.
This is a sensing practice—not a forcing one. Your sit bones do move, but it’s subtle. The aim is to bring awareness and fluidity, not to push or exaggerate the movement. Let the imagery guide a natural sense of expansion and release.
This imagery promotes pelvic awareness, fascial adaptability, and a sense of inner spaciousness without tension.
About the Author
Abby Lord is a pelvic floor specialist, Hypopressives master trainer, and certified TRE provider with over a decade of experience in supporting women through holistic pelvic health recovery. Drawing on modalities such as somatic movement, fascia release, breathwork, and strength training, she empowers her clients to reconnect with their bodies, release stored tension, and move confidently again.
Work With Me
If you would like to work with me, you can find all the ways we can connect at www.hypopressivescotland.com
References & Further Reading
Bø, K., et al. (2015). Pelvic Floor Muscle Function and Strength in Women With Pelvic Organ Prolapse.International Urogynecology Journal.
DeLancey, J.O. (1992). Anatomy and biomechanics of genital prolapse. Clinical Obstetrics and Gynecology.
Petros, P.E., Ulmsten, U. (1993). An Integral Theory of Female Urinary Incontinence. Acta Obstet Gynecol Scand.
Bordoni, B., & Morabito, B. (2020). Fascial Anatomy and Function. Cureus.
Lowenstein, L., et al. (2012). Pelvic Floor Muscle Function in Women with Chronic Pelvic Pain. Journal of Sexual Medicine.
NHS Squeezy App: https://www.squeezyapp.com
Franklin, E. (2003). Pelvic Power: Mind/Body Exercises for Strength, Flexibility, Posture, and Balance for Men and Women. Princeton Book Company.
Bowman, K. (2017). Move Your DNA: Restore Your Health Through Natural Movement. Propriometrics Press.
