Part of Pelvic floor weakness
Pelvic floor exercises for prolapse: what they change and what they do not
Warning signs, and when to get help
Do pelvic floor exercises help a prolapse?
They help the symptoms, which is what most women come in wanting changed. They are much less reliable at moving the organ, and the two are worth keeping separate in your head from the start.
The POPPY trial is the biggest test of this. Hagen and colleagues recruited 447 women with newly diagnosed, symptomatic stage 1 to 3 prolapse across the UK, New Zealand and Australia, and compared one-to-one pelvic floor muscle training with a lifestyle advice leaflet. At 12 months the women who had the training reported a greater fall in prolapse symptoms, by an adjusted 1.52 points on the symptom score, with a confidence interval running from 0.46 to 2.59 and a p value of 0.0053. Two thirds of the women returned their 12-month questionnaires, which is worth knowing when you read any trial of a long program.
The authors' own conclusion is one sentence long: one-to-one pelvic floor muscle training for prolapse is effective for improvement of prolapse symptoms. Note what it is not a sentence about.
That is also where UK guidance puts it. NICE suggests considering supervised pelvic floor muscle training, for at least 16 weeks, as a first option for women with symptomatic stage 1 or stage 2 prolapse (NG123, recommendation 1.7.5). Two words in that one sentence carry the weight. Consider is a softer instruction than offer, and NICE uses the two deliberately, so this is a reasonable first thing to try rather than something every woman must be put through. And supervised means with a clinician checking, not a leaflet.
The stage in that recommendation is part of it, not decoration, and most women reading this will not know their own. If nobody has staged yours, that is the thing to get done, because it decides which of the answers below applies to you. Staging is a physical examination, and NICE's own assessment recommendations have it recorded with the POP-Q system by whoever evaluates a prolapse in specialist care.
In clinic the honest version sounds like this. The bulge sensation at the end of a long day on your feet is the symptom that usually improves first, the dragging settles, and the trips to the toilet get easier. Looking in a mirror three months in, most women do not see a difference. Both of those things can be true at once.
Two facts from POGP's own prolapse guide take some of the dread out of this. Prolapse is common, affecting about 1 in 3 women who have had children, and it also happens to women who have never been pregnant. And it is not a one-way street: not all prolapses get worse, and some improve. The guide also describes symptoms that vary from day to day and within a single day, fine in the morning and uncomfortable by evening, which is worth knowing before you judge your progress on one bad afternoon.
Can pelvic floor exercises reverse a prolapse?
Sometimes, by a small amount, in a minority of women. That is the whole answer, and the trial that asked the question directly is the one to go by rather than any headline about it.
Braekken and colleagues ran an assessor-blinded randomized trial in 109 women with stage 1, 2 or 3 prolapse. Everyone got lifestyle advice and was taught the knack, the trick of squeezing just before a cough. The training group also got individual physical therapy sessions and home exercises. After the program, the prolapse had improved by one stage on the standard measurement in 19 percent of the training group against 8 percent of the control group. Ultrasound showed the bladder and the rectum sitting higher in the trained group, and their symptoms were fewer and less bothersome.
So an improvement by one stage happened, and it happened in about one woman in five, not in most. Eight percent of the control group improved by a stage as well, which tells you prolapse measurement moves about a little on its own. Nobody in this trial was returned to a pelvis that looked untouched by childbirth, and that is not what either trial behind this page set out to measure or reported. What they measured was a symptom score, a stage, and on ultrasound how high the bladder and rectum sat, and the largest anatomical change either of them reported was one stage in 19 percent.
The word people type is reverse, and we would sooner give you the number than argue about the word. One stage, in 19 percent, over six months, with better symptoms and a higher bladder across the group. If that is worth six months of squeezes to you, it is a reasonable thing to want. If you were expecting it to be gone, now is the time to recalibrate.
One more part of the answer is in the guidance, not the trials. NICE's recommendation does not stop at the end of the program: if the training has helped, it advises women to carry on with their pelvic floor muscle training afterwards (NG123, recommendation 1.7.5). Whatever you gain here is held by continuing, not banked. That is the realistic shape of this, and it is a better thing to know early than to discover a year later when the heaviness comes back.
What they change, and what they do not
Four things the evidence supports, and each one needs stating precisely.
They reduce prolapse symptoms: the heaviness, the dragging and the bulge sensation. The clearest evidence for that is the 447 women in POPPY.
They improve how the pelvic floor muscle works, which is what the ultrasound measurements in the Braekken trial were showing when the bladder and rectum sat higher.
They move the staging in a minority, by one stage, and not reliably enough to plan around.
They cost you very little, and neither trial attributed any harm to the training itself. Braekken reported no adverse effects. POPPY recorded eight adverse events, six of them vaginal symptoms, one a case of back pain and one a case of abdominal pain, plus one unexpected serious adverse event. All nine were in the training group, and all were regarded as unrelated to the intervention or to taking part in the study (Hagen 2014).
That is why NICE puts the training ahead of an operation rather than after one. It reserves the offer of surgery for women whose symptoms have not improved with non-surgical treatment, or who have declined it (NG123, recommendation 1.8.1). The declining half of that sentence is real and gets left out when the order is explained. A woman who does not want a course of exercises or a pessary can be offered surgery without working through them first, so this is an order of options rather than a set of hurdles.
The NHS does not put them in an order at all, and we should not read one into it. It lists hormone treatment, vaginal support pessaries, physiotherapy with pelvic floor muscle training, and surgery as the options that may apply, and says you and your doctor will decide together which is best for you. A pessary sits outside the ordering for the same sort of reason, because NICE suggests considering one either on its own or alongside the training (1.7.6).
What they do not do is rebuild connective tissue or put a womb back up a canal. They also do not treat the other things a prolapse brings with it. If emptying your bladder or your bowel has become a problem, or sex is painful, those need naming at an appointment rather than being folded into a squeezing program. The same goes for a prolapse that is getting worse while you train.
How to do pelvic floor exercises with a prolapse
The technique is the same as it is for leaking, and the one thing that changes is how carefully you check that it is a lift.
One gate comes before the instructions, not after them. If you have had an operation for prolapse or for leaking, or one is planned, your surgical team decides when you start and how much you do, and what they tell you comes before everything in this section. For a man after prostate or other urological surgery, Continence Health Australia's instruction is to wait until your surgeon has checked your healing before starting pelvic floor muscle exercises.
Start lying down, knees bent, before you try sitting or standing, and POGP says the same thing about where to begin: sitting or lying down is often easier at the start. If you are pregnant and past the first three months, check with your physio before exercising flat on your back. Imagine stopping yourself passing wind and stopping yourself peeing at the same time, then squeeze and lift up and in, and let go completely. Our pelvic floor exercise lying down video times the lift with the breath out and the release with the breath in, which keeps the let-go from getting dropped. Keep your buttocks and thighs out of it. Do not pull your tummy in hard, and never hold your breath.
The check that matters with a prolapse is direction. A hand flat on your lower tummy will tell you if you are pushing out rather than lifting in, and if you feel a push down or a bulge instead of a lift, stop and get the technique looked at before you do hundreds of repetitions of it. POGP's advice if you find the exercises difficult or you are not improving is to ask to be referred to a specialist physiotherapist, and with a prolapse we would take that advice early, not late.
One piece of positioning advice is specific to prolapse, and it is better followed than improvised on. POGP's prolapse guide says the exercises can often be done in any position, but if your prolapse bulges beyond the vaginal entrance you may find it better to do them lying down, and if it is less severe you may find sitting easier. As the muscles improve, work toward doing them standing, and then while walking and bending, because standing is where the symptoms happen.
Two more things from the same guide. Tighten the pelvic floor before any activity that raises the pressure in your tummy, which is what it calls drawing up before the effort, because that is what resists the downward movement. And if you are thinking of buying a trainer or a device, POGP's position is that there is no evidence yet that using a device beats simply doing the exercises, though there is no reason not to use one if it stays in and does not hurt.
Americans will know these as Kegels. Same exercise, same instruction.
How often, and how long before anything changes
If you have had an operation for prolapse or for leaking, or one is planned, the numbers below are not yours to set: your surgical team gives you the dose and the start date, and that holds whatever this section says.
POGP suggests building toward 10 long squeezes of up to 10 seconds, then 10 short, quick squeezes, at least 3 times a day, with the muscle let go fully after each one, and says to work the muscles until they tire. If 10 seconds is nowhere near what you can hold, start little and often instead. The NHS puts the beginner version as a 2-second hold, 10 times, building toward 10 seconds. Both kinds of squeeze matter: a long hold is what keeps you comfortable standing, a quick one is what you need before a cough. Your physio will adjust this.
Two figures get quoted for the timescale and they measure different things, so keep them apart. The 16 weeks is how long a supervised program should run: NICE suggests considering supervised pelvic floor muscle training for at least 16 weeks for symptomatic stage 1 or stage 2 prolapse (NG123, recommendation 1.7.5). The 3 to 5 months is when POGP says you should notice an improvement, which is a statement about your symptoms rather than about the length of a course. Neither is a deadline for getting better, and the NHS puts it loosely for the same reason, saying it may take a few months before you see any benefit. The trials sit either side: Braekken measured at 6 months, POPPY at 12.
Be careful with numbers borrowed from the leaking literature, because they are not the same number. The three months you will see quoted elsewhere is NICE's first-line duration for stress or mixed urinary incontinence, which is a different recommendation for a different problem. For prolapse the figure is 16 weeks and supervised.
Then keep going. NICE advises continuing the training afterwards if the program has helped, and POGP suggests carrying on once a day to hold on to the gain. With a prolapse that maintenance dose is not optional, because the load on the pelvic floor does not go away.
Can pelvic floor exercises make a prolapse worse?
No trial we read found that, and we still see people do a version of these exercises that makes their symptoms worse. The difference is in what the muscle is actually doing.
On the evidence: Braekken and colleagues reported no adverse effects and concluded the training can be used as a treatment for prolapse. POPPY's eight adverse events and one serious adverse event all fell in the training group, and all were regarded as unrelated to the intervention or to taking part. So a correctly performed pelvic floor contraction is not something to be afraid of with a prolapse.
One qualifier on how far that reaches. POPPY recruited women at new diagnosis, and neither trial set out to test training in the weeks after a prolapse repair, so neither has anything to say about what is safe on a fresh repair. That timing comes from your surgical team.
The ways it goes wrong are mechanical, and all of them raise the pressure pushing down rather than the lift holding up. Bearing down instead of lifting, which is the commonest and the easiest to do by accident while concentrating hard. Holding your breath through every squeeze. Pulling the stomach in strongly, which Continence Health Australia's pelvic floor guidance warns against for exactly this reason, alongside never holding your breath. Doing the exercises while straining on the toilet, which the NHS says weakens the pelvic floor and makes leaking worse.
If your symptoms are reliably worse after your exercise routine, that is information rather than bad luck. Stop, and get the contraction checked.
Pelvic floor exercises for prolapse after birth
This is the commonest route to the question, and the one place where the timing is not yours to decide alone.
If you have recently given birth, including by cesarean section, or you have a gap down the middle of your stomach muscles (diastasis recti), ask your physio, midwife or doctor first. The postnatal core and pelvic floor page covers the months after a birth properly, including what to expect and what to report, and diastasis recti covers the gap itself, because the two often turn up together and the tummy work is paced differently when they do.
What we would add from clinic is that a bulge sensation in the first weeks after a birth is common and frightening, and it is not a verdict. It still gets checked, which is what the warning list at the foot of this page is for, and not every heaviness after a birth turns out to be a prolapse that stays.
Bladder, uterus and bowel prolapse: does it change the exercises?
Not really, and that surprises people who have just been given a specific diagnosis.
The NHS describes pelvic organ prolapse as the womb, bladder or bowel bulging into the vagina, and the muscle layer you are training is the same floor underneath all three. Both trials behind this page recruited women with prolapse of more than one type and trained them the same way.
What does change is the symptoms you are tracking, and therefore how you judge whether anything is improving. The NHS lists urinary problems such as incomplete emptying, more frequent urination and small leaks with coughing, sneezing or exercise, as well as constipation and other bowel problems, pain or numbness during sex, and the bulge or heaviness itself. Pick the one or two that bother you most and watch those over months, rather than hunting for the bulge each week.
POGP's guide sets out which symptoms go with which wall, which is useful when you are trying to work out what to report. A front wall prolapse, behind the bladder, tends to produce trouble emptying, urgency, going more often including at night, leaking, and a slow or hesitant stream, sometimes with a need to change position on the toilet to empty properly. A back wall prolapse, in front of the back passage, tends to produce difficulty or incomplete emptying of the bowel with more straining than normal, wind or bowel leakage, bowel urgency, and sometimes a need to press around the vagina or the anus with your fingers to empty at all. Its advice on the bladder is worth quoting in substance, because people do the opposite: do not push or strain to empty, because that can increase the prolapse.
One question people are often too embarrassed to ask, so here is the answer from the same guide. Sex with a prolapse is safe and will not damage it or make the bulge worse. Different positions and a suitable lubricant may make it more comfortable, and pain during sex is still worth reporting rather than putting up with.
Staging is worth understanding, because it is the number everything else hangs off. IQWiG, the German health institute, describes stage 1 as the organs having slipped down only a little, stage 2 as reaching the level of the vaginal opening, stage 3 as up to a centimeter of the vagina or womb bulging out of it, and stage 4 as a large part doing so. The NHS uses the same 1 to 4 scale, with 4 being severe.
Where pessaries and surgery fit
Exercises are not in competition with the other options, and the choice between them is not ours to make.
The NHS sets out vaginal support pessaries, which are plastic or silicone devices placed in the vagina to support the pelvic organs, and surgery to lift and support the organs if the prolapse is severe. Its list also includes a hormone treatment, which is a prescribing decision and not something this page gives advice about. What it is for is still worth knowing, because the name invites the wrong hope: NICE suggests considering vaginal estrogen for a woman who has a prolapse along with the genitourinary symptoms of the menopause (1.7.3), and IQWiG states that there is no evidence hormone treatment reduces the prolapse itself, although it can protect the lining of the vagina when a pessary is used. IQWiG adds that pessaries come in different shapes and sizes and should be individually fitted.
Two practical things about a pessary come from NICE's own list of what should be explained before you start one (1.7.8). More than one fitting may be needed to find a suitable pessary, so a first one that does not sit well is not the end of the option. And a pessary should be removed at least once every 6 months to prevent serious pessary complications, which is the part that gets forgotten once it is comfortable and out of mind. The complications the same recommendation asks to be described are vaginal discharge, bleeding, difficulty removing the pessary, and the pessary coming out on its own. If any of those happen, or you cannot get it out, go back to the service that fitted it rather than waiting for your next review, and NICE asks for referral to a urogynecology service where pessary care is not available locally (1.7.7).
What the operation does is worth separating from what it promises. IQWiG puts the aim as lifting the pelvic organs, stabilizing them and strengthening the connective tissue, and says surgery usually does not involve removing the womb, though a hysterectomy is sometimes recommended. Surgery can usually correct the prolapse and reduce the symptoms that come with it. The organs may drop down again after a while, though, and that sentence belongs in the appointment rather than in the small print.
NICE puts the same point among the things a surgeon has to go through with you before you decide, alongside the benefits and risks of each procedure including changes in urinary, bowel and sexual function, and the fact that the long-term adverse effects of all of these procedures are uncertain (1.8.2). It names patient decision aids for uterine prolapse and for vaginal vault prolapse as the way to have that conversation.
One other thing catches women out. Repairing a front wall or a top-of-the-vagina (apical) prolapse can leave you leaking urine when you were not before, and NICE asks for that to be explained in advance, with the warning that further treatment may be needed (1.8.4). It also says not to add an anti-leaking operation to prolapse surgery in a woman who is not leaking (1.8.3). So new leaking after a repair is a recognized possibility with treatments of its own, rather than proof that the repair has failed.
Mesh is narrower than it sounds in both directions. The NHS page says that the operation supporting a prolapse with mesh placed through the vagina is no longer carried out on the NHS unless a woman has no other option, and that if you have previously had vaginal mesh inserted and think it might be causing problems you should speak to a GP or your surgeon. NICE asks for front wall and back wall repairs to be offered without mesh (1.8.20 and 1.8.23), and transvaginal mesh repair of either wall should only be used in the context of research, because the safety concerns are serious and well recognized and the evidence on how well it works in the long run is not good enough (NICE interventional procedures guidance 599, now HealthTech guidance 456). That is not the same as no mesh ever. Mesh placed through the abdomen or by keyhole surgery is still among the choices for some prolapses, such as sacrocolpopexy for a vault prolapse (1.8.16).
If one of those is offered to you, NICE says you should be told the type of mesh and whether it is permanent, have the details entered in a national registry, and be given written information naming the implant, its manufacturer, the date and the implanting surgeon (1.8.6). Those are reasonable things to ask for rather than wait for.
If you already have mesh, it is worth knowing what gets checked. NICE lists the new symptoms that should be assessed for a possible mesh complication: pain or a change in feeling in the back, tummy, vagina, pelvis, leg, groin or between the legs, whether it comes out of nowhere or with movement or sex; vaginal discharge, bleeding, pain during sex, or injury or pain for a male partner; repeated urine infections, leaking, being unable to empty, or difficulty or pain passing urine; difficulty or pain opening the bowels, bowel leakage, bleeding from the bottom or passing mucus; and signs of infection, alone or with any of those (1.10.1). A suspected mesh complication goes to a urogynecologist, urologist or colorectal surgeon for specialist assessment rather than to a physio (1.10.2).
NICE's sequence is the clearest way to see where you are. It suggests discussing all the options with you, including no treatment at all, non-surgical treatment and surgery (NG123, recommendation 1.7.1). It suggests considering a vaginal pessary for symptomatic prolapse, either on its own or together with supervised pelvic floor muscle training, so the two are not alternatives (1.7.6). And it reserves the offer of surgery for women whose symptoms have not improved with non-surgical treatment, or who have declined it (1.8.1). Read that last one as good news about the order of things rather than as a threat: doing the exercises properly is part of how the decision about surgery gets made, not a delay before it.
Where you sit on the staging decides which of those three is actually aimed at you. The exercise recommendation is the only one of them with a stage attached, and that stage is 1 or 2 (1.7.5). The pessary recommendation names symptomatic prolapse with no stage limit (1.7.6), and so does the recommendation on surgery (1.8.1). At stage 3 or stage 4, then, exercises are not the first option the guideline describes, and nobody should be grinding through a 16 week program instead of being assessed for the other two.
Train alongside whatever gets decided, by all means, because that is the part the trials support. But if you have been told your prolapse is stage 3 or stage 4 and exercises are all that has been offered, ask about a pessary and about a surgical opinion.
The same guidance also suggests considering lifestyle advice for women with prolapse, covering weight loss if your body mass index is over 30, keeping heavy lifting to a minimum, and preventing or treating constipation (1.7.2). Those three sit alongside the exercises, not instead of them, and constipation is the one we would deal with first, because straining undoes the training faster than anything else on the list.
Activity gets its own advice, and both sources that give it are writing for a woman who already has a prolapse, which is the part that falls off when the advice gets passed on. The NHS list of things you can do yourself says to avoid physical activities that put a lot of strain on the pelvic floor, and it names heavy lifting, running and trampolining. POGP is less absolute and more usable: high-impact exercise such as jumping, running or aerobics may make symptoms worse, especially while the pelvic floor muscles are not strong, so it suggests low-impact work in the short term, among them cycling, a cross trainer, fast walking, pilates and swimming, and it says that if your usual routine makes your symptoms worse you should get advice on how to modify it rather than give it up. Lifting weights with a weak pelvic floor sets out what to change first, and after an operation your surgical team's limits come before all of it.
After an operation, two things matter more than the exercise dose. NICE asks for a review 6 months after surgery for prolapse, including a vaginal examination and, where mesh was used, a check for mesh exposure (1.8.24), and asks providers to make sure a woman who has had prolapse surgery can be referred on again if symptoms come back or a complication is suspected (1.8.25). Until your own team clears you, their plan beats everything on this page, the dose and the positions included. And if something goes wrong in the weeks after the operation, the people to contact are the ones who operated, not a physio appointment some weeks away. The warning list at the foot of this page says what to contact them about.
The practical point is that pelvic floor exercises sit underneath all of it. You can train while you use a pessary, and you can train while you wait for an opinion. Once an operation is planned, ask your surgical team whether to carry on and for how long, because their instruction outranks this page. The muscle work is often part of the plan after surgery too, on your surgeon's timetable and not ours. If you have had any surgery for prolapse or incontinence, follow the program your surgical team gave you.
There is one honest limit to add here, and it cuts against the hope that training will protect a repair. The OPTIMAL trial randomized 374 women in the United States who were having transvaginal surgery for a prolapse at the top of the vagina plus stress incontinence, with a sling, to either five perioperative sessions of behavioral therapy with pelvic floor muscle training or usual care. The training added nothing measurable: no better urinary scores at 6 months, and no better prolapse scores or anatomical success at 2 years (Barber 2014). The secondary report found no difference in quality of life or sexual function either (Weidner 2017).
Two things that result does not say. It does not say the training is harmful, and it does not reach every operation: the trial studied vaginal apical surgery done with a sling, and its own authors say the findings may not apply to vaginal prolapse procedures without a sling, or to apical surgery done through the abdomen. So where your own team wants you doing pelvic floor work after an operation, do it on their instructions. Just do not count on it to hold the repair up.
When to be seen
A prolapse that you can feel should be looked at once by a clinician, even if you intend to manage it with exercises. The NHS advice is to see a GP for a lump in or around your vagina or any other symptoms of prolapse.
Then there is the list at the foot of this page, which is a different set of questions.
The lines that cannot wait are about the nerves at the base of the spine and about a bladder that will not empty at all. Wind or poo coming out of the vagina needs advice the same day. Bleeding after the menopause and blood in your pee both need checking even if they happen once and stop. New trouble emptying your bladder or bowel, or needing to push the bulge back to empty, goes to your doctor rather than into a workaround, and the same day if you are passing only small amounts with a full, swollen lower tummy. The bowel lines are there for the same reason. Poo or wind leaking when you cannot stop it, and blood from your bottom or a change in your bowel habit that is not normal for you, get checked on their own account rather than being filed under the prolapse.
Several of the lines are for a woman who has had an operation, and they are worth reading before you start rather than after. A fever, heavy bleeding, smelly discharge or a wound that is oozing or coming apart in the weeks afterwards goes to the surgical team the same day and not to a physio, and that holds whether the operation was done for the prolapse itself or in your pelvis for some other reason, a hysterectomy for fibroids among them. Severe or sudden pelvic pain, a wound that opens up and bleeding that suddenly gets much heavier are on their own line, because those need emergency services or an emergency department instead of a phone call. A newly swollen, warm or tender calf or thigh has a line of its own, because surgery in the pelvis raises the risk of a blood clot. And the day the bulge, the heaviness or the leaking comes back, or new pain, bleeding or trouble emptying starts, is the surgical team again rather than a training problem to work around, and after mesh surgery those are the symptoms a specialist checks the mesh for. Red flags in physiotherapy explains why we treat that list as its own set of questions.
For everything else, the route is a pelvic health physio or physical therapist. Ask for one if you cannot tell whether your squeeze is a lift, if you are doing the squeezes regularly and not improving, or if the symptoms are stopping you doing things. POGP puts the referral trigger that way too, as difficulty with the exercises or no improvement, rather than as a number of weeks. The staged pelvic floor program is where the squeezes and the movement work are set out, transverse abdominis activation is the gentle lower tummy hold that goes with them, and the pelvic floor in menopause covers what changes around that time and what training does and does not reach.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
- Emergency: you suddenly cannot control your bladder or bowels at all. The same applies to new leaking of pee or poo, new trouble starting to pee, not being able to feel yourself peeing, not noticing when you need to poo, a new change in how your genitals feel during sex, or new trouble getting an erection or ejaculating, if it comes with back pain, sciatica, or pain, tingling, numbness or weakness in one or both legs. Call emergency services or go to an emergency department straight away. These can also be signs of cauda equina syndrome.
- Emergency: you cannot pee at all, especially if your lower tummy feels full and painful. Call emergency services or go to an emergency department straight away.
- Emergency: since any operation in your pelvis, including an operation for prolapse or for leaking, removal of the womb (hysterectomy) or removal of the prostate gland, you have pain in your tummy or pelvis that is severe or came on suddenly, a wound from the operation that opens up, bleeding that suddenly becomes much heavier or that soaks a pad within an hour, or you feel faint, dizzy or breathless, your heart is pounding, or you feel very unwell. Stop your pelvic floor exercises and call emergency services or go to an emergency department straight away, and do not drive yourself.
Get help today
- Wind or poo coming out of your vagina. Get medical advice the same day, as this needs checking urgently.
- Same day: since an operation for prolapse or for leaking, you have a fever or feel hot, cold or shivery, heavy bleeding from your vagina or blood clots, discharge that smells, a wound from the operation that is oozing or whose edges are coming apart, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding from the repair. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
- Same day: since an operation in your pelvis for any other reason, for example removal of the womb (hysterectomy) or removal of the prostate gland, you have a fever or feel hot, cold or shivery, heavy bleeding, discharge that smells, a wound from the operation that is oozing or whose edges are coming apart, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
- Same day: since any operation in your pelvis, a calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that feels different from normal muscle soreness. Stop your pelvic floor exercises and get medical advice the same day, because surgery in the pelvis raises the risk of a blood clot (deep vein thrombosis). If you are also short of breath or have chest pain, call emergency services.
- Same day: pain or burning when you pee together with a high or very low temperature, feeling hot or cold and shivery, or pain in your back just under the ribs. Get medical advice the same day, as this can be a kidney infection. If you also become confused, very drowsy or have trouble speaking, call emergency services or go to an emergency department straight away.
- Same day: blood in your pee, which may look pink, red or dark brown, even a small amount, even once, and even with no pain. Get medical advice the same day. It needs checking even if it goes away.
Book an appointment
- Within a few days: any bleeding from your vagina after your menopause, including spotting or pink or brown discharge, even if it is only a small amount, only happened once, or came on during or after sex. Book an appointment with your doctor within a few days. Bleeding after the menopause is usually not serious, but it has to be checked, because it can be a sign of cancer, and cancer found early is easier to treat.
- Blood in your poo, bleeding from your bottom, or a change in your poo or how often you need to go that is not normal for you. See your doctor within a few days. If your poo is black or dark red, or you have bloody diarrhea, get medical advice the same day. If you are bleeding non-stop from your bottom, or there is a lot of blood or you see large clots, call emergency services.
- Routine: a bulge or lump you can feel or see inside or coming out of your vagina, or a feeling of heaviness or pressure in your lower tummy or vagina. Book an appointment with your doctor. This can be a sign of pelvic organ prolapse, and pelvic floor exercises are often part of the treatment once it has been checked.
- Routine: since an operation for prolapse or for leaking, the bulge, the heaviness or the leaking you had it done for has come back or is getting worse, or you have new pain, new bleeding or discharge from your vagina, or new trouble peeing or pooing. Stop your pelvic floor exercises and book an appointment with your surgical team rather than waiting for your next routine review. A repair can give way, and after mesh surgery these are also the symptoms a specialist checks the mesh for. Which of those it is takes an examination, and it is not something this page or a physiotherapist can tell you.
- Routine: new trouble emptying your bladder or your bowels, a weak or stop-start stream, dribbling after you think you have finished, a feeling that you have not emptied, or needing to push the bulge back to empty at all. Book an appointment with your doctor and say that you have a prolapse, rather than working around it, because an emptying problem has its own causes and its own checks. If you are passing only small amounts and your lower tummy feels full or swollen, or you are leaking all the time without feeling the need to go, get medical advice the same day.
- Routine: poo or wind leaking out when you cannot stop it, not reaching the toilet in time, not being able to get fully clean after going to the toilet, streaks or stains of poo in your underwear, or finding that you no longer notice when you need to go, without any of the signs above. Book an appointment with your doctor, as there are treatments that help, and ask about a pelvic health physio or a continence service.
Common questions
Can you do pelvic floor exercises with a prolapse?
Yes, and that is the usual recommendation rather than a special case. Both of the trials behind this page recruited women who already had a symptomatic prolapse, graded stage 1 to 3, and gave them pelvic floor muscle training (Hagen 2014, Braekken 2010). The NHS lists regular pelvic floor exercises among the things to do yourself for a prolapse, alongside physiotherapy with a specialist. What matters is that the squeeze is a lift rather than a push down, which is worth having checked once by a pelvic health physio or physical therapist rather than assumed. One exception to the yes: if you have had surgery for a prolapse or for leaking, or you are waiting for an operation, your surgical team decides when you start and how much, and their instructions come before anything on this page.
How often should I do pelvic floor exercises for a prolapse?
POGP, the UK group of pelvic health physiotherapists, suggests working toward 10 long squeezes held for up to 10 seconds and then 10 short, quick squeezes, at least 3 times each day, letting the muscle go fully after each one. If your holds are shorter than that or you tire quickly, POGP says to start little and often instead. The NHS version is to hold for 2 seconds at first and build toward 10, 10 times. Once things have improved, POGP advises carrying on once a day to keep what you have gained. Your physio will adjust this. After an operation for prolapse or for leaking, or while you are waiting for one, the dose is your surgical team's to set, including when to start.
How long do pelvic floor exercises take to work for prolapse?
Think in months. POGP tells people to expect an improvement in 3 to 5 months, and the NHS says you may have to keep going for a few months before you see any benefit. The two prolapse trials measured their results at 6 months (Braekken 2010) and 12 months (Hagen 2014), which tells you something about the timescale the researchers themselves expected. The first thing to change is usually not the bulge but the dragging feeling at the end of a long day on your feet.
Can pelvic floor exercises help stage 3 prolapse?
There is trial evidence at that stage, and it is not a promise. Both trials included women with stage 3, so the group is not excluded from the research, but neither reported results separately by stage, so we cannot tell you how much of the benefit sat with the milder cases. What the Braekken trial does show is that moving up a stage happened in a minority, 19 percent against 8 percent in the control group. The guidance is narrower than the trials: NICE's suggestion of a supervised program of at least 16 weeks as a first option names symptomatic stage 1 or stage 2 and says nothing about stage 3 or 4 (NG123, recommendation 1.7.5). So at stage 3 the exercises are still worth doing, including alongside a pessary or while you think about surgery, but they are not the first option the guideline describes, and that decision belongs with your doctor or gynecologist.
References
- Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet. 2014;383(9919):796-806. https://doi.org/10.1016/S0140-6736(13)61977-7
- Braekken IH, Majida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology. 2010;203(2):170.e1-7. https://doi.org/10.1016/j.ajog.2010.02.037
- Braekken IH, Majida M, Engh ME, Bo K. Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial. Obstetrics and Gynecology. 2010;115(2 Pt 1):317-324. https://doi.org/10.1097/AOG.0b013e3181cbd35f
- Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023-1034. https://doi.org/10.1001/jama.2014.1719
- Weidner AC, Barber MD, Markland A, et al. Perioperative Behavioral Therapy and Pelvic Muscle Strengthening Do Not Enhance Quality of Life After Pelvic Surgery: Secondary Report of a Randomized Controlled Trial. Physical Therapy. 2017;97(11):1075-1083. https://doi.org/10.1093/ptj/pzx077
- National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management (NICE guideline NG123). Published 2 April 2019, last updated 24 June 2019. https://www.nice.org.uk/guidance/ng123
- National Institute for Health and Care Excellence. Transvaginal mesh repair of anterior or posterior vaginal wall prolapse (interventional procedures guidance IPG599, now HealthTech guidance HTG456). Published 15 December 2017. https://www.nice.org.uk/guidance/ipg599
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pelvic Organ Prolapse: a guide for women. POGP 2020, 2023. https://thepogp.co.uk/Resources/9/pelvic_organ_prolapse_a_physiotherapy_guide_for_women
- NHS. Pelvic organ prolapse. Page last reviewed 3 July 2025. https://www.nhs.uk/conditions/pelvic-organ-prolapse/
- Institute for Quality and Efficiency in Health Care (IQWiG). Pelvic organ prolapse. InformedHealth.org. Last updated 23 June 2025. https://www.informedhealth.org/pelvic-organ-prolapse.html
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pelvic floor muscles. https://thepogp.co.uk/patients/pelvic_health_advice/pelvic_floor_muscles.aspx
- Continence Health Australia. 10 step guide to putting your pelvic floor first. Pelvic Floor First. https://www.pelvicfloorfirst.org.au/pages/10-step-guide-to-pelvic-floor-friendly-exercise.html
- NHS. Urinary incontinence: 10 ways to stop leaks. Page last reviewed 15 June 2023. https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/
- NHS. Constipation. Page last reviewed 26 October 2023. https://www.nhs.uk/conditions/constipation/
- NHS. Bowel incontinence. Page last reviewed 15 August 2024. https://www.nhs.uk/conditions/bowel-incontinence/
- NHS. Bleeding from the bottom (rectal bleeding). Page last reviewed 12 April 2023. https://www.nhs.uk/symptoms/bleeding-from-the-bottom-rectal-bleeding/
- NHS. Postmenopausal bleeding. Page last reviewed 24 September 2026. https://www.nhs.uk/conditions/post-menopausal-bleeding/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-22.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.