How to Recognize the Early Signs of Prolapse in Pregnancy
Authored by Dr. Maryssa Steffen, PT, DPT and Board-certified pelvic specialist
What Happens If You Have a Prolapse During Pregnancy?
Pelvic organ prolapse (POP) refers to the bulging of the uterus, bladder, and/or bowel as a result of impairment of the supporting tissues surrounding the vagina.
During pregnancy—particularly in the second and third trimesters—as your baby grows and uterine volume increases, this added weight places more load on your perineal tissues. Your pelvic floor muscles, nerves, connective tissues, and blood vessels experience increased pressure, especially during daily activities such as walking, lifting, coughing, or standing for longer periods of time.
Your pelvic floor muscles support your bladder, vagina, rectum, and lower back. When these muscles and connective tissues are overloaded or not functioning optimally, symptoms of pelvic floor dysfunction—including pelvic organ prolapse—can arise.
Reduced pelvic floor support may also contribute to urinary leakage with coughing, sneezing, laughing, or running.
Symptoms of Pelvic Organ Prolapse During Pregnancy
Pelvic organ prolapse during pregnancy can feel different for different people. Clinically, we often reference questions from the Pelvic Floor Distress Inventory, such as:
How often do you experience pressure in your lower abdomen?
Do you experience heaviness or dullness in your pelvis?
Do you feel or see a bulge or something falling out in your vaginal area?
Do you need to use your hands to press on the vagina or around the rectum to complete a bowel movement?
Do you feel like your bladder does not empty completely?
Do you need to press on a vaginal bulge to start or finish urinating?
If you answered “yes” to many of these questions, it is appropriate to reach out to your medical provider and a pelvic physical therapist trained in pregnancy care.
Learn more about pelvic floor PT services.
Pelvic organ prolapse symptoms are often described as:
A sensation of heaviness, pressure, or bulging in the vagina
Feeling like you are “sitting on a ball”
Feeling as though “something is falling out”
Other symptoms may include urinary urgency, feeling the need to pee shortly after voiding, constipation, incomplete bowel movements, fecal or urinary incontinence, and pain with penetrative sex.
These symptoms can feel embarrassing or isolating, but pelvic organ prolapse is fairly common. Prevalence estimates range widely—from 3% to 50%—depending on how symptoms are defined and measured.
Pregnancy and childbirth are well-established risk factors for developing pelvic organ prolapse.
Why Prolapse Symptoms May Change During Pregnancy
As pregnancy progresses, many people understandably decrease their level of physical activity. You may be navigating pain, swelling, fatigue, nausea, or discomfort.
You may also worry that exercise could cause pregnancy complications—even if your provider has not placed you on pelvic rest. If your doctor has cleared you for movement, most exercise is safe. If you need individualized guidance, this is where prenatal pelvic floor physical therapy can be especially supportive.
You may find yourself asking:
Do I lack motivation to exercise right now?
Do I feel unsure what types of exercise are safe for my body and my baby?
Do I need specific, individualized guidance?
If you answered “yes,” working with a physical therapist trained in pregnancy and pelvic health can help.
Risk Factors for Pelvic Organ Prolapse in Pregnancy
Risk factors for pelvic organ prolapse include:
Increasing age and number of pregnancies
Forceps delivery
Infant birth weight over 10 pounds
Chronic constipation
Smoking
Connective tissue disorders
Occupations involving heavy lifting
Prior hysterectomy
Chronic strain or stress
What Causes Pelvic Organ Prolapse?
Pelvic organ prolapse can involve different regions of the vaginal wall:
Anterior vaginal wall prolapse (near the bladder) may result from weakness or injury to the pubocervical fascia, leading to bladder or bladder neck descent.
Posterior vaginal wall prolapse is often related to weakness or injury of the rectovaginal septum, allowing the rectum or small bowel to press into the vagina.
Apical prolapse involves descent of the uterus, cervix, or vaginal cuff.
Most commonly, prolapse involves more than one compartment.
Prenatal Pelvic Floor Physical Therapy and Prolapse
Research consistently supports the role of prenatal pelvic floor physical therapy in preventing and managing pelvic floor dysfunction.
A meta-analysis of 4,609 participants found that structured pelvic floor muscle training reduced vaginal bulging compared with watchful waiting in the late postpartum period.
A larger meta-analysis (41,275 participants) showed reduced rates of stage II or greater prolapse within 12 months postpartum when pelvic floor muscle training was implemented in late pregnancy.
Pelvic floor muscle training during pregnancy has been shown to increase muscle strength and reduce the degree of anterior vaginal wall prolapse at six weeks postpartum, with benefits lasting for several months.
Importantly, pelvic floor muscle training is not just about strengthening. It includes learning how to contract, relax, coordinate, and manage intra-abdominal pressure—skills that are especially relevant during pregnancy.
If you already have symptoms of pelvic floor dysfunction during pregnancy, individualized guidance from a pelvic floor specialist is recommended.
You can learn more about our prenatal pelvic floor physical therapy services here, which focus on education, movement, breath, posture, and symptom management during pregnancy.
Additional Ways to Support Your Pelvic Floor During Pregnancy
1. Manage Constipation
Constipation increases downward pressure and strain on the pelvic floor.
Support bowel health by:
Eating adequate fiber (25–30 grams daily from food sources)
Drinking water when thirsty
Responding to bowel urges without delay
Using a foot stool so your knees are higher than your hips when sitting on the toilet
Breathing (not breath-holding) during bowel movements
Limiting time on the toilet to 5–10 minutes
If it is not complete, either get up and wait until the next urge, or you can use your hands to gently push your perineum, pictured below:
2. Continue Safe, Supported Exercise
Walking with rest breaks, swimming, and aquatic exercise can be excellent options during pregnancy. Water-based exercise can also reduce swelling when the water level is above your heart.
Postural strengthening and pressure management strategies are key components of prenatal pelvic floor physical therapy and can help reduce prolapse-related symptoms.
Pelvic Floor Exercises and Pregnancy
Exercise and pelvic floor muscle training are recommended during pregnancy and postpartum to prevent and treat urinary incontinence and pelvic organ prolapse symptoms.
However, proper assessment matters. Pelvic floor training includes evaluating how well you can both contract and relax the pelvic floor. Individuals with symptoms often benefit from personalized guidance rather than generalized exercise advice.
Support Is Available
If you are pregnant and experiencing prolapse symptoms, you are not alone—and you are not without options.
If you are located in California, you can book a discovery call to learn more about our prenatal pelvic floor physical therapy services. We offer both in-person visits in Oakland, CA, and virtual prenatal pelvic floor physical therapy throughout California.
Support during pregnancy can make a meaningful difference—both now and postpartum.
References
Ryhtä, Iina et al. “Effectiveness of exercise interventions on urinary incontinence and pelvic organ prolapse in pregnant and postpartum women: umbrella review and clinical guideline development.” JBI evidence implementation vol. 21,4 394-408. 1 Dec. 2023, doi:10.1097/XEB.0000000000000391
He, RuiJu et al. “The effect of pelvic floor muscle training and perineal massage in late pregnancy on postpartum pelvic floor function in nulliparas: A randomised controlled clinical trial.” Complementary therapies in medicine vol. 77 (2023): 102982. doi:10.1016/j.ctim.2023.102982
