Pelvic organ prolapse is when the bladder, uterus or rectum drops and presses into the walls of the vagina, because the muscles and tissues that hold it up have stretched or weakened. For stage 1 or 2 prolapse that causes symptoms, a supervised program of Kegel exercises (pelvic floor muscle training) is a first option to consider.
Kegel exercises can ease heaviness and bulging and may help slow the prolapse getting worse. They don't reliably move the tissue back where it was, and the evidence is for supervised programs, so start with an examination.
What prolapse feels like
The most common sign of pelvic organ prolapse is a feeling of heaviness or dragging in the vagina, or a sense that something is coming down. Some women feel or see a bulge. Symptoms may get worse as the day goes on or after lifting, are often worse after standing for a long time, and may ease when lying down.
Prolapse can also make it harder to empty the bladder or bowel, cause leaks, make sex uncomfortable, or make tampons hard to insert. Some women have a prolapse that a doctor can see but that causes no symptoms at all.
Doctors name prolapse by what has dropped: the bladder into the front wall (cystocele), the rectum into the back wall (rectocele), or the uterus, or the top of the vagina after a hysterectomy. They grade it in stages from 1 (mild) to 4 (the most severe).
What the research says about Kegel exercises for prolapse
A large trial, POPPY, enrolled 447 women with symptomatic stage 1 to 3 prolapse. Those who had one-to-one pelvic floor muscle training with a physiotherapist reported fewer prolapse symptoms at 12 months than those who got a lifestyle advice leaflet. Hagen et al., Lancet 2014.
The UK's NICE guideline says to consider supervised pelvic floor muscle training for at least 16 weeks as a first option for women with symptomatic stage 1 or 2 prolapse. The key word is supervised: a specialist checks your technique and builds the plan. NICE guideline NG123.
Why an examination comes first
A bulge or heaviness is not always prolapse, and the right plan depends on the type and stage. A pelvic floor physical therapist or gynecologist can confirm it, check whether you can both contract and fully relax the pelvic floor, and tell you whether exercises, a pessary or both suit you.
The examination also catches the most harmful mistake: bearing down instead of lifting. Pushing down adds pressure to the tissues that are already sagging. A Kegel exercise for prolapse is a lift, up and in, followed by a full release. When to see a pelvic floor specialist.
How Kegel exercises fit into a prolapse plan
- Slow holds build strength and endurance: lift up and in, hold for a few seconds while breathing, then let go completely.
- Quick lifts train the fast response you need before a cough, a sneeze or picking something up.
- The Knack puts that response to work: a squeeze just before the effort, held through it. The Knack, step by step.
- Lying down first. Some physical therapists start you lying down, where gravity pulls less on the prolapse, then progress to sitting and standing as you're able.
- Most days, for months. Guidelines talk about at least 16 weeks. Short daily sessions are easier to keep up than long occasional ones.
Habits that take pressure off the pelvic floor
Lifestyle changes may improve results alongside training. The usual advice: avoid straining on the toilet and deal with constipation, avoid heavy lifting, use the Knack and don't hold your breath when you do lift, get a chronic cough looked at, and avoid high-impact exercise such as running or jumping, or get a specialist's guidance before returning to it.
If your BMI is over 30, NICE says weight loss can help with prolapse symptoms.
Other treatments for prolapse
A vaginal pessary is a removable support device that a clinician fits; it can be used alone or together with pelvic floor training. After menopause, if you also have vaginal symptoms such as dryness, a doctor may suggest vaginal estrogen. When symptoms stay bothersome despite conservative treatment, surgery is an option, and the decision is made with a specialist. Pelvic floor changes in menopause.
Where the Kegelia app fits
The Kegelia app is for the daily-practice part of a prolapse plan, once a specialist has said strengthening is right for you. A jellyfish's bell draws up and in as you lift and opens as you release, so the movement you copy is a lift, never a push down. Long Hold sessions suit slow holds and Quick Flicks suit quick lifts, in 1, 3 or 5 minutes.
The Kegelia app has no prolapse-specific program, doesn't measure your muscle and can't tell whether your prolapse is improving. It doesn't replace a supervised program; it makes the home practice between appointments easier to keep. What the Kegelia app can and can't do.