Updated March 25, 2026 — This post has been reviewed and expanded with current treatment information.

Childbirth is a wonderful miracle, but it does have its own unique complications, some of which people are hesitant to talk openly about. Regardless of whether you have a vaginal delivery or cesarian section, prolapse is a very real possibility. There are many effective ways to treat prolapse, but first we should talk about why it happens, as well as the different types of prolapse.

Estrogen and progesterone are the primary pregnancy hormones. Estrogen helps with vascularization to the fetus, and stimulates milk production. Progesterone causes laxity (or loosening) of the ligaments and joints throughout the body. This allows the uterus to transform from a small pear into a space that can accommodate a full-term baby. Throughout the pregnancy, this increased laxity plus the weight of a growing baby adds a lot of force or pressure onto the pelvic organs. Then during childbirth, you’ve got pushing and pressure, both of which can cause additional stretching of the ligaments and fascia. In cases where there’s a very long second stage pushing, this can inflict even more force upon the organs within the pelvis.

There are three different kinds of prolapse: a cystocele or bladder prolapse, occurs when the bladder falls or presses into the anterior (front) vaginal wall; a rectocele is when the rectum falls or presses into the posterior (back) vaginal wall; a uterine prolapse is when the uterus protrudes into the vaginal canal.

Two additional types are worth knowing about: an enterocele occurs when the small intestine pushes down against the upper portion of the vaginal wall — this type is more commonly seen after a hysterectomy but can occur postpartum as well. A urethrocele involves the urethra descending into the vaginal wall, and often occurs alongside a cystocele. In clinical practice, it’s not uncommon for more than one type of prolapse to be present at the same time.

How will you know if you have a prolapse?

You may feel some pressure or something hanging down into pelvis. You may also see something protruding out of the vaginal opening. Both of these may indicate that a pelvic floor prolapse is present. To be properly diagnosed, be sure to schedule a follow-up appointment with your OBGYN will be helpful – probably about 6 weeks after you give birth. They will have you bear down or push to observe what occurs. Once diagnosed, there are a few options to consider for treatment: physical therapy, pessary, or surgery.

When Should You See a Pelvic Floor PT?

Not sure whether your symptoms warrant a call? Here are some signs it’s time to make an appointment:

• A feeling of pressure, heaviness, or bulging in the pelvic region
• Leaking urine when you cough, sneeze, laugh, or exercise
• Difficulty fully emptying your bladder or bowel
• Low back or pelvic pain that lingers beyond the early postpartum weeks
• Discomfort or pain with intercourse after you’ve been cleared to resume sexual activity

You don’t need to wait until symptoms are severe. Early intervention with pelvic floor PT often leads to faster, more complete recovery.

Pelvic floor physical therapy is the least invasive of treatments.

Your physical therapist will do a full evaluation to assess posture, strength, as well as an internal examination of the pelvic floor muscles. The primary goals of treating prolapse will be to reduce any excessive pressure onto the pelvic floor. This will include sharing breathing techniques for having bowel movements, as well as teaching body mechanics and proper lifting techniques.

Beyond these foundational techniques, pelvic floor PT for prolapse may also include:

• Internal and external manual therapy to address muscle tension, scar tissue, and fascial restrictions that contribute to prolapse symptoms
• Biofeedback, which uses real-time visual feedback to help patients learn to correctly activate and release the pelvic floor muscles — particularly useful when patients are unknowingly bearing down or holding tension
• Postural and core rehabilitation, because how you carry your body and manage intra-abdominal pressure throughout the day has a direct impact on prolapse symptoms
• SoftWave Therapy, an acoustic wave technology now available at both our NYC and NJ locations, which can support tissue healing and reduce pain for patients managing prolapse-related discomfort

The right combination of techniques depends on your specific presentation, which is why a thorough evaluation is always the starting point.

A pessary is a small ring like device, that is inserted vaginally to provide support for for the pelvic floor muscles, and keep the prolapse from hanging down further into the vaginal opening. Your doctor will fit this for you, it may take a few trials to get a good fit. Once you receive the pessary, you will most likely have to change it yourself, but in some cases the doctor can change it every 3 months.

It’s worth noting that pessaries have come a long way and are now available in many different shapes and sizes beyond the traditional ring — including dish, donut, Gehrung, and cube styles, among others. This expanded range means a better fit is achievable for more patients. If you’ve tried a pessary in the past without success, it may be worth revisiting the conversation with your provider.

Surgical interventions include: fixation or suspension of the tissues that are loose, either vaginally or abdominally. Usually a mesh is placed when abdominal surgery is performed. With surgery, there could be complications, which could include difficulty urinating and/or incontinence, as well as pain after sex. A hysterectomy can also be performed if the uterus is prolapsed, this can be done vaginally or abdominally.

Usually with time, the prolapse will improve. Once you are finished breastfeeding, your hormones will regulate, therefore reducing the ligamentous laxity. With this regulation of hormones, your pelvis with stabilize and the pelvic floor will be able to work better. If you still have questions about prolapse, follow-up with your doctor and discuss your possible options for treatment.

The Bottom line: If you do have prolapse, please don’t freak out! There are plenty of treatment options, and most likely your prolapse symptoms will decrease. Before you consider surgery, physical therapy is always a great option for basic strengthening and breathing techniques.

 If you’re in the New York City area and want to talk through your symptoms, we’re here. At 5 Point PT’s Flatiron District clinic, pelvic health is our specialty — and we’d love to help you find your way back to feeling like yourself. We also have a location in Millburn, NJ. Book an Appointment or give us a call to get started.