Pelvic floor muscle training is widely recommended as a first-line treatment for pelvic organ prolapse. Research consistently shows that it can improve symptoms such as the sensation of vaginal heaviness, bulging, or “something being there”, and in some women it can even improve the physical severity (stage) of a prolapse.
However, one of the most important findings from recent research is that not all prolapses respond equally to pelvic floor muscle training.
Why do some women improve more than others?
Historically, studies investigating pelvic floor exercises for prolapse have grouped together many different types and severities of prolapse, including:
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Front vaginal wall prolapse (bladder prolapse or cystocele)
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Back vaginal wall prolapse (rectocele)
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Uterine prolapse
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Mild through to more advanced stages of prolapse
This has made it difficult to understand which women are most likely to benefit from pelvic floor muscle training alone.
A systematic review and meta-analysis of randomised controlled trials (Wang et al., 2022) found that pelvic floor muscle training can improve prolapse stage, with women who performed pelvic floor exercises being more likely to experience an improvement compared with those who did not.
When researchers looked more closely at different prolapse types, they found that women with anterior (front wall) prolapse were significantly more likely to improve compared with women with posterior (back wall) prolapse. In fact, posterior prolapses did not show significant improvement with pelvic floor muscle training alone.
More recent research (Siyoum et al., 2025) compared women receiving lifestyle advice alone with women receiving lifestyle advice plus a structured pelvic floor muscle training program. Women who completed the pelvic floor training program experienced greater improvements in prolapse symptoms, particularly the bothersome sensation of vaginal bulging.
While only around one in five women experienced a significant improvement in their prolapse symptoms, this represents a group of women who were able to avoid more invasive treatments such as a pessary or surgery after a period of safe, conservative management.
Researchers also found that women with lower-stage prolapse were more likely to respond well to pelvic floor muscle training.
Which prolapses are most likely to improve with pelvic floor exercises?
Current evidence suggests that the women most likely to experience improvement with pelvic floor muscle training are those with:
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Stage 1 or Stage 2 prolapse (mild to moderate prolapse)
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Anterior (front vaginal wall) prolapse, also known as a bladder prolapse or cystocele
For these women, a well-prescribed pelvic floor exercise program, alongside appropriate lifestyle advice, may significantly improve symptoms and reduce the severity of the prolapse.
What if you have a different type of prolapse?
Pelvic floor physiotherapy can still play an important role for women with posterior (back wall) prolapse, uterine prolapse, or more advanced prolapse that reaches or extends beyond the vaginal opening. However, pelvic floor exercises alone are less likely to change the position of the prolapse.
In these cases, treatment may include a combination of:
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Vaginal support pessaries
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Pelvic floor muscle training
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Advice around bowel habits, lifting and reducing unnecessary strain
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A broader strength and exercise program
In some cases, these types of prolapse may require surgical intervention. If this is the case, conservative measures implemented pre-op like those listed above can improve the success of the surgery.
Understanding the exact type and stage of your prolapse is essential to choosing the most appropriate treatment approach.
The importance of an accurate prolapse assessment
A common misconception is that all prolapse symptoms can be solved by simply “doing more Kegels” or attending a general exercise class such as Pilates. While exercise can be beneficial for overall health and strength, the most effective management plan depends on accurately identifying the type and severity of prolapse.
This is why assessment by a pelvic health physiotherapist trained in vaginal examinations and prolapse assessment is so important.
If pelvic floor exercises have not improved your symptoms, it does not mean you have failed. It may simply mean that your particular type of prolapse requires a different management approach, such as a pessary, a different exercise strategy, or discussion of other treatment options such as surgery.
How FitRight Women’s Health can help
At FitRight Women’s Health, our experienced pelvic health physiotherapists provide thorough prolapse assessments and personalised management plans. We can help you understand your prolapse, determine whether pelvic floor muscle training is likely to benefit you, and discuss all available treatment options including pessary management, exercise strategies, and when appropriate, referral for further medical or surgical opinion.
You do not need to navigate prolapse management alone. With the right assessment and treatment plan, many women can significantly improve their symptoms and return to the activities they enjoy.
Book an appointment with our team today and let's create a plan that's right for you.
