Pelvic Organ Prolapse and Pessary Management

Expert, evidence-based care for prolapse — with clarity and confidence.

Pelvic organ prolapse (POP) is common, particularly after childbirth and during the menopausal years. While it can feel confronting, it is highly manageable with the right assessment, education and support.

At Terra Physiotherapy, pelvic organ prolapse care is delivered with precision, discretion and a whole-body approach — helping you feel informed, supported and confident in your body.

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Pelvic organ prolapse assessment and care at Terra Physiotherapy

What is pelvic organ prolapse?

Pelvic organ prolapse (POP) happens when the muscles, connective tissues, and ligaments that support the pelvic organs become less supportive, allowing one or more organs to shift downward into the vaginal canal. This can affect the front wall (bladder), the top of the vagina or uterus, or the back wall (bowel/rectum).

You may notice:

A feeling of heaviness or pressure
A vaginal bulge sensation
Urinary leakage or urgency
Difficulty emptying bladder or bowels
Discomfort during exercise
Symptoms that worsen by the end of the day

Prolapse does not automatically mean surgery. Many women improve significantly with conservative physiotherapy and structured rehabilitation.

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Our Approach to Prolapse Care

If you prefer not to proceed with an internal examination, alternative assessment options are available. These may include externally positioned real-time ultrasound and guided functional movement assessment. We assess more than just the pelvic floor. Your evaluation may include:

Detailed health and symptom history
Internal pelvic floor examination (with informed consent)
Real-time ultrasound biofeedback
Breathing and pressure management assessment
Postural and biomechanical evaluation
Strength and load tolerance testing

Your comfort and choice are always prioritised. Treatment may include:

Pelvic floor rehabilitation
Pressure management strategies
Progressive strength training adapted to prolapse stage
Safe return-to-exercise planning
Lifestyle and load modification guidance

You are not alone.
Prolapse is common — and it is manageable.

Pessary Fitting and Management

Pessaries are medical-grade silicone devices inserted vaginally to provide internal support to pelvic organs.

They can:   

Reduce heaviness and bulge symptoms
Improve bladder function
Support exercise and activity
Provide a non-surgical management option.

At Terra Physiotherapy, we provide:

Professional pessary fitting
Education on insertion and removal
Ongoing review and monitoring Integration of pessary use with rehabilitation
Pessary care is delivered collaboratively.

Management is shared with your GP or gynaecologist when appropriate, ensuring coordinated and safe ongoing care. Every fitting is individualised and carefully supervised to prioritise comfort, tissue health and long-term outcomes.

What to expect?

Your initial 60-minute consultation includes comprehensive assessment and discussion of management options.

Internal examination is only performed with informed consent. You remain in control throughout the process.
Follow-up sessions focus on progression, symptom monitoring and long-term strength planning.

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With the right guidance and support, many women return to exercise, daily life and strength training with confidence.

Your questions  answered…

Is pelvic organ prolapse common?

Yes. Prolapse is very common, particularly after childbirth and during the menopausal years. Many women experience symptoms at some point in their lives.

Does prolapse always require surgery?

No. Many women successfully manage prolapse with physiotherapy, strength training, lifestyle adjustments and pessary support. Surgery is not the only option and is not always necessary.

Is an internal examination required?

An internal pelvic examination allows the most accurate assessment of prolapse stage and pelvic floor function. However, it is always performed with informed consent, and you remain in control throughout the process.

If you prefer not to proceed with an internal examination, alternative assessment options are available. These may include externally positioned real-time ultrasound (transperineal imaging) and guided functional movement assessment. The assessment is always tailored to your comfort level.

Are pessaries safe?

When properly fitted and monitored, pessaries are safe and widely used. Regular review appointments ensure ongoing comfort and tissue health.

Can I exercise with prolapse?

In most cases, yes. With appropriate rehabilitation, pressure management and strength progression, many women return to exercise, Pilates-based movement and daily activity confidently.

Will my prolapse get worse over time?

Prolapse progression varies between individuals. Factors such as load management, strength, hormonal changes and lifestyle play a role. With guided rehabilitation and appropriate support, many women stabilise or significantly improve their symptoms.