Pelvic Prolapse — What Is It and How to Deal With It

Let's talk about something that affects a staggering number of women, yet is still whispered about in hushed tones, if discussed at all. Pelvic organ prolapse (POP) is common, it is real, and it is not something you simply have to put up with. Whether you have just been diagnosed, noticed something doesn't feel quite right, or you are deep in your own research, this blog is for you.

What Is Pelvic Organ Prolapse?

Pelvic organ prolapse is a condition characterised by the descent of pelvic structures, including the anterior (front) or posterior (back) vaginal wall. This means the uterus, cervix, or vagina. They can move into or beyond the vaginal canal, due to weakening of the pelvic floor's supportive tissues, including muscles, fascia, and ligaments. This structural weakness allows adjacent organs such as the bladder, rectum, or small intestine to herniate into the vaginal space. (Ive included several links that I trust in case anyone needs more information - NCBI )

Different organs may be involved, including the urinary bladder, the uterus, the vagina, the intestines, and the rectum and more than one organ at a time may descend. The main types are: News-Medical

Cystocele — the bladder descends into the front wall of the vagina (the most common type)

Rectocele — the rectum bulges into the back wall of the vagina

Uterine prolapse — the uterus descends into the vaginal canal

Enterocele — the small bowel pushes into the top of the vaginal wall

Urethrocele — the urethra descends alongside the front vaginal wall

Mild prolapse may be asymptomatic, but POP becomes clinically significant when it causes symptoms such as pelvic pressure, a sensation or visible bulge in the vagina, difficulty with urination or defecation, urinary or fecal incontinence, or sexual dysfunction. NCBI

The Grades Explained

Clinicians use the Baden-Walker grading system or the POP-Q (Pelvic Organ Prolapse Quantification) system to assess severity. In simple terms:

Grade 1 — at this stage you may not even know you have a small prolapse; it could be picked up on a routine cervical examination.

Grade 2 — this is when the bladder or bowel falls down far enough to be at the opening of the vagina.

Grade 3 — this is when your pelvic organs begin to bulge out of the vaginal opening; it can feel uncomfortable or painful.

Grade 4 — the most severe form, when the entire bladder or uterus comes out of the vagina, known as procidentia. Dr. Louis Newson

How to Deal With Grade 1 and 2

The good news is that Grade 1 and 2 prolapse responds very well to conservative, non-surgical management. The earlier you start, the better.

Pelvic Floor Physiotherapy This is the gold standard first step. A specialist women's health physiotherapist can assess your specific pattern of weakness and give you a tailored exercise programme. Generic Kegel exercises help, but proper assessment makes a huge difference.

Lifestyle Adjustments Avoiding heavy lifting, addressing chronic constipation (straining is a significant factor), maintaining a healthy weight, and avoiding high-impact exercise are all important. Pilates and yoga are particularly restorative and yin styles (ie more gentle) can be very supportive. It is important to learn exactly how to breath to prevent making it worse but a good Pilates instructor will be able to help you with this.

Pessaries A ring or shelf pessary, fitted by a gynaecologist or specialist nurse, can provide excellent symptom relief by mechanically supporting the prolapsed tissue. Many women use these very successfully long-term.

Topical Oestrogen Since oestrogen receptors are found in the squamous epithelium of the bladder, urethra, vagina, and pelvic floor muscles, the pelvic organs and their surrounding muscle and connective tissue are sensitive to oestrogen, and the decline during the postmenopausal period contributes not only to symptoms of pelvic organ prolapse but also to vulvovaginal atrophy, stress urinary incontinence, and sexual dysfunction. Topical oestrogen (typically estriol cream) applied vaginally helps restore tissue integrity and is widely recommended as part of conservative management. clinicaltrials

How I'm Dealing With Mine — My Personal Toolkit

I want to share my own approach here, as a TCM herbalist, acupuncturist, and bodyworker navigating a Grade 2 prolapse. This is not prescriptive for you but it is what is working for me and may well need adapting for you. My hope is that it may give you ideas, hope, and a framework.

Estriol Cream I am using topical estriol cream, a bioidentical, locally-acting oestrogen. Local oestrogen therapy works by increasing vaginal tissue blood flow, epithelial thickening, increased epithelial secretion and decrease in vaginal pH.

Pelvic floor exercises may enhance the efficacy of local oestrogen therapy by improving blood flow, which could facilitate better oestrogen absorption and distribution. I apply it nightly as directed. It is well-tolerated, minimally systemic, and makes a noticeable difference to tissue quality. ( clinicaltrialsnih )

Specific Exercises I am working with a combination of targeted pelvic floor contractions, hypopressive breathing exercises, and restorative yoga postures. Hypopressives — low-pressure fitness techniques that reduce intra-abdominal pressure. These are particularly well-suited to prolapse and worth looking into. Inversions (legs up the wall, supported bridge) give the pelvic floor a literal rest from gravity and I do these daily.

TCM Herbs — Bu Zhong Yi Qi Tang In Chinese medicine, the treatment principle for prolapsed organs is to lift the Qi of the middle jiao by tonifying the Spleen and benefiting Qi. There is a famous herbal formula called Bu Zhong Yi Qi Tang which is the first choice for this condition. This formula contains eight ingredients, with Huang Qi (Radix Astragali) as the most important ingredient, used in high doses. I use a modified version of this formula tailored to my own pattern. It is warming, tonifying, and works beautifully alongside acupuncture.

Acupuncture is significantly effective in lifting Spleen Qi. Points on the Spleen and Stomach meridians can be selected, such as SP10, SP6, ST36, ST25, alongside local points on the Ren meridian including REN12, REN6, REN4, and REN3, all with tonifying manipulation. I also include DU20 (Baihui) at the crown of the head which is the single most powerful point for raising sunken Qi.

Moxibustion is essential for this pattern — it is a pure deficiency and sinking pattern where moxa plays a critical role. Moxa on Baihui DU-20 is the single most important intervention for raising sunken Qi and is classically indicated for all forms of organ prolapse. Located five cun (thumb widths) within the anterior hairline on the governing vessel channel, it has the ability to raise the Yang, especially with the use of moxibustion. I also use moxa on REN4 and REN6 to warm and tonify the lower jiao. For uterine prolapse specifically, Zigong (EX-CA1) and Weidao GB-28 can be added.

Bodywork Craniosacral therapy and visceral manipulation can help restore mobility and motility to the pelvic organs and their surrounding fascia. As a bodyworker I find this approach deeply supportive in addressing the structural and energetic patterns that contribute to prolapse, not just the symptoms.

How to Deal With Grade 3 and 4

At Grades 3 and 4, the prolapse is protruding beyond the vaginal opening and conservative management alone is unlikely to be sufficient for most women. This is when a referral to a urogynaecologist is essential.

Medical Options Include:

Surgery — there are several approaches including anterior/posterior vaginal repair, uterine suspension procedures, and for women who have completed their families, hysterectomy. Surgical outcomes are generally good, though it is important to know that recurrence is possible, which is why pelvic floor rehabilitation before and after surgery matters enormously.

Pessary Support — even at higher grades, a well-fitted pessary can provide enough symptom relief to avoid or delay surgery, or to improve tissue quality before an operation.

Pre-operative Topical Oestrogen — many urogynaecologists now recommend using topical oestrogen for several weeks prior to surgery to improve tissue health and surgical outcomes.

Holistic and TCM support absolutely still has a role at Grades 3 and 4 to support tissue quality, maintain pelvic floor function, manage symptoms, and support recovery but it works best alongside, not instead of, medical care at this level.

A Word of Hope

Pelvic prolapse is one of those conditions that can feel deeply demoralising. There can be a sense that your body has let you down, that things will never quite be the same. I understand that feeling personally from just the past few days, but I want to leave you with this: the body has remarkable capacity to heal, adapt, and strengthen when given the right support.

Women are managing prolapse brilliantly every day through movement, herbs, acupuncture, good medical care, and a refusal to accept that this is simply something to endure in silence.

East and West have wisdom to offer here, and the most powerful approach draws from both. You do not have to choose between your GP and your acupuncturist, between estriol cream and Bu Zhong Yi Qi Tang. You can have all of it.

Start where you are. Get a proper assessment. Build your team. And know that you are far from alone.

Please note: this blog is for informational purposes and reflects my personal and clinical experience. It is not a substitute for individual medical advice. Always consult your GP or women's health specialist for a diagnosis and treatment plan tailored to you.