Pelvic organ prolapse (POP) occurs when the muscles and connective tissues of the pelvic floor weaken, causing one or more organs to descend into the vagina. This common condition can cause discomfort, bulging, or a sensation of heaviness. Pelvic floor exercises (PFE), also known as Kegels, are the recommended non-invasive intervention to strengthen the supportive structures in the pelvis. This article examines the effectiveness of PFE in managing symptoms and their potential to reverse the physical descent of a prolapse.
Understanding Pelvic Organ Prolapse
Pelvic organ prolapse is characterized by the movement of organs such as the bladder, uterus, or rectum from their typical positions into the vaginal canal. This descent results from damage or weakness in the muscles, ligaments, and fascia that form the pelvic floor, which supports the internal organs. When the bladder pushes into the front wall of the vagina, it is called a cystocele; when the rectum bulges into the back wall, it is a rectocele.
The most common cause of supportive tissue failure is pregnancy and vaginal childbirth, which can stretch and injure the muscles. Other factors contributing to chronic strain include frequent straining due to chronic constipation, persistent coughing, and heavy lifting. Healthcare providers use a grading system, such as the Pelvic Organ Prolapse Quantification (POP-Q) system, to classify the severity of the descent from Stage 0 (no prolapse) to Stage 4 (the organ has descended completely outside the vagina).
Proper Technique and Consistency
The effectiveness of pelvic floor exercises depends entirely on correct execution and consistent practice. The first step is to accurately identify the pelvic floor muscles, which can be done by imagining stopping the flow of urine or preventing gas. This action should result in a sensation of “squeezing and lifting” the muscles upward and forward from the back passage to the bladder.
It is necessary to practice two types of contractions to build both muscle endurance and quick-reaction strength. Slow-hold squeezes are performed by contracting the muscles and holding the lift for up to 10 seconds, followed by fully relaxing for an equal amount of time. These slow contractions build the endurance needed to support the pelvic organs throughout the day. Quick contractions involve a rapid squeeze and immediate release, repeated 10 to 20 times. This quick-twitch strength allows the pelvic floor to react instantly to sudden increases in abdominal pressure, such as from a cough, sneeze, or laugh. For strengthening to occur, these exercises should be performed in sets of 8 to 10 repetitions, ideally three to five times per day. It is important to breathe normally and avoid tensing the buttocks, thighs, or abdominal muscles, which indicates an incorrect technique.
Realistic Expectations for Reversal
Pelvic floor exercises are the first-line treatment for managing prolapse symptoms, but their ability to achieve a complete anatomical “reversal” is limited, especially in advanced stages. The primary benefit is a significant reduction in bothersome symptoms, such as the feeling of heaviness, bulging, or pressure, which substantially improves the quality of life. Research indicates that women who perform PFE experience greater improvement in prolapse symptom scores compared to control groups.
While PFE rarely returns a prolapsed organ to its original position, it can objectively improve the physical stage of the prolapse in some cases. Studies show that a small percentage of women with mild to moderate prolapse (Stages 1, 2, and sometimes 3) can see a measurable improvement of one POP-Q stage. This improvement is achieved by increasing the strength and tone of the pelvic floor muscles, which provides greater structural support and elevates the pelvic organs by several millimeters.
For mild prolapse (Stage 1 or 2), consistent PFE can be highly effective at preventing the condition from worsening. The exercises build muscle but do not repair torn fascia or severely weakened ligaments, which cause higher-grade prolapse. Improvements in muscle strength and endurance can be seen within weeks, but maintaining the benefit requires ongoing commitment over several months. The goal should be symptomatic relief and prevention of progression, rather than an expectation of full physical correction, particularly for more advanced cases.
When to Seek Advanced Treatment
While pelvic floor exercises are beneficial for most women, they may not be sufficient when the prolapse is severe or when symptoms remain debilitating despite adherence to a PFE program. If the sensation of bulging is persistent, interferes with daily activities, or causes significant issues with bladder or bowel function, a specialist consultation is necessary. A urogynecologist or a women’s health physiotherapist can assess the specific type and grade of the prolapse.
For cases where PFE is not enough, non-surgical options often involve a vaginal pessary, a removable device made of silicone. Pessaries come in various shapes and sizes, such as the ring pessary for mild to moderate prolapse or the Gellhorn pessary for more advanced cases. They work by physically supporting the dropped organs to keep them in place. Surgical intervention, which may include procedures like vaginal colporrhaphy or sacrocolpopexy, is typically reserved for more severe prolapse (Stages 3 and 4) or when conservative methods fail to provide adequate relief. These procedures aim to reconstruct the pelvic floor supports and return the organs to their natural position.