Pelvic organ prolapse (POP) is more common than most people think—and far more complex than simply “weakened pelvic muscles.” It’s a condition that can impact bladder, bowel, sexual, and postural health. But to truly understand why pelvic organ prolapse happens, we need to look beyond the pelvic floor itself and explore how the entire body—especially the thoracic spine, diaphragm, hips, and pelvis—plays a role in keeping our internal organs where they belong.
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when one or more pelvic organs—such as the bladder, uterus, or rectum—descends from its normal position and pushes against the vaginal walls. This descent happens due to a loss of support from the muscles, fascia, and ligaments that form the pelvic floor and pelvic cavity.
You may hear prolapse described by the organs involved:
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Cystocele – Bladder prolapse into the vaginal wall
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Rectocele – Rectum pressing into the vaginal wall
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Uterine prolapse – Uterus dropping into the vaginal canal
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Enterocele – Small intestine bulging downward
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Vaginal vault prolapse – Occurs after hysterectomy when the top of the vagina loses support
Why Does Pelvic Organ Prolapse Happen?
While childbirth is a well-known risk factor, prolapse is the result of multiple system failures across the body. Let’s break it down.
1. Pelvic Floor Muscle Dysfunction
The pelvic floor muscles create a hammock-like structure that supports the pelvic organs. These muscles work in coordination with the deep core and breathing mechanics to hold everything in place. But when:
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These muscles are too weak
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Chronically tight and uncoordinated
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Or fatigued after pregnancy, chronic straining, or poor posture
…they can no longer provide the necessary support.
2. Thoracic Spine Stiffness and Poor Posture
Think your upper back doesn’t matter? Think again. The thoracic spine helps create the shape and pressure dynamics of your entire trunk. A slumped or flexed thoracic spine:
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Reduces the ability of the diaphragm to move properly
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Alters intra-abdominal pressure, pushing more force downward
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Affects the rib cage and pelvic alignment, making it harder for the core and pelvic floor to activate efficiently
In other words, a collapsed chest often leads to a collapsed pelvic floor.
3. Diaphragm Dysfunction and Pressure Mismanagement
The diaphragm and the pelvic floor are two ends of a pressure system. They move together during breathing:
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Inhale: Diaphragm moves down, pelvic floor lengthens
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Exhale: Diaphragm rises, pelvic floor lifts
If your diaphragm is restricted—due to shallow breathing, rib cage stiffness, or stress—you may not be managing intra-abdominal pressure correctly. That pressure needs to go somewhere, and unfortunately, it’s often downward onto the pelvic organs.
4. Pelvic and Hip Imbalances
The pelvis and hips act as the foundation for the pelvic organs. When the pelvis is tilted, rotated, or compressed due to:
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Poor posture
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Muscle imbalances
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Old injuries
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Or sitting for long periods
…it disrupts the tension and balance in the pelvic fascia and ligaments. This altered mechanics can pull on the vaginal walls or reduce the structural support around organs.
5. Chronic Pressure and Strain
Conditions that increase intra-abdominal pressure (chronic coughing, constipation, weightlifting with poor technique, obesity) can gradually weaken the support structures. Without proper counter-support from the diaphragm and pelvic floor, the organs start their slow descent.
How Pelvic Floor Therapy Can Help
Pelvic floor physical therapy takes a whole-body, integrated approach to address prolapse. Here’s how it works:
✅ Rebuilds Pelvic Floor Coordination
Therapists teach you how to properly contract, relax, and coordinate your pelvic floor. This is key—not every prolapse is caused by weakness. Sometimes, it’s poor timing or overactivity.
✅ Optimizes Diaphragm and Breathing Mechanics
Learning how to breathe properly helps regulate pressure and allows the pelvic floor to work in harmony with the core and diaphragm. Your therapist may work on rib cage mobility and abdominal tension to restore this balance.
✅ Improves Thoracic Spine Mobility
Gentle mobilization of the upper back and ribs helps improve posture and core activation. This improves alignment, so the pelvic floor is in a more optimal position to support organs.
✅ Aligns the Pelvis and Hips
Manual techniques and exercises restore mobility and alignment to the pelvis, hips, and sacrum. This ensures the fascia and ligaments have the right tension to support your organs naturally.
✅ Teaches Pressure Management
Learn how to lift, strain, and move without pushing pressure down into your pelvic floor. This includes coaching on body mechanics, toilet posture, and exercise modifications.
Other Benefits of Pelvic Floor Therapy for Prolapse:
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Improves bladder and bowel control
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Reduces pelvic pressure or heaviness
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Enhances sexual function and comfort
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Prevents worsening of symptoms
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Avoids or delays surgery
Final Thoughts
Pelvic organ prolapse isn’t just a pelvic floor problem—it’s a whole-body coordination issue. From the diaphragm to the hips, the way you move, breathe, and hold your posture all affect how well your body supports your internal organs.
The good news? Your body is adaptable. With skilled pelvic floor physical therapy and a holistic understanding of how everything is connected, you can reduce symptoms, regain confidence, and restore function—from the inside out.
Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at [email protected].
