Pelvic Floor Physical Therapy for Pelvic Organ Prolapse in San Francisco, CA

POP (Pelvic Organ Prolapse) happens when the uterus, bladder, urethra, gastrointestinal tract, and/or rectum protrude through the vaginal walls. Rectal prolapse may also occur. Rectal prolapse is when part or all of the rectum shifts down and out of the anus. Two of the primary causes of POP are weakness in the fascia and pelvic floor muscles. Obesity and vaginal delivery are two common risk factors that may cause damage and deterioration to the pelvic floor muscles and fascia, resulting in the prolapse of pelvic organs.


The Facts

  • Half of all women develop pelvic organ prolapse in their life
  • Prolapses are classified on a scale of I – IV, with Grade IV being entirely out of the vagina
  • Approximately 20% of women will experience pelvic floor reconstruction for POP
  • There is a 30% recurrence rate of pelvic organ prolapse after surgery, thereby requiring a second procedure
  • Pelvic floor physical therapy improves pelvic floor muscles function and reduces pelvic organ prolapse symptoms


  • Feelings of heaviness or bulging in the vagina
  • Urine and/or fecal leaking (incontinence)
  • Abnormal bowel and bladder emptying
  • Bladder and bowel urgency, frequency
  • Nocturia (nighttime urination)
  • Recurrent bladder infections
  • Pelvic pain
  • Painful sex
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Causes of Pelvic Organ Prolapse

  • Genetics
  • Obesity
  • Menopause
  • Childbirth, with vaginal deliveries causing a higher risk
  • Age-related pelvic floor and girdle changes
  • Previous Hysterectomy

Associated Diagnoses

  • Urethrocele
  • Cystocele
  • Rectocele
  • Enterocele
  • Rectal prolapse

Diagnostic Challenges

Studies show that women under report symptoms of pelvic organ prolapse and are not always offered pelvic floor physical therapy as a treatment option. Over-the-counter and medically prescribed pessaries may be helpful. Studies show that women with pelvic organ prolapse that undergo pelvic floor physical therapy have reduced symptoms, improved function, and better surgical outcomes. Typically women with Grades III and IV POP are advised to consider surgery. In these cases, pelvic floor physical therapy can help before and after surgery.

How We Can Help You

POP can be associated with pelvic floor muscles that are too tight, and/or too weak, or they are uncoordinated and do not function properly. It is important to understand that historically people were told to ‘do kegels’ upon getting diagnosed with POP. If your pelvic floor muscles are too tight, kegel exercises may make your symptoms worse, which is why we advise working with a pelvic floor physical therapist to ensure proper rehabilitation. The pelvic floor muscles may need to be lengthened before they are strengthened. In addition, our pelvic floor muscles should work with our entire core. As women age and sustain day-to-day micro-injuries and normal body wear-and-tear, our pelvic floor and core muscles start working against each other, leading to things like incontinence and pelvic organ prolapse. In your pelvic floor physical therapy examination, the physical therapist will discuss your medical history, prior diagnoses, past treatments, and their effectiveness. This discussion will give an overview of your history to support a regimen that works for you.

Our physical therapists specialize in pelvic floor health and understand what you are experiencing and the frustrations of failed treatment attempts. During your exam, the physical therapist will examine tissues, muscles, nerves, joints, and their movement patterns. Following the examination, your pelvic floor physical therapist will review the findings and fill you in on what the details mean. The physical therapist creates an assessment that explains how you developed your symptoms and creates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one time per week for roughly 12 weeks. We can help you prepare for surgery, or possibly delay or avoid it. We are here for you after surgery to prevent recurrences and help you restore function. You are given a home exercise program to complement your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team, including your surgeon if you are working with one. We are here to help you recover and live your best life!

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