Key point
In mild to moderate prolapse, pelvic floor muscle training can improve support and reduce symptoms. Advanced cases require surgical intervention – but rehabilitation training remains important afterwards.
A bit of anatomy – what holds the uterus in place?
The uterus and the bladder are located in the lesser pelvis. The bladder lies anterior and inferior, behind it is the vagina, above the vagina is the uterus, and posterior to the vagina is the rectum. Two systems keep them in place:
From above: the peritoneum and strong ligaments (broad ligament, utero-sacral ligaments, suspensory ligaments) fix the uterus to the pelvic bones and the sacrum. Imagine a chandelier fastened to the ceiling by a wire – it is primarily these structures that hold the uterus in place.
From below: the pelvic floor muscles support the pelvic organs like a closure plate. These muscles surround the urethra, the vagina and the anal opening – they ensure urinary and fecal continence.
The mechanism of prolapse
Uterine prolapse: The suspensory ligaments stretch and lose support → the uterus descends → the cervix indents into the vagina. Bladder prolapse: The posterior wall of the bladder sags and bulges into the vagina.
What causes prolapse?
Uterine and bladder prolapse result from weakening of the pelvic floor muscles and supporting tissues. Main risk factors include:
| Risk factor | How it acts |
|---|---|
| Pregnancy and childbirth | During difficult labor the ligaments and pelvic floor muscles can be injured or stretched |
| Obesity | Abdominal fat acts as a “weight” on the internal organs, pulling them downward |
| Menopause | Decreased estrogen levels reduce tissue elasticity |
| Chronic cough, constipation | Persistently elevated intra-abdominal pressure strains the pelvic floor |
| Repeated heavy lifting | Increases intra-abdominal pressure gradually stretching supporting structures |
| Sedentary lifestyle, little exercise | Pelvic floor muscles weaken, reducing support |
What symptoms does it cause?
In mild cases prolapse may cause no symptoms – many women are unaware of it. Symptoms appear gradually:
An uncomfortable sensation in the vagina, pelvis, lower abdomen or lower back. A dragging pain that may worsen during sexual intercourse or menstruation. A feeling of a “weight” or pressure, as if something is “about to fall out.” On self-examination or during hygiene you may feel a bulge in the vagina.
Urine may leak—especially with lifting, coughing or sneezing. Frequent urge to urinate. Recurrent urinary tract infections because the bladder cannot empty fully. Difficulty with bowel movements.
Sexual intercourse may become painful. Involuntary urine leakage can occur during sex. Achieving orgasm may become more difficult.
In severe prolapse the mucosa or even the cervix can protrude from the vagina. This can dry out, chafe, itch or develop small sores that may bleed. Surgical intervention is required in such cases.
Diagnosis
Prolapse is most often discovered during a routine gynecological exam or during colposcopy (vaginal inspection). It can be confirmed with ultrasound or MRI, but usually physical examination is sufficient.
Treatment options
Treatment depends on the severity of the prolapse. There are two main approaches: improving support with muscle training, or surgical intervention.
Pelvic floor exercises (Kegel exercises): Voluntary pelvic floor muscle contractions, 2–3× daily for 5–10 minutes. Inexpensive and can be done anywhere, but alone it may take months to achieve results.
FES (functional electrical stimulation): The device triggers muscle contractions via a vaginal or anal probe – more focused than voluntary exercises. 20–30 minutes daily for at least 8–10 weeks. Maintenance treatment (1–2 sessions weekly) is required to preserve results.
Biofeedback + FES combination: The device senses when you contract the muscles and "assists" the contraction – the two effects add up. This combined method can bring the fastest improvement among home treatment options.
Vaginal weights (balls): Medical devices placed in the vagina (e.g. Fleur ball, Fleuron set) that train the muscles passively by being retained. To prevent them from slipping out the pelvic floor muscles must engage.
Pessary: A ring-shaped, flexible device placed in the upper part of the vagina that supports the uterus and the bladder. It is removable, cleanable and can be reinserted. A pessary is prescribed by a physician.
Surgical intervention is required for severe, advanced prolapse:
Laser treatment: Aims to stimulate regeneration of the vaginal elastic fibers without cutting.
Laparoscopic/abdominal surgery: A ligament-like support is sutured to the uterus and fixed to the pelvic bone to pull the uterus back into place.
Postoperative rehabilitative muscle training is important to maintain the surgical result.
What can you expect from muscle training?
Returning to the chandelier analogy: the uterus is primarily held by the ligaments that fix it from above – not by the pelvic floor muscles below. Muscle training improves support, but it does not shorten the ligaments.
| Degree of prolapse | What to expect from muscle training? |
|---|---|
| Mild (cervix in the upper third of the vagina) | Training alone can bring complete symptom relief. Improved pelvic floor support can compensate for mild ligament stretching. |
| Moderate (cervix down to the middle part of the vagina) | Symptom improvement is expected – but complete resolution is not guaranteed in all cases. Training can slow progression. |
| Severe (bulging at or beyond the vaginal opening) | Muscle training alone is not sufficient. Surgical intervention is required – afterwards muscle training is part of rehabilitation. |
Important
If prolapse is detected early, pelvic floor muscle training and electrostimulation offer a real chance of achieving symptom-free status. The achieved condition can be maintained with regular exercise, targeted training, keeping a healthy weight and avoiding a sedentary lifestyle. If you stop training, the muscles can gradually weaken and symptoms may recur.
Which device should you choose?
| Segment | Device | For whom? | Main advantage |
|---|---|---|---|
| Entry | Fleur vaginal ball | Prevention, mild symptoms, training without electricity | Passive muscle training, wearable anywhere |
| Fleuron set | Progressive muscle-building, measurable improvement | 4 weight levels, step-by-step | |
| Kegel Toner | Mild–moderate stress incontinence, first stimulator | 2 programs, simple use, affordable | |
| Mid | Biolito | Stress, urge, mixed incontinence | 2 channels, 10 programs, good value |
| Perfect PFE Women | Female stress/urge incontinence | 4 woman-optimized programs, with probe | |
| Myolito | Incontinence + pain relief in one | TENS + EMS + FES in one device, 12 programs | |
| Premium | Sure Pro | Urge incontinence, tibial nerve stimulation | 15 programs, 2 channels, TIBN, rechargeable battery |
| evoStim UG | Various incontinence types + pain + vaginismus | 5 program groups, IntelliSTIM, 6 compatible probes | |
| evoStim P | Rehabilitation controlled with biofeedback | Pressure-biofeedback, ETS, real-time feedback | |
| evoStim E | Clinical-level measurement, EMG-biofeedback | EMG-biofeedback, objective muscle strength measurement |
The full range can be found on the incontinence devices category page.
When should you not use electrostimulation?
- Cardiac pacemaker
- Pregnancy
- Active malignant disease in the treatment area
- Acute inflammation or infection in the pelvis
- Severe prolapsus (bulging) – surgical treatment is required first
Pelvic floor exercises (Kegel exercises) are usually possible even in the above cases – the restriction applies to electrostimulation devices. Consult your treating physician.
Frequently asked questions
In mild prolapse, muscle training can improve support and achieve symptom-free status. In moderate cases symptoms can be reduced, but full reversal is not always expected. Severe prolapse requires surgical intervention.
With daily electrostimulation treatment noticeable improvement is expected after 8–10 weeks. With standalone pelvic floor exercises several months are required. Maintenance treatment (1–2 times weekly) is necessary to preserve results.
Yes. Surgery restores the ligaments, but it does not improve the condition of the supporting muscles. Postoperative rehabilitative muscle training can help maintain the result.
In uterine prolapse the uterus descends into the vagina (from above). In bladder prolapse the posterior wall of the bladder bulges into the vagina (from the front). Both are related to weakening of the pelvic support structures and often occur together.
Risk can be reduced: regular pelvic floor exercises, maintaining a healthy weight, avoiding heavy lifting, treating chronic cough/constipation. Targeted muscle training is especially important after childbirth and around menopause.
Read more
Incontinence treatment – complete guide →
Urinary incontinence and its treatment →
Treatment in practice – protocols →
The adult-diaper trap →
Intim exercise guide →
All incontinence devices →
Summary – Quick overview
Sources
- Todhunter-Brown A, Hazelton C, Campbell P, et al. (2022). Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 9(9):CD012337. DOI: 10.1002/14651858.CD012337.pub2
