A Feeling of Heaviness: Understanding Pelvic Organ Prolapse and What Can Help

SELF CAREWELLNESSPELVIC HEALTHLIFESTYLE

Jodi Bremner PT, Founder of Hervana Women's Wellness

6 min read

A thoughtful woman sitting on a sofa with text about Pelvic Organ Prolapse and a feeling of heaviness.

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The signs of prolapse can be subtle

The symptoms of pelvic organ prolapse can vary from woman to woman. Some of the most common include:

A feeling of heaviness, fullness or pressure in the pelvis
A dragging or pulling sensation
Feeling as though something is sitting low in the vagina
A bulge that you can see or feel
Pressure that becomes more noticeable later in the day
Symptoms that increase after standing, lifting or taking a long walk
Changes in bladder emptying, urgency or leakage
Constipation or a feeling that you cannot fully empty your bowel
Discomfort or altered sensation during intimacy

Some women notice their symptoms more during their period. Others find that the heaviness eases when they lie down and returns after being upright for a while.

This pattern can offer useful information, but symptoms alone cannot tell us exactly what is happening. If you notice a new bulge, persistent pressure or a sensation that concerns you, it is worth speaking with your doctor, nurse practitioner, gynaecologist or pelvic floor physiotherapist.

And please know this: you do not have to wait until symptoms are severe before asking for help.

Why can prolapse become more noticeable in midlife?

There is rarely one single cause. Often, it is the accumulation of many seasons of life.

Pelvic organ prolapse can be more likely or more noticeable after:

Pregnancy and vaginal birth
Years of lifting, carrying and physically demanding work
Chronic constipation or repeated straining
A persistent cough
Connective tissue sensitivity or a family tendency toward prolapse
Previous pelvic surgery
Hormonal changes during perimenopause and menopause

During perimenopause, estrogen begins to fluctuate and gradually decline. This can influence vaginal moisture, tissue elasticity and the way the pelvic floor and surrounding connective tissues respond to pressure.

That does not mean every pelvic symptom is caused by hormones. It also does not mean heaviness should be dismissed as “just menopause.”

Your body may be moving through a new landscape. It deserves to be listened to with care.

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Pelvic Floor Physiotherapy

Upcoming Experiences

Smiling middle-aged woman with grey hair standing in a sunlit hallway, looking thoughtfully out a window.

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There is a particular kind of heaviness that can be difficult to describe.

Perhaps it feels like pressure low in your pelvis. A dragging sensation. A feeling that something is sitting lower than it used to. Maybe you notice it after a long walk, a day on your feet, lifting laundry baskets, or as the afternoon stretches into evening.

You may even wonder if you are imagining it.

You are not.

As a pelvic floor physiotherapist, I hear these words often from women in midlife and perimenopause. Many have been carrying the sensation quietly, assuming it is simply something they must live with.

But pelvic organ prolapse is common. It can be supported. And it is not automatically a conversation about surgery.

What is pelvic organ prolapse?

Pelvic organ prolapse happens when one or more of the pelvic organs rests lower than it usually does within the vagina.

The organs involved may include:

The bladder, called an anterior vaginal wall prolapse, or cyctocele
The uterus
The bowel or rectum, called a posterior vaginal wall prolapse, or rectocele

Your pelvic organs are supported by a remarkable partnership of muscles, ligaments and connective tissue called fascia. The pelvic floor muscles form the base of this support system. They also help with bladder and bowel control, sexual function, movement and pressure management.

When this support system is stretched, weakened, less coordinated or placed under repeated strain, an organ may settle lower.

This does not mean your body has failed. It means your body is asking for a different kind of support.

Some women have a prolapse without any symptoms at all. Others notice a distinct change in how their pelvis feels.

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A mature woman with long grey hair wearing an olive green coat walks along a leaf-covered path in the golden autumn sunlight.

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Pelvic organ prolapse physiotherapy can offer meaningful support

When women search for pelvic organ prolapse physiotherapy, they sometimes imagine a rigid exercise program or endless pelvic floor squeezes.

That is not how I approach care.

The pelvic floor is not simply a muscle that needs to be made stronger. It is part of a whole pressure and support system. Sometimes the muscles need strengthening. Sometimes they are overworking and need to soften. Often, they need better coordination.

In an assessment, I may look at:

How you breathe and manage pressure
Whether your pelvic floor is gripping, bracing or bearing down
How your pelvic floor coordinates with your diaphragm and deep abdominal muscles
Your posture, lifting patterns and movement habits
Bladder and bowel routines
Constipation, straining or chronic coughing
The activities that make your symptoms better or worse

Your plan may include gentle strengthening, relaxation and lengthening, breath coordination, toileting strategies, bowel support and practical changes to lifting or exercise.

A pelvic floor physiotherapist can also help you understand whether a pessary might be worth discussing with your physician or gynaecologist. A pessary is a removable device placed in the vagina to provide additional support. For some women, it offers comfort during walking, exercise or longer days on their feet. It is one possible tool, not a requirement.

The right plan depends on your body, your symptoms and the life you are actually living.

What happens at a first appointment?

It is completely understandable to feel nervous about pelvic floor care. Many women worry that they will be rushed into an internal examination or asked to do something before they feel ready.

At Hervana Women’s Wellness, the first appointment begins with a conversation.

I want to understand what you have noticed, when it began, what makes it better or worse, and how it is affecting your day-to-day life. We talk about your goals and any questions you may be carrying.

An internal assessment is only completed if it is appropriate, explained clearly and agreed to by you. You can pause or change your mind at any time.

There is no test you have to pass. No perfect way to describe your symptoms. Just a shared process of understanding what your body may need.

You can learn more about our approach to pelvic health physiotherapy or choosing a pelvic floor physiotherapist.

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A few gentle things you can try today

These practices are not a substitute for an individual assessment, but they can help you begin noticing how your body responds.

Let your exhale be soft

Sit or lie down comfortably. Breathe in without forcing anything. As you slowly exhale, imagine your ribs melting inward and your pelvic floor becoming less guarded.

You do not need to squeeze. You do not need to lift strongly. Simply notice whether you are gripping, holding your breath or bracing your belly.

Sometimes support begins with learning that you are allowed to soften.

Use a footstool for bowel movements

Placing your feet on a small stool can bring your knees slightly above your hips. This may help your pelvic floor relax and make bowel movements easier.

Try not to strain or hold your breath. Give yourself time. If constipation is ongoing, speak with your healthcare provider.

Split heavy loads into smaller trips

Two lighter grocery bags may be kinder to your body than one heavy load. You might also use a cart, ask for help or take a pause between trips.

This is not about avoiding movement. It is about finding ways to move that reduce unnecessary pressure and leave you feeling supported.

Rest with your legs supported

At the end of the day, try lying down for five to ten minutes with your lower legs resting on a chair or cushions.

Let your breath slow. Notice whether the heaviness changes when your body is horizontal. This information can be helpful when you speak with your care provider.

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A human pelvis model and stethoscope on a wooden desk in a serene physical therapy or holistic health clinic.

A serene woman practicing mindful breathing while lying on a rug with legs elevated on a soft ottoman at home.

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Living well with heaviness this season

Autumn reminds us that not everything needs to be held up forever.

There may be wisdom in carrying fewer things. In setting down a load before it becomes too much. In letting rest be part of care, rather than something you earn only after exhaustion.

If your pelvis feels heavy, this does not mean you need to stop living your life. It may mean you need more information, more support and a little more kindness in the way you move through your days.

Most women with mild to moderate prolapse can begin with conservative care such as education, lifestyle adjustments, pelvic floor muscle training and physiotherapy. Surgery may be appropriate for some women, particularly when symptoms are severe or significantly affecting quality of life, but it is not the only path.

Please seek medical assessment for a new or worsening bulge. Contact a healthcare professional promptly if you experience significant bleeding, severe pain, difficulty urinating, inability to empty your bladder, fever, tissue that remains outside the vagina, or a bulge that cannot be gently reduced.

You deserve to know what is happening in your body. You deserve choices. And you deserve care that meets you with compassion.

At Hervana Women’s Wellness, I offer women’s physiotherapy that honours the whole woman: her body, her breath, her history and the season she is moving through.

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If you have noticed a sense of heaviness, let today be the day you write it down, speak it aloud, or reach out for one gentle piece of support.