Exercise guide
A pelvic organ prolapse is when your womb, bladder or bowel bulges into your vagina. It's common, especially after childbirth and the menopause, it isn't life-threatening, and it doesn't always get worse. Pelvic floor exercises are the first treatment: in trials they eased symptoms by a modest amount, and the National Institute for Health and Care Excellence (NICE) suggests at least 16 weeks of supervised training for a mild prolapse.
Most exercise is still fine. For now, UK advice is to avoid heavy lifting, running, jumping and trampolining, though that advice comes from experts rather than from trials.
This guide covers how to do your pelvic floor exercises, which exercise suits, how much evidence sits behind the limits, how to build back up by watching your symptoms, exercising with a pessary, what to do after surgery or a birth, and when to see a general practitioner (GP). Our 3D figure can't show the pelvic floor muscles working, so the squeezes have written steps.
A prolapse can be seen on examination in many women who have had children, though far fewer notice symptoms. Pelvic, Obstetric and Gynaecological Physiotherapy (POGP), the UK's pelvic health physiotherapists, says a prolapse isn't life-threatening and not all prolapses get worse; some improve. See a GP if you notice a lump or bulge in or around your vagina.
In a trial of 447 women, one-to-one training eased symptoms more than a leaflet of advice at 12 months, and across 16 trials it eased symptoms, mainly in the short term. NICE suggests a supervised programme of at least 16 weeks for a mild prolapse.
The National Health Service (NHS) and the Royal College of Obstetricians and Gynaecologists (RCOG) advise avoiding heavy lifting, running and trampolining with a prolapse, and an NHS pelvic health service adds deep squats, deadweight lifting and crunches. This is expert advice: NICE found no trials of lifestyle changes for prolapse.
Walking, swimming, water classes, cycling while you stay seated, a cross-trainer, Pilates and yoga with any uncomfortable positions adapted, dancing without jumps, and gentle strength training while you watch your symptoms.
Once your pelvic floor is strong, NHS pelvic health physiotherapists say you can try other exercise, stopping if your symptoms get worse. POGP says you should be able to keep exercising with a well-fitted pessary, a device worn in the vagina to support it.
After prolapse surgery, the RCOG advises light loads only for the first month and nothing heavy until 4 to 6 weeks, and POGP says to wait at least 3 months for high-impact exercise. After a birth, UK guidance advises against running before 3 months. Your own team's advice comes first.
The NHS describes a pelvic organ prolapse as your womb, bladder or bowel bulging into your vagina. The RCOG explains that these organs are held in place by ligaments and by muscles known as the pelvic floor. If these are weakened by overstretching, the organs can bulge into the vagina, and sometimes a prolapse is large enough to come out of it.
A bulge of the front wall of the vagina, with the bladder behind it, is the most common. The back wall can bulge with the bowel behind it, the womb can drop down, and after a hysterectomy the top of the vagina can drop instead (a vault prolapse). Having more than one type at once is common.
The NHS lists:
Source 1
Symptoms are often worse at the end of the day, after standing for a long time, or after lifting, coughing or straining, and they ease when you rest or lie down. A prolapse may cause no symptoms at all, and it's sometimes found during a cervical screening test.
Figures differ because they count different things, so here is each one with what it measures:
Pregnancy and childbirth, especially a vaginal birth, are the most common cause. Getting older, especially after the menopause, a higher weight, long-term constipation and straining, a persistent cough, heavy lifting or repeated bending at work or home, previous pelvic surgery such as a hysterectomy, a family history, and conditions such as joint hypermobility, Marfan syndrome and Ehlers-Danlos syndromes raise the risk too.
A prolapse is graded from 1 to 4, where 4 is severe. The RCOG says women with stage 1 usually have mild or no symptoms and rarely need treatment, and the NHS says you may not need treatment if it isn't bothering you. Symptoms can stay the same, get worse or improve over time, and they often vary from day to day.
The options are no treatment if it isn't bothering you, lifestyle changes, pelvic floor training (usually with a specialist pelvic health physiotherapist), vaginal oestrogen after the menopause, a pessary, and surgery for a more severe or bothersome prolapse. NICE asks clinicians to discuss all of these, including no treatment. Vaginal mesh is no longer used on the NHS unless there's no alternative.
A rectal prolapse (the back passage coming down through the anus), a prolapsed or slipped disc in the spine and mitral valve prolapse in the heart are different conditions that share the word, and this guide doesn't cover them. Our herniated disc guide covers a slipped disc.
In the POPPY trial, 447 women with a newly diagnosed prolapse had one-to-one pelvic floor training or a leaflet of lifestyle advice. At 12 months, their symptom score, which runs from 0 to 28, had fallen by 3.8 points with training against 2.1 with the leaflet: a real but modest difference. Only two-thirds of the women returned the 12-month questionnaire.
Across 16 trials with 2,063 women, training lowered symptom scores, made women more than twice as likely to report an improvement and improved the stage of the prolapse, mainly in the short term (up to 6 months). The reviewers rated the certainty low to moderate. An earlier analysis of 13 studies with 2,340 women found much the same.
In the pooled trials, the effects beyond 6 months, and in women aged 55 or over, weren't clear (very low certainty), and training didn't clearly help a bulge of the back wall. In the PREVPROL trial of 414 women with a prolapse they hadn't sought treatment for, five physiotherapy appointments over 16 weeks plus Pilates-based classes gave slightly fewer symptoms 2 years later (a score of 3.2 against 4.2), which the researchers called small, but probably important. An older Cochrane review found training raised the chance of the prolapse stage improving by 17%.
NICE suggests supervised training for at least 16 weeks for a mild prolapse (stage 1 or 2), or at least 4 months in its later guideline, and carrying on afterwards if it helps. POGP says to expect an improvement in 3 to 5 months, then to keep practising once a day, and the RCOG describes a 3 to 6 month course of physiotherapy.
NICE recommends supervised pelvic floor training, one-to-one or in a group, with at least one review during the programme and one at the end. It says supervised exercise such as yoga may help alongside it, because some exercises done incorrectly can raise the pressure on the pelvic floor. It found no evidence that unsupervised activity such as walking or swimming makes symptoms better or worse.
Hypopressive exercises, a breathing and posture technique, added nothing to pelvic floor training in 7 small trials, and on their own they helped less than pelvic floor training. In a 12-week trial in women with a stage 2 prolapse, pelvic floor training eased the bulge, the heaviness and leaking more than hypopressives did.
Other treatments have their own evidence. In a Cochrane review, a pessary added to pelvic floor training probably helped more women feel their prolapse had improved than training alone (one trial of 260 women; moderate certainty), though pessaries caused more side effects. NICE also suggests vaginal oestrogen after the menopause for women with vaginal dryness, and surgery if other treatments haven't helped or you'd rather not try them.
Our wording of POGP's routine and NICE's advice, matching our pelvic floor guide, which covers finding the right muscles in more detail. NICE suggests at least 16 weeks of training supervised by a specialist; ask your GP or refer yourself to a pelvic health physiotherapist.
See the movement on the 3D figure: Pelvic floor exercise (Kegel)
The pelvic floor exercise page's dose is the routine above: 8 slow holds of up to 10 seconds and 8 quick squeezes, 3 times a day, building towards 10 of each. The relaxation page's dose is 5 to 10 slow breaths, 1 to 3 times a day, plus a full release after every squeeze.
With a prolapse, for now:
NICE found no evidence on lifestyle changes for prolapse, so its advice to minimise heavy lifting comes from its committee's experience. Its later guideline noted a study in which weight training alongside pelvic floor training improved leaking, and asked for research on weight training.
The two kinds of study point different ways. In a survey of 3,934 women who lift weights for exercise, those lifting more than 50 kg didn't report more prolapse symptoms; women lifting 15 kg or less were more likely to, and a survey can't show cause and effect, since women with symptoms may already have cut back. A 2023 review of strenuous exercise came down the other way: single hard sessions increased vaginal descent or symptoms for a while, symptoms were most common in Olympic weightlifters and powerlifters (up to 23%), and it concluded that strenuous exercise increased symptoms and reduced pelvic floor support.
Lifetime hard activity wasn't linked with prolapse in a study of middle-aged women, and in 47,674 UK women followed for 8 years, moderate and vigorous activity weren't linked with developing a prolapse, apart from vigorous activity after a hysterectomy. So the UK advice is a sensible precaution while you have symptoms, not a proven rule, and not a ban for life.
NHS pelvic health physiotherapists list these as generally safe, and POGP suggests the same kinds of exercise:
The usual UK guidelines apply: build towards 150 minutes a week of moderate activity, such as brisk walking, plus strength exercises on 2 days, choosing low-impact forms. Moderate means you can talk but not sing.
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The Royal Berkshire service says: "Once your pelvic floor is strong with good endurance, you may trial other exercises, but you must stop if symptoms worsen." POGP says that if your usual exercise makes your symptoms worse, seek advice on how to change it or try a different activity. POGP adds that many women find they can be more active with a well-fitted pessary, and the UK return-to-running guideline suggests one can help a return to running.
Our suggestion: after several months of regular pelvic floor training, once everyday life causes no symptoms, try one harder activity at a time, at a low level, and drop back if you feel heaviness, dragging or a bulge, or you leak, during or after it. For running, the checks in the UK return-to-running guideline make a sensible bar, including 30 minutes of walking, jogging on the spot for a minute, 10 forward bounds and 10 hops on each leg, with no pain, heaviness, dragging or leaking. A pelvic health physiotherapist can help you plan it.
Tighten your pelvic floor before each lift, and breathe out as you lift rather than holding your breath (our suggestion). POGP says it's not only the weight that can bring on symptoms: frequent or repeated bending and lifting can too, so split loads into smaller ones. The Royal Berkshire service suggests avoiding heavy boxes and heavy baskets of wet laundry.
Build towards 150 minutes a week at a talk-but-not-sing effort, as the NHS advises, and stay seated on a bike. The recumbent bike and elliptical trainer pages' dose is 10 to 20 minutes at a moderate effort to start, building towards 30. The step jack is the no-jump version of a jumping jack, for circuits and classes.
3D demoTreadmill walkingBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoElliptical trainerBeginner · Cardio machine
Front crawl (freestyle swimming)Intermediate · Other / check instructions
3D demoStep jack (low-impact jumping jack)Beginner · No equipment2 or 3 times a week with light loads: squeeze your pelvic floor before each effort and breathe out as you work. Our starting point is 2 sets of 8 to 15; the side-lying tummy draw-in page's dose is up to 10 holds of up to 10 seconds. The prolapse strength workout below puts them together.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoGlute bridgeBeginner · No equipment
3D demoClamshellBeginner · No equipment
3D demoSide-lying tummy draw-inBeginner · No equipment
3D demoBird dog, one limb at a timeBeginner · No equipment
3D demoBand rowBeginner · A band + An anchor point
3D demoWall push-upBeginner · A wall
3D demoFarmer's carryBeginner · A dumbbell + A kettlebellWhile you have symptoms, and until a pelvic health physiotherapist has given you an individual plan.
Jogging, sprints, skipping, jumping jacks, burpees, box jumps, hops and bounds, and trampolining. POGP counts any activity where both feet leave the ground at once as high impact. Swap them for fast walking, a cross-trainer or step jacks.
Heavy deadlifts, kettlebell swings, heavy squats, the leg press, Olympic lifts and heavy carries. Lighter versions, with the knack and breathing out, are a later step to plan with a pelvic health physiotherapist.
The Royal Berkshire service advises avoiding deep squats, because the pelvic floor is vulnerable in that position: deep squat holds, Cossack squats, wide plié squats and pistol squats. Shallow squats to a chair are fine.
Source 8
Crunches, sit-ups, bicycle crunches, V-ups, and Pilates moves that curl you up, such as the hundred and the roll-up. Use the side-lying tummy draw-in or the bird dog instead, and keep any small curl-up small, stopping if it brings on heaviness (our suggestion).
Source 8
Holding your breath and bearing down as you lift or push, and long spells of standing still, which tend to make symptoms worse.
The prolapse strength workout is built for a prolapse. Despite its title, the pregnancy Pilates workout suits anyone with a prolapse: it has seated, side-lying and all-fours work and no crunches. In the dance workout, keep the plié squats shallow or skip them. After a prolapse repair, the exercises after a hysterectomy routine fits the first 6 weeks. Leave out high-intensity interval, jumping and heavy barbell workouts for now (our suggestion, following the NHS advice).
A 25-minute strength workout for a pelvic organ prolapse: pelvic floor squeezes, sit-to-stands, push-ups, rows, bridges and side-lying work, with no jumping or crunches.
25 minBeginner12 movesA bench or box, A wallA 5-minute daily pelvic floor workout for women and men: slow holds and quick squeezes, three times a day, with how to find the right muscles.
5 minBeginner2 movesNo equipmentAn 8-minute routine for a tight pelvic floor: slow breathing and comfortable positions to help the muscles let go, with no strengthening squeezes.
8 minBeginner5 movesFirm cushionA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA steady bike ride for a first triathlon or fitness: 5 to 10 minutes easy, a ride you can talk through, optional short faster bursts and an easy cool-down.
45 minBeginner4 movesCardio machine, A wallA 30 to 45-minute beginner pool swim: a shoulder warm-up on the side, easy lengths, a main set of repeats with rests, and an easy swim down, any stroke.
35 minBeginner5 movesOther / check instructionsA 20-minute Pilates workout for any trimester: seated, standing, all-fours and side-lying moves, with no lying on your back or front and no jumping.
20 minBeginner15 movesA wall, A bench or boxA 35-minute no-jump dance workout to music: marching, step-touches, step jacks, punches, step-ups and pliés, then trunk and pelvic floor work and a cool-down.
35 minBeginner14 movesA wall, A stepA gentle 15-minute routine for the first 6 weeks after a hysterectomy: circulation and breathing, pelvic floor and deep tummy exercises, then a daily walk.
15 minBeginner11 movesCardio machineThe women's plans build in daily pelvic floor exercises; use this guide's swaps for jumping, intervals and heavy lifts. The walking plan builds to 150 minutes a week.
A weekly workout plan for women: three strength days, cardio and pelvic floor training, with the evidence on periods, pregnancy and menopause.
3 training days45 minBeginner3 days a weekA weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginner6 days a weekA free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner5 days a weekA postpartum workout plan from the first days after birth to running and lifting again, week by week, with a caesarean track and readiness checks.
5 training days25 minBeginnerA pessary is a device, often a ring, that sits in the vagina to support its walls. A clinic fits it, and you may need more than one fitting to find the right one. NICE says it can be used on its own or with supervised pelvic floor training. It only helps while it's in place, it doesn't cure the prolapse, and it can sometimes cause new leaking.
POGP's leaflet says: "You should be able to continue exercise with a pessary. Many women find they can be more active once they have a correctly fitted device in place." A well-fitted pessary shouldn't fall out when you exercise, though it can move. Keep doing your pelvic floor exercises with it in. Some women wear a pessary only for the activities that bring their symptoms on. No trial has tested exercise outcomes with a pessary.
In a Cochrane review of 4 trials with 478 women, a pessary plus pelvic floor training probably helped more women feel their prolapse had improved than training alone (one trial of 260 women; moderate certainty). Pessaries caused more side effects than training (low certainty), and whether a pessary helps more than no treatment, or than training alone, is uncertain.
Source 16
In the TOPSY trial of 340 women, learning to look after your own pessary, with a 30-minute teaching session, a leaflet and a helpline, worked as well as clinic care for quality of life at 18 months, and still did at 4 years, when complications were no more common and it cost less.
NICE says a pessary should be removed at least once every 6 months; your clinic will tell you how often to change or clean yours. See the clinic for bleeding, pain or a smelly discharge, or if it keeps falling out. If it gets stuck, contact the clinic, your GP or the nearest accident and emergency (A&E) department.
UK advice after a prolapse repair varies: the RCOG's timeline is quicker than POGP's, and your own team may give you different timings. Both start with walking and pelvic floor exercises. Our hysterectomy guide has a routine for the first 6 weeks after gynaecological surgery.
The RCOG says there's no evidence that normal levels of physical activity are in any way harmful, and that a regular, gradual build-up of activity helps your recovery. Its guide:
Source 11
POGP's booklet for major gynaecological surgery is more cautious:
Source 12
In a trial of 108 women after prolapse surgery, those told to return to activity at their own pace, with no limits on lifting or high-impact exercise, were as satisfied (98% against 94%) and had the same examination results at 3 months as those told to avoid heavy lifting and strenuous exercise, with fewer prolapse and bladder symptoms. A review of 5 trials with 434 women agreed. The long-term effects haven't been tested. In a study of 466 women, just over half were inactive before surgery and 3 months after it, and the timing of starting exercise made no difference to symptoms.
In the OPTIMAL trial of 374 women, adding pelvic floor training before and after vaginal prolapse surgery didn't improve bladder symptoms at 6 months or prolapse symptoms at 2 years. The RCOG still advises carrying on with the exercises, before and after surgery.
The RCOG says about 25 to 30 in every 100 women who have prolapse surgery develop another prolapse, more often with a higher weight, constipation, a long-standing cough or heavy physical activities.
Source 7
The UK return-to-running guideline advises against running before 3 months after a birth, or later if you have pelvic floor symptoms such as heaviness, dragging or a bulge; this timing is expert opinion. If a prolapse is found, it suggests a pessary may help you return to running. Our postpartum guide covers the checks and the timing.
Source 13
NICE recommends considering vaginal oestrogen for women with a prolapse and vaginal dryness or other menopausal changes in the vagina: ask your GP. Pelvic floor training helps in the same way at any age. Our menopause guide covers exercise through the menopause.
Sit fully on the toilet with your feet on a footstool, and don't strain. Drink about 1.5 to 2 litres a day and eat more fibre. The NHS suggests gentle exercise like walking to help avoid constipation.
NICE suggests advice on losing weight if your body mass index (BMI) is over 30, though its later review found no effect of weight loss on prolapse symptoms. Our weight loss guide covers how.
A persistent cough strains your pelvic floor, so get it treated, and if you smoke, stopping helps. Squeezing your pelvic floor before you cough or sneeze helps too.
POGP says: "Having sex with a prolapse is safe and will not damage or make the bulge worse."
Source 2
Break up long spells of standing, and lie down for a while if your symptoms build up later in the day.
This is general information, not a diagnosis. In the US, call 911 where this page says 999.
The NHS says see a GP if:
Source 1
In many areas you can refer yourself. See one if the exercises are hard to do, if your symptoms haven't improved after about 3 months of regular practice, or before you go back to running, jumping or heavier lifting.
Stop, drop back to an easier level and rest if you feel heaviness, dragging, pressure or a bulge, or you leak, during or after an activity. If you see or feel a bulge when you squeeze, stop the pelvic floor exercises and get help.
See your clinic for bleeding, pain or a smelly discharge, or if your pessary keeps falling out. If it's stuck, contact the clinic where it was fitted, your GP or the nearest A&E.
The RCOG says to seek medical advice for:
Source 11
Chest pain, shortness of breath or coughing up blood can mean a clot in the lung: the RCOG says seek medical help immediately.
Call 999 (911 in the US) for chest pain, severe difficulty breathing or someone who collapses during or after exercise. Our heart disease guide lists the signs.
Source 11
Numbness around your genitals or bottom, or suddenly not being able to pee or control your bladder or bowels, needs urgent help: our pelvic floor guide lists these signs and what to do.
The UK advice is to avoid heavy lifting and running while you have symptoms and until you've had individual advice, and it's expert opinion. NHS pelvic health physiotherapists say that once your pelvic floor is strong you may try other exercise, stopping if symptoms get worse, and POGP says you should be able to exercise with a well-fitted pessary. Studies of hard exercise disagree on whether it worsens prolapse.
They usually ease the symptoms rather than make the prolapse disappear, and the benefit in trials was modest and mainly short term. The RCOG says they "may not get rid of your prolapse but are likely to improve your symptoms".
Childbirth was the main factor in most studies, and lifetime hard activity wasn't linked with prolapse in middle-aged women. NICE lists lack of exercise among the risk factors for pelvic floor problems and says physical activity can help prevent them. Whether very heavy or high-impact training adds risk is unsettled.
In small trials, it added nothing to pelvic floor training, and on its own it helped less.
POGP's answer to this question is "No. You should be able to continue exercise with a pessary."
Source 10
POGP says sex with a prolapse is safe and won't damage it or make the bulge worse.
Source 2
POGP says it can happen to any woman, even if she hasn't had children, and after a hysterectomy the top of the vagina can drop.
Daily pelvic floor exercises come first: NICE suggests a supervised programme of at least 16 weeks for a mild prolapse. For general fitness, choose low-impact exercise such as walking, swimming, cycling while seated, a cross-trainer, and Pilates or yoga with any uncomfortable positions adapted, plus gentle strength training while you watch your symptoms. Squeeze your pelvic floor before you lift or strain.
They can ease the symptoms, though they usually don't make the prolapse disappear. In the POPPY trial of 447 women, one-to-one training reduced symptoms more than advice alone at 12 months, and pooled trials show benefits in the short term. A pessary or surgery are other options, and you can use pelvic floor exercises alongside them.
Months, not weeks. NICE recommends at least 16 weeks of supervised training, and POGP says to expect an improvement in 3 to 5 months. Once they help, keep going once a day to hold on to the improvement.
For now, UK advice is to avoid heavy lifting, running, jumping and trampolining, and one NHS physiotherapy service adds deep squats, deadweight lifts such as deadlifts, and abdominal crunches. Drop back from anything that brings on heaviness, dragging or a bulge. These limits are expert advice rather than trial results, and a pelvic health physiotherapist can help you plan a return.
UK guidance says to avoid running for now if you have a prolapse. Some women go back to running once their pelvic floor is strong, building up slowly and stopping if symptoms come back, often with a pessary fitted. Get a pelvic health physiotherapist's assessment first, and after a birth wait at least 3 months.
The NHS advises avoiding heavy lifting with a prolapse, though NICE found no trials behind this advice. Whether lifting causes or worsens a prolapse is unclear: women who lift heavy weights didn't report more symptoms in a large survey, but a review found single hard sessions increased symptoms for a while. Use light weights, squeeze before each lift, breathe out as you lift, and ask a pelvic health physiotherapist before going heavier.
Shallow squats, such as sitting down on and standing up from a chair, are usually fine with a pelvic floor squeeze first. One NHS physiotherapy service advises avoiding deep squats, because the pelvic floor is vulnerable in that position. Stop if you feel heaviness or a bulge.
Yes. POGP says you should be able to carry on exercising with a pessary, a well-fitted one shouldn't fall out (though it can move), and you should keep doing your pelvic floor exercises. Some women wear a pessary only for the activities that bring their symptoms on. See your clinic for bleeding, pain or a smelly discharge.
That's typical: symptoms are often worse after a long day, after standing for a long time, or after lifting or straining, and they ease when you rest. It doesn't mean walking is harmful. Break long walks or spells of standing into shorter ones, lie down for a while if you need to, and keep up your pelvic floor exercises.
Yes, adapting any positions that feel uncomfortable. NICE says supervised exercise such as yoga may help alongside supervised pelvic floor training. Leave out moves that curl you up or make you bear down if they bring on heaviness.
Walk from the day you get home and build up. The RCOG advises light loads only for the first month, nothing heavy or strenuous until 4 to 6 weeks, and contact or power sports from 6 weeks, while POGP advises waiting at least 3 months for high-impact exercise and competitive sport. In trials, women told to return at their own pace did as well at 3 months as those told to hold back, but your surgical team's advice comes first.
Not more than pelvic floor training. In small trials, adding hypopressive exercise to pelvic floor training made no extra difference, and hypopressives on their own helped less. Stick with pelvic floor training as the main exercise.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
