My prolapse is not too bad, should I just wait?….

prolapsepreventative pelvic healthpessaryrunning

25 June

Don't Wait Until Your Prolapse Gets Worse: Why Prevention Is the Future of Pelvic Health

"My prolapse isn't that bad... should I just wait?"

It's one of the most common questions I hear in the clinic.

Many women come to see me after having children because they're beginning to notice a feeling of heaviness during a long run, after carrying their children all day or towards the end of a busy afternoon.

Often, when I examine them, I'm surprised by how little prolapse is actually present.

Their symptoms are real.

But the structural changes are often mild.

This raises an important question.

If the prolapse is mild, should we simply wait until it becomes worse before doing something about it?

My answer is usually no.

A New Way of Thinking About Pelvic Health

For many years, pelvic organ prolapse has been managed in a reactive way.

Women are often told:

"Come back if it gets worse."

"Stop running."

"Avoid heavy lifting."

"We'll think about surgery later."

While these recommendations are sometimes appropriate, they often overlook an important opportunity.

What if we could support the pelvic floor before symptoms became severe?

What if we viewed pelvic health the same way we think about dental health or bone health?

We don't wait until every tooth needs removing before we start brushing.

We don't wait until someone breaks a hip before encouraging strength training.

Pelvic health deserves the same preventative approach.

Symptoms Don't Always Match What We See

One of the fascinating aspects of pelvic health is that examination findings and symptoms don't always tell the same story.

I've assessed women with significant prolapse who have very few symptoms.

I've also met women with only minimal anatomical changes who feel considerable heaviness while running or standing for long periods.

Why?

Because symptoms are influenced by much more than anatomy alone.

They also depend on:

Hormonal changes
Connective tissue health
Muscle endurance
Training load
Fatigue
Previous childbirth injuries
Bladder and bowel function
The amount of time you've spent on your feet that day

This is why pelvic health assessment is about understanding the whole person, not simply measuring the position of the bladder or uterus.

The Window of Opportunity

One of my favourite conversations to have is with women in their thirties and early forties.

They've finished having children.

They're returning to running.

They're lifting weights.

They're chasing toddlers.

Life is busy.

Symptoms may be mild, but they're beginning to notice small changes.

This is not bad news.

It's actually an opportunity.

At this stage, we can often influence the next several decades of pelvic health through relatively simple strategies.

Rather than waiting for symptoms to progress, we can focus on protecting the tissues that are already working incredibly hard.

Movement Is Not the Enemy

One of the biggest misconceptions surrounding prolapse is that women should avoid high impact exercise forever.

As a physiotherapist—and as someone who loves running myself—I find this message concerning.

Running improves:

Cardiovascular health
Bone density
Muscle strength
Mental wellbeing
Longevity
Confidence

Removing these benefits may create new health problems while solving only part of the pelvic floor problem.

Instead, I prefer asking a different question.

How can we help women continue doing what they love?

That answer might include:

Improving pelvic floor muscle function
Optimising whole-body strength
Cross-training
Managing internal pelvic pressures and adjusting training load
Supporting recovery
Improving tissue health
Using a pessary during higher-impact activities when appropriate

The goal isn't to stop women moving.

The goal is to help them move well.

Sometimes Small Supports Make a Big Difference

Many women assume that using a pessary means their prolapse must be severe.

In reality, pessaries can be thought of as supportive equipment—much like wearing a supportive sports bra or appropriate running shoes.

For some women, wearing a pessary only during longer runs provides enough additional support to continue training comfortably.

Others choose to wear one more regularly.

The decision is highly individual and should be guided by symptoms, lifestyle and personal goals rather than prolapse stage alone.

Hormones Matter More Than Most Women Realise

Another important aspect of preventative pelvic health is recognising the influence of hormones.

Many women notice changes while breastfeeding.

Others begin experiencing symptoms during perimenopause.

Reduced oestrogen may contribute to:

Vaginal dryness/ sexual discomfort
Tissue sensitivity
Recurrent infections- UTI/ thrush or even BV
Bladder irritation/ urgency/frequency
A greater awareness of pelvic heaviness

Sometimes the prolapse itself hasn't changed at all.

The tissues have simply become more sensitive.

Understanding this distinction allows treatment to address tissue health as well as muscle function.

Preventing Compensation

One of the hidden risks of ignoring mild symptoms is the way women naturally begin changing their behaviour.

Without realising it, they may:

Stop running
Avoid lifting weights
Give up jumping
Reduce walking distances
Avoid carrying their children
Limit sexual activites/ ignore changes in arousal response and climax
Lose confidence in their bodies

Over time, these changes may lead to reduced strength, lower bone density, poorer cardiovascular fitness, loss of sexual confidence/pleasure and increasing fear of movement.

Ironically, these compensations may create bigger long-term health consequences than the prolapse itself.

Prevention Is About Preserving Options

My goal as a pelvic health physiotherapist isn't simply to reduce symptoms today.

It's to help women continue living the lives they want for the next twenty or thirty years.

That means preserving the ability to:

Run with friends
Lift grandchildren
Hike on holidays
Exercise through menopause
Maintain bone strength
Stay independent and active as they age

Sometimes prevention looks like pelvic floor rehabilitation.

Sometimes it involves strength training.

Sometimes it involves local vaginal oestrogen.

Sometimes it involves a pessary.

Most often, it involves a thoughtful combination of strategies tailored to the individual woman.

The Matremaga Philosophy

At Matremaga Physiotherapy, we believe pelvic health isn't simply about treating problems when they become severe.

It's about recognising early signs, understanding why they're happening and giving women the knowledge and confidence to make informed decisions before those symptoms begin limiting their lives.

Pelvic health isn't about asking women to stop doing the things they love.

It's about helping them continue doing those things for as long as possible.

Because prevention isn't about preparing for old age.

It's about protecting the life you want to keep living.

—

Melinda Sandon
Principal Physiotherapist
Matremaga Physiotherapy

Support for Every SeasonUnderstanding the Hidden Emotional Impact of Bowel Urgency and Faecal Incontinence

One of the most difficult conversations I have in the clinic often begins with the same sentence.

"I know it probably doesn't sound like a big deal, but..."

Then a woman tells me about the bowel accident she had.

Sometimes it happened last week.

Sometimes it happened five years ago.

Sometimes it only happened once.

Yet despite the time that has passed, the memory remains vivid.

Not because of the physical event itself, but because of what it took away.

Confidence.

Spontaneity.

Trust in their body.

The freedom to leave the house without planning every toilet stop.

The confidence to go for a walk, attend a social event or book a holiday.

The ability to stop thinking about their bowel every waking minute.

More Common Than Most Women Realise

Bowel urgency and faecal incontinence remain some of the least discussed consequences of pelvic floor injury, childbirth trauma, bowel surgery and pelvic floor dysfunction.

Women will often tell their physiotherapist something they have never told a partner, friend or even their doctor.

Not because the symptoms are rare.

Because they are embarrassed.

Many have spent years quietly adapting.

Sitting near exits.

Carrying spare underwear.

Avoiding long walks.

Declining invitations.

Learning every toilet location in a shopping centre.

What looks like good coping from the outside is often a life becoming gradually smaller.

The Constant Mental Load

One of the most challenging aspects of bowel urgency is that the symptoms are unpredictable.

Many women describe feeling completely well most of the time.

Then one day they experience overwhelming urgency with only seconds to respond.

The accident may be minor.

The emotional impact rarely is.

Afterwards, the mind naturally begins asking questions:

"What if that happens again?"

"What if I'm not at home next time?"

"What if I'm travelling?"

"What if there isn't a toilet nearby?"

Over time, these thoughts can create a state of constant vigilance.

Many women become experts at risk assessment.

They know where every toilet is.

They monitor what they eat.

They avoid unfamiliar situations.

They stop exercising.

They stop travelling.

Not because they want to.

Because they no longer trust their body.

Understanding What Is Happening

It is important to understand that bowel urgency is not always a simple muscle weakness problem.

Continence depends upon several systems working together:

Healthy anal sphincter muscles
Pelvic floor support
Normal rectal sensation
Appropriate stool consistency
Effective communication between the bowel and nervous system

When one or more of these systems is disrupted, warning signals may become less reliable.

Some women experience reduced strength.

Others experience altered sensation.

Some experience both.

This is why two women with similar birth injuries may have completely different symptoms.

There Is Hope

One of the most important things I tell women is this:

A setback does not mean you are back at the beginning.

Many women come to an appointment devastated because they have experienced a single accident after months of progress.

They assume something has gone wrong.

Often it hasn't.

Recovery is rarely linear.

There are good weeks and difficult weeks.

There are fluctuations related to stress, illness, hormones, diet and life circumstances.

One difficult day does not erase months of progress.

The Goal Is Bigger Than Continence

When we work together in pelvic health physiotherapy, the goal is not simply to reduce accidents.

The goal is to rebuild confidence.

To help you feel safe leaving the house.

To trust your body again.

To travel.

To exercise.

To say yes to opportunities without first checking where the nearest bathroom is located.

Continence is important.

But confidence is life-changing.

If This Sounds Familiar

Please know you are not alone.

These conversations happen in my treatment room every week.

They are common.

They are valid.

And they deserve support.

There are effective treatment options available, including pelvic floor rehabilitation, bowel management strategies, electrical stimulation, dietary modification and behavioural retraining.

Most importantly, there is hope.

Your life does not need to become smaller because of your bowel symptoms.

With the right support, many women regain not only better control, but the confidence to fully participate in life again.