Pelvic floor exercises for prolapse: a 16-week plan for women
Pelvic floor exercises can ease the symptoms of a mild to moderate prolapse: the bulge, heaviness and dragging feeling. The core is a slow squeeze and lift, held up to 10 seconds, repeated about 10 times, three times a day, plus a set of quick squeezes and "the Knack", a squeeze just before you cough, sneeze or lift. The UK's NICE guideline recommends at least 16 weeks of supervised pelvic floor training for prolapse that causes symptoms, and the large POPPY trial found it eased symptoms more than advice alone.
This guide covers what prolapse is, which exercises help, how to start lying down and build up, a week-by-week 16-week plan, everyday habits that take the load off, using exercises with a pessary, and when to see a doctor.
What pelvic organ prolapse is
Prolapse means one or more of the pelvic organs, the bladder, womb or bowel, has dropped down and is pressing into the vagina. It happens when the muscles and supporting tissue of the pelvic floor are stretched or weakened, often by childbirth, years of straining, a long-term cough, heavy lifting, extra weight, or the drop in estrogen at menopause. It's common: many women have some degree of prolapse after having children, and many don't know it.
| Type | What has dropped | Often felt as |
|---|---|---|
| Front wall (cystocele) | The bladder | A bulge, slow stream, needing to pee often, feeling you haven't emptied |
| Back wall (rectocele) | The rectum | Trouble emptying the bowel, needing to press near the vagina to open your bowels |
| Womb (uterine prolapse) | The womb and cervix | Heaviness, dragging, something "coming down", worse at the end of the day |
| Vault prolapse | The top of the vagina, after a hysterectomy | Bulge or heaviness |
Doctors grade prolapse by how far it has dropped, from stage 1 (a little) to stage 4 (outside the vagina). Exercises help most at the milder stages.
Do pelvic floor exercises help prolapse?
Yes, for many women. The research:
- The POPPY trial (Hagen and colleagues, The Lancet, 2014) followed 447 women with stage 1 to 3 prolapse. Women who had 16 weeks of one-to-one pelvic floor training with a physiotherapist, over five appointments, had fewer prolapse symptoms at 6 and 12 months than women given a leaflet on lifestyle advice.
- NICE (guideline NG123, 2019) recommends at least 16 weeks of supervised pelvic floor training for women with stage 1 or 2 prolapse that causes symptoms.
- IQWiG, the German health evidence institute, concludes that exercises can improve symptoms in mild and moderate prolapse and may sometimes stop it getting worse, but have a limited effect when the organs have already dropped a long way.
Exercises ease symptoms; they may not change how the prolapse looks on an exam. Women often say the bulge feels smaller, the heaviness comes later in the day or not at all, and leaks are fewer.
The exercises
1. Finding the right muscles
Sit or lie comfortably. Imagine you're stopping wind and stopping the flow of pee at the same time. Squeeze and lift those muscles up and in. Your belly, bottom and thighs stay soft and you keep breathing. Let go fully afterwards. With prolapse it matters that you lift: pushing or bearing down adds pressure on the organs. If you're not sure, see our guide on how to know if you are doing Kegels correctly for home checks.
2. Slow squeezes (strength)
- Squeeze and lift as above.
- Hold it, breathing normally. Start with what you can manage, even 3 seconds.
- Let go fully and rest for as long as you held, or longer.
- Repeat up to 10 times. Build toward 10-second holds.
3. Quick squeezes (speed)
Squeeze and lift quickly, hold for a second, let go fully. Up to 10 in a row. These help the muscles react fast when you cough or move.
4. The Knack (timing)
Squeeze and lift just before a cough, sneeze, laugh, lift or standing up, and hold it through the effort. Over weeks it becomes automatic. The Knack is the exercise most women notice first in daily life. Our guide on leaking when you sneeze or cough has practice drills.
5. Squeezes with hips raised
Lying on your back with a pillow under your hips, gravity helps the organs move back up a little. Many women find squeezes easier and more comfortable here, especially at the end of the day when heaviness is worst.
6. Bridge with a lift
Lying on your back, knees bent, feet flat. Breathe in. As you breathe out, lift your pelvic floor, then lift your hips off the floor. Hold for 3 breaths, lower, let go. 8 to 10 times. This links the pelvic floor to your bottom muscles, which you'll use in daily lifting.
Start lying down, then build up
Gravity pulls on a prolapse when you stand. That's why most women start exercises lying down, where the muscles don't have to fight it, then move to sitting and standing as they get stronger. Our guide to pelvic floor exercises lying down has four positions for bed.
A 16-week pelvic floor plan for prolapse
Three sessions a day, each about 3 to 5 minutes. Hold times are a goal, not a rule: go by what you can do with a full lift and a full let-go.
| Weeks | Position | Each session |
|---|---|---|
| 1 to 2 | Lying, hips on a pillow | Slow squeezes: hold 3 to 5 seconds, 8 to 10 times. Quick squeezes: 5. Practise the Knack before standing up. |
| 3 to 4 | Lying | Slow: hold 5 to 6 seconds, 10 times. Quick: 10. Knack before every cough and sneeze. |
| 5 to 6 | Lying and sitting | Slow: hold 6 to 8 seconds, 10 times. Quick: 10. Add the bridge with a lift, 8 times, once a day. |
| 7 to 8 | Sitting | Slow: hold 8 seconds, 10 times. Quick: 10. Knack before every lift. |
| 9 to 12 | Sitting and standing | Slow: hold 10 seconds, 10 times. Quick: 10. Bridge 10 times. Knack in daily life. |
| 13 to 16 | Standing, and during tasks | Slow: hold 10 seconds, 10 times. Quick: 10. A lift held while you carry shopping or pick up a grandchild. |
| After 16 | Any | Keep one full session a day, most days, and the Knack always. |
If a stage feels too hard, stay on it another week. If heaviness is worse after a session, rest a day, drop back a stage, and check you're lifting rather than pushing.
For a full daily routine that includes these and a keep-up plan, see our pelvic floor exercise routine for women, and for adjustments for knees, hips and backs, pelvic floor exercises for women over 50.
Everyday habits that take the load off
- Don't strain on the toilet. A stool under your feet, lean forward, breathe out gently. Treat constipation with fiber, fluids and movement. If you have a back-wall prolapse, your doctor may show you how to support the area with your fingers to empty.
- Lift with a breath out and the Knack. Bend your knees, hold the load close, squeeze and lift your pelvic floor, breathe out as you stand. Don't hold your breath.
- Treat a long-term cough. Every cough pushes down on the pelvic floor. Ask your doctor about a cough that won't go, and if you smoke, stopping helps.
- Weight. If you're carrying extra weight, NICE suggests losing some, as it lowers the pressure on the pelvic floor.
- Pace your day. Heaviness often builds by evening. A 10-minute lie-down with hips raised in the afternoon can help.
- Exercise choice. Walking, swimming, cycling and low-impact strength work are usually fine. Running, jumping and very heavy lifts can bring on symptoms; build up slowly and check with a pelvic floor physiotherapist.
Exercises with a pessary
A pessary is a small silicone device placed in the vagina to hold the organs up. It's a common first treatment for prolapse, alongside exercises or instead of surgery. Many women find exercises easier to feel with a pessary in, because the organs are supported. You can do the same plan with a pessary in place. Your doctor or nurse will check it at regular visits.
Exercises after prolapse surgery
Follow your surgeon's advice on when to start. Studies have not shown that exercises after surgery improve the result, but many surgeons still suggest gentle pelvic floor work once healing allows, especially for leaks, and the habits above (no straining, careful lifting, treating constipation) matter after surgery too.
Exercises to avoid at first
- Sit-ups, crunches and full planks that make you bear down or hold your breath.
- High-impact moves: jumping, skipping, running, until your floor can hold up to them.
- Heavy lifting with a held breath.
- Deep squats with heavy weights.
- Anything that makes the bulge or heaviness feel worse during or after.
Many of these can come back later, with a strong pelvic floor and good breathing. A pelvic floor physiotherapist can help you return to the exercise you enjoy.
Signs the exercises are working
- The heaviness or dragging feeling comes later in the day, or less often.
- The bulge feels smaller or you notice it less.
- Fewer leaks when you cough or lift.
- Your squeezes feel stronger and you can hold longer.
- Emptying your bladder or bowel is a little easier.
Some women notice changes within 3 to 4 weeks; for others it takes months. Give it the full 16 weeks before judging it.
When to see a doctor
See a doctor if you feel a bulge, heaviness or dragging; there are treatments beyond exercise. See one soon if you have:
- A bulge that's outside the vagina, sore, or bleeding.
- Trouble emptying your bladder, or you can't pee.
- Repeated bladder infections.
- Bleeding after menopause.
- Exercises that make things worse, or no change after 16 weeks.
Ask for a referral to a pelvic floor physiotherapist. NICE recommends supervised training because many women don't lift correctly without a check.
Frequently asked questions
Can pelvic floor exercises reverse a prolapse?
They can ease symptoms and may stop a mild prolapse getting worse, but they don't always change how far the organs have dropped. Severe prolapse usually needs a pessary or surgery.
How long does it take for pelvic floor exercises to help prolapse?
Some women notice a change in 3 to 4 weeks. NICE suggests at least 16 weeks of training, and the POPPY trial ran for 16 weeks.
Are Kegels good for a prolapsed bladder?
Yes, a correct Kegel (lift, not push) is the base of exercise for a front-wall prolapse. Add the Knack and the habits above.
Can I walk with a prolapse?
Yes. Walking is usually fine and good for you. If heaviness builds on long walks, shorten them and build up.
What makes prolapse worse?
Straining on the toilet, a chronic cough, heavy lifting with a held breath, high-impact exercise, and extra weight all add pressure.
Should I do exercises lying down?
Starting lying down is easiest, especially with your hips on a pillow. Move to sitting and standing as you get stronger.
Start tonight with your hips raised
Tonight, lie with a pillow under your hips and do 8 slow squeezes, lifting up and in, letting go fully each time. To see in a minute why so many women find Kegels don't help, and what a daily plan built up week by week looks like, take the free 1-minute check. For more on leaks, urges and the pelvic floor after 40, see all our pelvic floor guides.
Sources: NICE guideline NG123, Urinary incontinence and pelvic organ prolapse in women: management, 2019. Hagen S. et al., Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial, The Lancet, 2014. Informed Health (IQWiG), Pelvic floor exercises and vaginal pessaries for pelvic organ prolapse. NHS, Pelvic organ prolapse. Mayo Clinic, Prolapsed uterus. Cleveland Clinic, Pelvic organ prolapse. Pelvic Exercises (Michelle Kenway, physiotherapist), Exercises for prolapse. This guide is education, not medical advice.