Pelvic Organ Prolapse
Hair, Skin & Nail
That 'Falling Out' Feeling: A Guide to Pelvic Organ Prolapse
That heavy, dragging, or “something is falling out” sensation in your vagina isn’t in your head. It’s the classic sign of Pelvic Organ Prolapse (POP) — a deeply distressing but common condition in perimenopause.
POP happens when the supportive “hammock” of muscles and tissues that holds your pelvic organs (like the uterus, bladder, or rectum) in place starts to weaken.
As that support gives way, one or more of these organs can begin to bulge or drop into the vaginal canal.
What’s Happening in Your Body? Your pelvic floor is made of muscles and connective tissues (fascia) that rely on estrogen and collagen to stay strong and flexible. During perimenopause:
Estrogen declines, which slows down the body’s ability to produce collagen.
The fascia becomes weaker and less springy, like a stretched-out rubber band.
Combined with strain from childbirth, constipation, or heavy lifting, the support system can begin to fail — resulting in prolapse.
Actionable Tips for Pelvic Support:
See a Pelvic Floor Physical Therapist: This is the #1 most important step. A trained PT can help assess what kind of prolapse you’re dealing with and create a personalized plan to restore strength and support (it’s much more than just Kegels!).
Master Your “Core Breath”: Learn how to engage your diaphragm when breathing. When you inhale, your belly and ribs should expand. When you exhale, your pelvic floor gently lifts — building strength without strain.
Try This: Drink plenty of water and eat fiber-rich foods to avoid constipation. If you’re straining to poop, use a stool like a Squatty Potty to elevate your knees and relax the pelvic floor.
Avoid Straining: Pressure from chronic constipation or incorrect lifting can worsen prolapse.
Try This: Always exhale as you lift — and never hold your breath when lifting anything heavy.
The 'Knit Your Muscles' Visualization for a Better Kegel
Many women do Kegels incorrectly, bearing down instead of lifting up, which can make prolapse worse. This visualization can help you connect to the right muscles in the right way.
Why it Works:
It helps you engage the full length of the pelvic floor muscles in a gentle, supportive lift rather than an isolated clench.
How to do it:
- Sit comfortably with your feet flat on the floor. Imagine the four bony points of your pelvic floor: your pubic bone in the front, your tailbone in the back, and your two sit bones on either side.
- As you exhale, imagine you are gently “knitting” those four points together. Visualize them drawing inwards and upwards toward the center of your body.
- Think of the feeling of gently sipping a thick milkshake through a straw, or picking up a small blueberry with your vaginal opening. The feeling should be a gentle, internal lift, not a hard squeeze of your glutes or abs.
- As you inhale, feel everything relax and lower back down completely. The relaxation phase is just as important as the lift.
Collagen, Elastin, and Fascia: The Science of Your Pelvic Support System
The pelvic floor isn’t just made of muscle. It’s held together by an intricate network of connective tissue, especially collagen and elastin, that acts like scaffolding to keep your organs in place.
Here’s what each does:
- Collagen provides strength and structure — think of it like the beams of a house.
- Elastin provides stretch and recoil — like the waistband of yoga pants.
- Estrogen is essential for producing both.
- But during perimenopause:
- Estrogen declines
- Collagen production slows
- Fascia becomes less elastic and more prone to sagging or strain
- If your fascia is already weakened from childbirth or chronic pressure (like years of straining on the toilet), these changes can compound, making prolapse more likely or more severe.
- Strengthening your pelvic muscles helps — but if fascia isn’t strong enough to hold everything in place, you’ll also need strategies to rebuild the whole support system.
This article is intended to inform and empower, not to replace personalized medical advice. If you have any concerns about your health, please speak with your doctor or a qualified healthcare provider.
