Pelvic Organ Prolapse in Athletes: A Hidden Performance Barrier

At our pelvic floor physical therapy clinic, we’re seeing more high-performing athletes—runners, lifters, and gymnasts--struggling with symptoms they never expected: pelvic pressure, heaviness, or a feeling of bulging. These aren’t sedentary individuals or newly postpartum moms alone—these are high-performing, strong, capable athletes dealing with pelvic organ prolapse (POP).

Prolapse doesn’t discriminate by fitness level. In fact, athletes can be at higher risk due to the unique demands their bodies face. Understanding how prolapse affects high-performance individuals—and how to manage it—can make the difference between sidelining symptoms or sidelining the athlete.

Why Does Prolapse Happen in Fit Bodies?

Pelvic organ prolapse occurs when the pelvic organs descend into the vaginal canal due to weakened or overloaded support structures. While often associated with childbirth or aging, athletes are at risk due to:

• High intra-abdominal pressure (IAP): Heavy lifting, bracing, jumping, and high-intensity training all spike IAP. When unmanaged, it strains the pelvic floor.

• Core imbalances: Many athletes overtrain their outer core while neglecting the deeper stabilizers like the pelvic floor and transverse abdominis.

• Under-recovered tissues: Intense training with poor recovery can lead to tissue fatigue and fascial compromise.

• Postpartum return to sport: Returning to intense exercise too soon can overload a healing pelvic system.

Recognizing Prolapse in Athletes

Symptoms vary, but can include:

• A sensation of vaginal pressure or bulging during or after activity

• Lower back or pelvic aching after intense workouts

• Urinary leaking or urgency during jumping or running

• Difficulty with core engagement or pelvic instability

These signs often show up during movement, not at rest—so athletes might not connect symptoms with pelvic floor dysfunction right away.

Assessment: It’s More Than Lying on a Table

At our clinic, we assess prolapse dynamically—in motion, under load, and in the context of the athlete’s sport. This might include:

• Postural and breathing assessment under load

• Observation during squats, jumping, or lifts

• Internal exam (if appropriate) to assess prolapse grading and pelvic floor coordination

This functional approach gives us a real-world picture of what’s happening—not just a static measurement.

Treatment Isn’t About Stopping—It’s About Strategizing

Athletes don’t want to be told to stop doing what they love. Our approach focuses on load management and pressure control:

• Training the pelvic floor to work with breath and movement, not against it

• Modifying techniques temporarily (e.g., box jumps instead of double-unders, lighter lifts with better exhalation strategies)

• Building progressive tolerance to impact and load

• Integrating full-body strength and mobility to offload excessive pelvic strain

We also coordinate with coaches, trainers, and medical providers when needed, to support a return to sport with confidence—not fear.

Conclusion

Prolapse is not the end of performance—it’s a call for recalibration. With tailored pelvic floor physical therapy, athletes can regain control, strength, and resilience. Whether you’re lifting barbells or chasing a finish line, your pelvic health shouldn’t be your weakest link.