Why Does Prolapse Happen? Turns Out, Your Pelvic Floor Has Receipts

Written By Jillaine Wall
 
 

If you’ve recently been introduced to the word “prolapse,” (ahem… in the previous blog post) you might also be having a WTF moment and thinking:

Why does prolapse happen?

Did I lift too much? Was it childbirth? Is this my punishment for eating that block of cheese in university and then having to push too hard when I pooped in 2013? (No, by the way.)

Let’s take a deep breath and zoom out for a second. Prolapse is common, but it’s not necessarily random. Though there are reasons why you might be more prone to prolapse, it’s not your fault, and we can help. 

In this post, we’re going to dig into the why behind prolapse. And we’re doing it without blame, fear, or the usual “you should’ve done your Kegels” lecture.

First: A Quick Refresher — What’s a Prolapse Again?

In case you missed the first post in this series (no judgment — live your life), here’s the post on “What is prolapse?”. 

To sum up: pelvic organ prolapse happens when one or more of your pelvic organs (bladder, uterus, rectum) starts to descend or press into the vaginal space. That shift happens when the support structures — your pelvic floor muscles, ligaments, and fascia — aren’t able to hold or support these tissues as well as they used to.

This can be graded by varying degrees of descent into the vaginal canal or possibly out of the vagina entirely. With a higher degree of descent, symptoms are often, though not always, more prevalent and there is also a chance you could have a prolapse without even knowing it. 

So the big question is: why do those support systems weaken or stretch in the first place?

Let’s break it down.

1. Childbirth (But Not in the Way You Think)

Okay, yes — childbirth is one of the biggest contributors to pelvic organ prolapse. But let’s unpack that a little.

During pregnancy and delivery, your body does incredible things. Your uterus grows, your abdominal wall stretches to accommodate a small human, your pelvic floor softens to let that human pass through. That’s a hell of a feat, but it is not always without complication.

There are certain factors during this “miracle of life moment” that can put you at a higher risk of pelvic organ prolapse at some point postpartum through to menopause, and most are completely out of your control.

Risk factors for prolapse after birth:

  • Vaginal deliveries (especially if they involve prolonged or very fast labours)

  • Forceps or vacuum-assisted births

  • Very large babies

  • Pushing for a long time

  • Perineal tearing or episiotomies

  • Weak tissue recovery postpartum

BUT (and this is a big but) it’s important to understand that not everyone who gives birth has a prolapse, and not everyone with a prolapse has given birth. It’s not as simple as “you pushed a baby out, so here is your new pressurized pink friend.”

Your pregnancy and birth story (if you have one at all) are only part of this equation.

2. Chronic Pressure or Strain

Prolapse happens when the load on the pelvic floor outweighs the support it can offer. Both a heavy load and a consistently present load can cause these issues. And pelvic floor load? It doesn’t just come from babies.

Things that increase intra-abdominal pressure (a fancy way of saying “stuff that makes you bear down” or hold your breath when doing a task) can stretch and stress the pelvic floor over time:

  • Chronic constipation or straining to poop

  • Chronic coughing (think asthma, smoking, or other lung conditions)

  • Repetitive heavy lifting (especially with poor pressure management)

  • High-impact activities (running/jumping) over time or too early following birth or surgery

  • Holding your breath while lifting or bracing your core incorrectly

  • Obesity (increased pressure on the pelvic floor at rest and with movement)

All of these load your pelvic floor system. If you’ve got strong support structures, your body can handle that load. But if support is weak, mismatched, your muscles are poorly coordinated or overwhelmed? That’s when prolapse can start to show up.

3. Hormonal Changes

I’m talking about estrogen.

Estrogen keeps the vaginal walls thick, elastic, and well-lubricated. It also helps maintain the strength and integrity of connective tissue — think ligaments, fascia, and the muscles that support your organs.

As you can imagine, when estrogen levels drop — like during:

  • Postpartum

  • Breastfeeding 

  • Perimenopause

  • Menopause (whether natural or brought on post-surgery)

…those tissues become less plump (I know that’s a gross word, sorry) and overall less resilient. This results in less overall support and increases the inherent risk of prolapse and prolapse symptoms. It’s also grounds for worsening an already present prolapse. 

That’s why many people first notice a prolapse years after having kids, or when they stop breastfeeding and their period returns, or during menopause. It’s not always about the event — it’s about when your body no longer has the resources to keep compensating.

4. Genetics & Tissue Type

This part often gets overlooked, but it’s huge.

Some people have inherently stretchier tissue — we’re talking about connective tissue disorders like Ehlers-Danlos Syndrome, or just generally “bendy” types who can fold in half without trying. Flexible joints? Easy bruising? You might be more prone to prolapse simply because your tissues don’t rebound the same way.

It’s anything that’s within your control — it’s your genes. You didn’t do anything wrong. In the same way that you can’t control your eye colour or your height, this one is in nature’s court.

With heredity in mind, if your mom, sister, or aunt has prolapse? Yes, you might have a genetic predisposition. Again, it’s not a guarantee, just something that shifts your risk profile.

5. Surgical History or Injury

Past surgeries can affect pelvic support, especially if:

  • You’ve had a hysterectomy

  • You’ve had pelvic radiation or cancer treatments

  • You’ve had extensive abdominal surgery

  • You’ve had prior prolapse repairs or mesh placements

Removing the uterus, for example, changes the tension on the vaginal walls and can lead to vaginal vault prolapse later on. Surgeries can create scar tissue or alter muscular coordination of your core and pelvic floor.

Injury from trauma (including physical or sexual trauma) can also impact pelvic stability in a variety of different ways depending on injury severity or frequency. 

6. Posture, Breath, and Movement Patterns

This one may seem a bit woo woo on the surface but makes a HUGE difference. If you’ve heard me talk about the flower bloom breath, you’re on the right track. 

If you’re constantly clenching your abs, tucking your pelvis under, or breathing shallow into your chest (instead of down into your belly and pelvic floor - aka the flower bloom breath), your pelvic floor never gets to move through its full, functional range.

As you could imagine with any group of muscles, if you’re not moving through full range, you’re not able to get full strength.

Over time, poor breathing and movement patterns can result in poor load management and more strain on your pelvic floor.

In physiotherapy sessions, we often see:

  • Core over-recruitment (“sucking it in” or “holding a tight core” 24/7)

  • Butt-gripping or constantly clenching the glutes

  • Shallow chest breathing or holding breath during effort or lifting

These aren’t the cause of prolapse on their own — but they’re like low-level stress that accumulates over time and we can absolutely retrain them.

So... Which One “Caused” Your Prolapse?

Here’s the truth: it’s almost never one single thing.

Prolapse tends to be a perfect storm — a combination of load, support, genetics, life stages, and habits. Sometimes, it shows up years after the triggering event, when hormones shift or your body stops compensating, or your fitness goals or activity shift.

Believe it or not, that’s actually good news — because it means you aren’t stuck in a state of prolapse as a result of one single thing. We can change how you feel buy coming at it from different angles. 

We can:

  • Reduce unnecessary pressure

  • Rebuild support

  • Retrain movement patterns

  • Support hormones

  • Adjust lifestyle factors

Again… why does prolapse happen and how can we fix it? It’s not about fixing one broken thing. It’s about restoring balance to a system that’s been working overtime.

The Emotional Load: It’s Not Just Physical

Let’s not ignore the mental and emotional piece.

Prolapse can feel like your body let you down. It can bring up grief — especially if it affects your sex life, your workouts, or how you feel in your own skin.

You might feel shame. Embarrassment. Anger. Exhaustion.

Please know: those feelings are valid. But they’re not permanent. When we understand the why, we take back our power. We move from “what’s wrong with me?” to “what does my body need?” And in that, lies change. 

You Didn’t Cause This

…But you bet your pretty little sass you can improve it.

Let’s say that again for the people in the back: You didn’t cause this.

You didn’t fail by giving birth, or skipping a workout, or not doing enough Kegels. You aren’t doomed because your Mum and your Auntie Linda have prolapse. Prolapse happens because your body has been carrying a hell of a load in a variety of ways— and it’s asking for support.

At Hive Pelvic Health, we look at the whole picture:

  • What’s your body been through?

  • What’s your day-to-day pressure load?

  • What do your tissues need right now?

  • What are your goals — and how can we get you there?

This isn’t about going back to a “before.” It’s about moving forward with strength, awareness, tools and zero shame.

What’s Next?

In the next post, we’ll dive into the big question:
“Can a prolapse be fixed?”
(Listen: there’s a lot you can do — and surgery isn’t your only option.)

In the meantime, if you’re feeling overwhelmed, scared, or just fed up — you don’t have to figure it out alone.

Book an assessment. Bring your questions. Bring your fears. I’ll bring the plan.

Your hive deserves support — and that we can provide.

Here for you and your hive,

Laine

About the Author: Laine Wall

Hey Babe! Thanks for stopping by the Hive blog.

I am a Registered Pelvic Physiotherapist focusing on women’s health and perinatal and postpartum health. I love supporting women on their individualized pelvic health journey. 

I am the owner and founder of a pelvic physiotherapy clinic called Hive Pelvic Health in Millbrook, Ontario, also offering virtual appointments for those residing anywhere in Ontario, Canada. 

Have more questions?  Get in touch with me. 

Hive Pelvic Health is located in the township of Cavan-Monaghan, in Peterborough County. It is less than 20 minutes from Peterborough and 30 minutes from Durham region. 

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Jillaine Wall
Next

What Is a Prolapse? And What That Pressure, Bulge, or Weird Feeling Really Means