Pelvic floor disorders include uterine prolapse, bladder prolapse (cystocele), rectal prolapse (rectocele), stress urinary incontinence, and chronic pelvic pain. At Mother Hospitals, Boduppal, we diagnose and treat all pelvic floor conditions with conservative therapy (pelvic floor exercises, pessaries) and surgical options where needed. Call Dr. E. Prashanthi Reddy: 97059 93366.
Leaking urine, a feeling of heaviness, or something "coming down" — these are common pelvic floor symptoms that many women tolerate unnecessarily. At Mother Hospitals, Boduppal, we offer comprehensive pelvic floor assessment and treatment — from Kegel therapy to surgical repair.
MBBS, DGO, PG Diploma in ART – Kiel University, Germany | 20+ Years Experience | TGMC Reg: 50624
The pelvic floor is a group of muscles, ligaments, and connective tissue that forms a hammock-like support structure at the base of the pelvis. It holds the uterus, bladder, and bowel in position and plays a critical role in bladder and bowel control, sexual function, and support during pregnancy and childbirth.
When these muscles are weakened, overstretched, or disrupted — as commonly happens after vaginal delivery, with age, or at menopause — the structures they support can descend or malfunction, causing a range of pelvic floor disorders.
Many women accept pelvic floor symptoms — leaking urine, pelvic heaviness, or discomfort — as an inevitable part of ageing or having had children. They are not. These are treatable medical conditions.
Understanding the type and severity of your condition helps determine the most appropriate treatment. Dr. Prashanthi assesses each woman individually and explains the findings clearly.
Prolapse occurs when the supporting structures of the uterus, bladder, or rectum weaken, allowing these organs to descend into or beyond the vaginal canal. It is graded by severity:
| Grade | Description | Typical Symptoms |
|---|---|---|
| Grade I | Organ descends partway into the vagina | Mild heaviness, often no symptoms |
| Grade II | Organ descends to the vaginal opening | Pressure, dragging sensation, backache |
| Grade III | Organ protrudes beyond the vaginal opening | Visible bulge, difficulty walking, urinary symptoms |
| Grade IV | Complete prolapse — organ fully outside vagina | Severe bulge, urinary/bowel problems, discomfort |
Grade I and II prolapse are typically managed conservatively. Grade III and IV may require surgical repair.
Stress urinary incontinence is the involuntary leakage of urine during physical activity that increases abdominal pressure — coughing, sneezing, laughing, lifting, or exercise. It is caused by weakness of the urethral sphincter and/or pelvic floor muscles. SUI is one of the most common and yet most under-treated gynaecological conditions in India. Many women assume it is "normal" after childbirth — it is not, and it is very effectively treated with pelvic floor physiotherapy and, where needed, a minimally invasive TVT (tension-free vaginal tape) procedure.
Urge incontinence involves a sudden, overwhelming urge to urinate that is difficult to defer — often resulting in leakage before reaching the toilet. An overactive bladder (OAB) may cause frequency (needing to urinate more than 8 times per day), nocturia (waking at night to pass urine), and urgency with or without leakage. Unlike stress incontinence, urge incontinence is related to bladder muscle over-activity rather than sphincter weakness. Treatment includes bladder training, pelvic floor exercises, dietary modification, and when needed, medication to calm bladder muscle activity.
Not all pelvic floor disorders involve prolapse or incontinence. Pelvic floor muscle dysfunction can cause chronic pelvic pain, pain during intercourse (dyspareunia), difficulty with tampon use, and pain during gynaecological examinations. In some women, the pelvic floor muscles are hypertonic (overly tense) rather than weak — a pattern commonly seen in vaginismus and some forms of chronic pelvic pain. Treatment for hypertonic dysfunction is different from treatment for weakness — which is why accurate assessment is essential before starting any programme.
Pelvic floor disorders develop when the muscles, ligaments, and fascia supporting the pelvic organs are damaged, stretched, or weakened. Several factors increase the risk.
Vaginal childbirth — particularly prolonged labour, instrumental delivery (forceps or ventouse), or delivery of a large baby — can stretch and damage the pelvic floor. The levator ani muscle complex is particularly vulnerable. Injury may not cause immediate symptoms but can lead to prolapse or incontinence years later.
Each pregnancy places sustained pressure on the pelvic floor for nine months. Women who have had multiple pregnancies are at significantly higher cumulative risk of prolapse and stress urinary incontinence. Pelvic floor rehabilitation after each delivery reduces long-term risk.
Oestrogen decline at menopause weakens the collagen and connective tissue that supports the pelvic floor. This is why prolapse and incontinence often become symptomatic — or significantly worsen — after menopause, even in women whose pelvic floor was adequate before. Topical oestrogen therapy can help slow this deterioration.
Chronic constipation causing repeated straining at stool places persistent downward pressure on the pelvic floor over years. This gradually weakens the supporting structures and is a significant risk factor for rectocele and uterine prolapse.
Higher body weight increases the chronic load on the pelvic floor. Weight reduction — even modest — significantly reduces pelvic floor symptoms in overweight women and improves the outcomes of both conservative and surgical treatment.
Women with generalised joint hypermobility or connective tissue disorders (such as Ehlers-Danlos syndrome) have inherently weaker supportive tissue throughout the body — including the pelvic floor. These women may develop prolapse at younger ages and with less obstetric trauma than the general population.
Accurate diagnosis is the foundation of effective treatment. At Mother Hospitals, assessment is gentle, thorough, and explained clearly at every step.
Dr. Prashanthi performs a structured pelvic examination to assess the type and grade of prolapse, pelvic floor muscle strength (Oxford grading), urethral support, and any associated conditions. The examination is conducted respectfully and explained as it proceeds.
Pelvic ultrasound provides clear imaging of the uterus, ovaries, and bladder without radiation. Transperineal (external) ultrasound can assess bladder neck mobility and pelvic floor muscle function in women who are unable or unwilling to undergo internal examination.
When stress or urge incontinence needs to be assessed more precisely — particularly before surgical planning — a urodynamic study measures bladder function, urethral sphincter pressure, and the volume at which leakage occurs. This test is recommended selectively, not routinely.
Validated symptom questionnaires help quantify the severity of incontinence, prolapse, and pelvic pain — and track your improvement over the course of treatment. They also help identify the pattern of incontinence (stress vs urge) which guides the treatment approach.
Treatment is always tailored to the type, grade, and severity of your condition — and to your personal preferences regarding conservative versus surgical management. We always start with the least invasive effective option.
Pelvic floor physiotherapy is the first-line treatment for stress urinary incontinence and Grade I–II prolapse, and an important component of management for all pelvic floor conditions. Kegel exercises — repeated contractions and relaxations of the pelvic floor — strengthen the levator ani and improve urethral sphincter function over 8–12 weeks of consistent practice.
Biofeedback devices help women identify and correctly contract the pelvic floor muscles — which many women struggle to isolate at first. Surface EMG biofeedback provides real-time visual feedback that significantly improves exercise technique and outcomes compared to verbal instruction alone.
Research consistently shows that a supervised, structured Kegel programme reduces stress incontinence episodes by 50–75% in most women. It is safe, has no side effects, and the improvements are maintained long-term with ongoing practice.
A vaginal pessary is a soft medical device inserted into the vagina to support the prolapsed organ mechanically. It is an excellent option for women who are not suitable for surgery, who wish to avoid surgery, or who are waiting for planned surgical repair.
Pessaries come in multiple shapes and sizes — ring pessaries, Gehrung pessaries, and shelf pessaries for different prolapse patterns. Dr. Prashanthi fits the pessary during a clinic appointment. Most women find them comfortable and hardly noticeable once correctly fitted. Pessaries require regular cleaning and monitoring — typically every 4–6 months.
Surgery is recommended for Grade III–IV prolapse that has not responded to conservative management, or for stress incontinence that has failed physiotherapy. Options at Mother Hospitals include:
All surgical options are discussed in detail with the patient before any decision is made. Surgery is never the default — it is one option in a spectrum of care.
Childbirth — particularly vaginal delivery — is the most common cause of pelvic floor damage. Early rehabilitation significantly reduces long-term risk.
During vaginal delivery, the levator ani muscles stretch to several times their resting length. In most women, the muscles recover well — but recovery can be incomplete, particularly after prolonged labour, instrumental delivery, or large babies. Episiotomies and perineal tears can affect muscle continuity and nerve supply to the pelvic floor.
Pelvic floor exercises can begin as early as day one or two after a vaginal delivery — even before the perineum has fully healed. In fact, gentle contractions in the early post-delivery period promote circulation and speed healing. A formal Kegel programme is best started at the 6-week postnatal check, once assessed by Dr. Prashanthi.
At Mother Hospitals, postnatal pelvic floor rehabilitation is recommended for all women after vaginal delivery — not just those with symptoms. Prevention is far more effective than treatment after symptoms have developed.
Many women first notice prolapse or incontinence symptoms around the time of menopause — and there is a clear biological reason for this.
Oestrogen plays a critical role in maintaining the strength and elasticity of the collagen and smooth muscle that supports the pelvic floor. At menopause, oestrogen levels fall sharply — leading to thinning and weakening of the vaginal walls, ligaments, and pelvic floor fascia. This accelerates the descent of already weakened structures, and can convert a Grade I prolapse that was barely symptomatic into a Grade II or III that causes significant discomfort.
Vaginal dryness — another consequence of oestrogen decline — can also cause or worsen dyspareunia and increase the risk of vaginal wall prolapse.
At Mother Hospitals, pelvic floor management at menopause combines:
Dr. E. Prashanthi Reddy has managed pelvic floor disorders as part of her comprehensive gynaecology practice for over 20 years. She brings international training (Kiel University, Germany) and a deeply patient-centred approach to every consultation.
We never rush to surgery. Every patient is offered and guided through an appropriate conservative programme first. Surgery is considered when conservative treatment has been appropriately tried and found insufficient — or when the degree of prolapse makes non-surgical management impractical.
From biofeedback-guided Kegel therapy to pessary fitting to laparoscopic sacrocolpopexy and TVT — all options are available at Mother Hospitals. You receive continuity of care under one specialist rather than being referred between providers.
Because Mother Hospitals provides both maternity care and specialist gynaecology, post-delivery pelvic floor rehabilitation is seamlessly integrated into postnatal care. Women who deliver at Mother Hospitals receive structured pelvic floor follow-up as standard.
Prolapse is rarely dangerous in the sense of being life-threatening. However, severe prolapse can cause urinary obstruction, recurrent urinary tract infections, and significant quality-of-life impairment. If left unmanaged, prolapse can progress over time. Even Grade III prolapse causing protrusion beyond the vaginal opening can be managed effectively — either conservatively with a pessary or surgically.
Mild Grade I prolapse, particularly in younger women after delivery, can improve significantly with pelvic floor physiotherapy. It does not typically "heal" in the sense of the structural support fully restoring itself — but the symptoms can be well controlled and progression prevented with consistent pelvic floor rehabilitation. Grade III and IV prolapse generally require either a pessary or surgical repair for adequate symptom control.
Yes — for Grade I and II prolapse and for stress urinary incontinence, a properly performed, consistent Kegel programme produces significant symptom improvement in the majority of women. The key word is "properly performed" — many women perform Kegel exercises incorrectly, bearing down rather than lifting up. Biofeedback-guided physiotherapy, as offered at Mother Hospitals, ensures correct technique and dramatically improves outcomes compared to self-directed exercises alone.
Surgery is typically recommended for Grade III or IV prolapse causing significant symptoms that have not responded to conservative management, or when the patient prefers definitive surgical correction after being counselled about options. Surgery is also recommended if prolapse is causing urinary obstruction or recurrent infection. The surgical approach depends on which organs are prolapsed and whether the uterus needs to be retained or removed.
Yes — with appropriate guidance. High-impact exercise (running, jumping, heavy weightlifting) can worsen prolapse symptoms by increasing intra-abdominal pressure. However, many forms of exercise are safe and beneficial, including walking, swimming, cycling, and yoga with modifications. Dr. Prashanthi provides specific exercise guidance based on the grade of your prolapse and your current fitness level. Stopping all exercise is not the answer — being guided about appropriate activity is.
Stress urinary incontinence in the first few weeks after delivery is very common and often resolves with pelvic floor exercises. However, if leakage persists beyond 6 weeks after delivery, or is significant from the beginning, it should be assessed. It is not something to simply accept. Postnatal stress incontinence responds well to pelvic floor physiotherapy — and the earlier treatment begins, the better the outcome.
Pelvic floor disorders themselves do not affect egg quality, ovarian function, or fertility directly. However, conditions associated with pelvic floor dysfunction — such as endometriosis or pelvic organ prolapse causing anatomical distortion — can occasionally affect fertility. Vaginismus (a pelvic floor muscle condition) can prevent intercourse, making natural conception difficult. If you have pelvic floor concerns alongside fertility questions, Dr. Prashanthi can address both in the same consultation.
A vaginal pessary is a soft, medical-grade silicone device inserted into the vagina to provide mechanical support for a prolapsed organ. Most women find that once correctly fitted, a pessary is not noticeable during normal daily activities. There is a brief adjustment period while finding the right size. Pessaries require regular removal and cleaning (every 4–6 months in clinic, or at home for ring pessaries). They are a highly effective, completely reversible non-surgical option for prolapse management.
Dr. E. Prashanthi Reddy · TGMC Reg: 50624