A patient we’ll call Joan had her uterus removed in her 70s, not by choice but because doctors found a tumor. She did everything right afterward. Months of pelvic floor therapy with a specialist who focused on post-surgical recovery. Her therapist noticed her hip was tight and worked on it directly, session after session. But Joan kept saying the same thing. I feel the same as I did before the surgery. Eventually, her prolapse came back, and she needed a second surgery.
Her surgeon didn’t miss anything. Her pelvic floor therapist didn’t either. Tight hips were a real finding, and pelvic floor therapy was exactly the right call after her surgery. It just wasn’t the whole story.
If any part of that sounds familiar, especially if pelvic pressure after hysterectomy is something pelvic floor therapy hasn’t fully resolved for you, here’s the question worth asking. What if the pelvic floor isn’t the only piece of this?
Prolapse Can Recur Even After Surgery
Pelvic organ prolapse happens when the tissues and muscles supporting the bladder, uterus, or rectum weaken, letting one or more of those organs shift down into the vaginal canal. Surgery is often the right call, especially when prolapse is significant or affecting daily life. But surgery repairs what’s there in that moment. It doesn’t erase every factor that led to prolapse in the first place, things like tissue quality, prior childbirth, or how the whole body moves and loads the pelvis day to day. Those factors are often still around after the stitches heal.
A 2024 national follow-up study tracked more than 1,600 women with a history of pelvic organ prolapse for 10 years after hysterectomy. 16.5 percent needed a repeat prolapse surgery. 21.2 percent had at least one outpatient visit for recurring symptoms. Prolapse recurrence after hysterectomy isn’t rare, and it isn’t a sign that anyone missed something the first time around. This is also exactly why pelvic floor therapy after hysterectomy is so often the recommended first step, even when it turns out not to be the entire answer.
Part of why recurrence happens comes down to what led to the original prolapse in the first place. Prior vaginal deliveries, connective tissue that’s naturally more elastic, chronic coughing or straining, and higher body weight can all place ongoing demand on the same support structures a surgeon just repaired. None of these are things a patient did wrong. They’re simply part of the physiology that made prolapse likely to begin with, and surgery addresses the anatomy in front of it without necessarily changing those underlying contributors.
Why Pelvic Floor Therapy Is Important, But May Not Be the Whole Picture
This isn’t an argument against pelvic floor therapy. For a lot of women, it’s the right first step, and often the only step needed. It’s exactly why mPower refers patients to a pelvic floor specialist whenever that’s the right call.
What Joan’s case shows is that pelvic floor therapy, even done well by a skilled therapist, is looking at one important part of a bigger system. The hips, the abdominal wall, breathing mechanics, and the way you move through an ordinary day all shape how load travels through the pelvis. When one of those areas isn’t working the way it should, the pelvic floor often ends up picking up the slack, indefinitely. That’s part of why prolapse and pelvic floor therapy don’t always tell the whole story on their own, even when the therapy itself was excellent. An assessment that looks at the whole system, not just the pelvic floor on its own, can help find out.
Pelvic floor therapy and a whole-body evaluation aren’t competing approaches. They’re often two pieces of the same answer.
What Do Tight Hips Have to Do With Pelvic Health?
Hip mobility and pelvic health are more connected than most people expect. The muscles and connective tissue around the hip joint shape how the pelvis moves every time you walk, stand up, or climb a flight of stairs. When a hip is restricted, the body doesn’t just stop moving. It finds a workaround, usually by asking the trunk and pelvis to pick up more of the job.
Tight hips don’t cause prolapse. That’s too simple for what’s actually a complex system. But hip restriction can change how the pelvis is loaded over the course of a normal day, which is exactly why the relationship between hip tightness and pelvic floor function is one we take seriously in every evaluation. In Joan’s case, her tight hip was a real, correctly identified finding, the kind of detail worth chasing down because it can be part of the picture, even if it isn’t the whole answer for every patient.
Why the Deep Abdominal Wall Matters After Abdominal or Pelvic Surgery
The deep abdominal wall, especially the transverse abdominis and the connective tissue around it, works together with the diaphragm and pelvic floor to manage pressure inside your abdomen and pelvis with every breath and every movement. After abdominal or pelvic surgery, that tissue usually takes a hit, whether from the incision itself, scar tissue, or months of careful, guarded movement during recovery. It’s also tissue that standard post-surgical rehab rarely addresses directly.
This isn’t about weak abs causing prolapse. It’s that trunk stability and breathing mechanics share the same pressure system as the pelvic floor, and when that system isn’t working together, the pelvic floor often ends up carrying more than its share. This is also where diastasis recti, a separation along the connective tissue at the midline of the abdomen that’s common after pregnancy and abdominal surgery alike, can factor in. It doesn’t automatically mean something is wrong, but it can change how well the abdominal wall manages pressure day to day. Evaluating the deep abdominal wall, not just handing someone a sheet of core exercises, is often the missing piece after abdominal or pelvic surgery.
What About Urinary Leakage?
Urinary leakage, especially stress urinary incontinence, shows up alongside prolapse often, but the two don’t always share a cause. Urinary leakage after hysterectomy can come from pelvic floor muscle function, how pressure is managed during things like coughing or lifting, prior childbirth, surgical history, or some combination of all of it.
That’s exactly why leaking deserves its own look, rather than being treated as something that will simply resolve once prolapse is addressed. For Joan, leaking was the last symptom to let go, easing gradually rather than vanishing overnight. That’s a pattern worth expecting, not a sign that something isn’t working.
Where Does Shockwave Therapy Fit Into Pelvic Health?
Let’s be precise here, because this is the part people misunderstand most. Shockwave therapy doesn’t put a prolapsed organ back into place. It isn’t a substitute for medical management, pelvic floor therapy, or surgery when any of those are what’s actually needed.
What it’s built to do is change tissue that’s tight and restricted, in areas like the hip and the deep abdominal wall, into tissue that moves the way it should again. That’s the piece we saw in Joan. Our clinical experience at mPower is that some patients notice a change in pressure or tightness within the first visit or two. Others, especially with denser or older scar tissue like an earlier C-section, take longer for that same tissue work to fully resolve. A typical plan runs around 6 visits, and what happens along the way looks different for everyone.
For Joan, her pressure eased dramatically after her very first session. Her leaking came down slowly over the following weeks. By the end of her 6 visits, she was walking and exercising again without the symptoms that had held her back for two years. We didn’t cure her prolapse with shockwave. That was never what happened. What we did was help free up a hip and an abdominal wall that had been chronically restricted and compensating for years, quietly adding strain to her pelvic floor the whole time.
A Different Way to Look at Persistent Pelvic Symptoms
Most care for pelvic symptoms starts and stops with one question. Where does it hurt? At mPower, our approach to pelvic health physical therapy asks a few more. How does the whole body move? What’s restricted? How do the hips move through their full range? How is the abdominal wall doing its job during breathing and daily life? How does the pelvic floor respond under different conditions? And the one that matters most: what happens to the original symptom once those patterns actually change?
That last question tends to tell us the most. When easing a restriction somewhere else in the body changes how a symptom behaves, that’s not a coincidence. That’s information a single-area assessment is far less likely to catch.
In practice, this usually starts with watching how you move, not just asking where it hurts. A hip that doesn’t rotate fully. A breath that doesn’t expand the ribcage the way it should. A trunk that braces instead of moving freely during something as ordinary as standing up from a chair. Each of those observations gets tested against how your actual symptoms respond, and that response, more than any single finding on its own, is what shapes the plan from there.
When Should You Seek Additional Evaluation for Prolapse or Leaking?
Some symptoms deserve a conversation with your gynecologist, your surgeon, or a pelvic floor specialist, no exceptions:
✔ New or worsening pelvic pressure
✔ Visible bulging at the vaginal opening
✔ Changes in urinary or bowel function
✔ Difficulty fully emptying the bladder
✔ Pain in the pelvis, abdomen, or low back
✔ Symptoms returning after a previous prolapse surgery
✔ Any significant change in pelvic function
If you’re noticing any of these, please get it looked at. A movement-based assessment adds a lot to the picture, but it was never meant to replace medical care for these symptoms.
Let’s Find Out What’s Actually Going On
Joan’s story shows what can happen when someone finally looks at the whole picture, not just the pelvic floor. Your story will be your own, but the same questions that helped her are exactly where we’d start with you. A Discovery Visit is a real conversation, not a sales pitch, about your history, what you’ve already tried, and what we’d genuinely recommend next. If that includes a referral to a pelvic floor specialist or physician, we’ll help you get there too. Either way, you’ll walk away with real answers instead of more guessing.
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Frequently Asked Questions
Can prolapse come back after hysterectomy?
It can, and it’s more common than most people are told. A 2024 national follow-up study found that among women with a history of pelvic organ prolapse, 16.5 percent required a repeat prolapse surgery and 21.2 percent had an outpatient visit for recurrent symptoms within 10 years of hysterectomy (Kuittinen et al., 2024).
Why does prolapse recur after surgery?
Surgery repairs the support structures as they exist at the time of the procedure, but the underlying factors that contributed to prolapse in the first place, such as tissue quality or how the body moves and loads the pelvis, can still be present afterward, which is part of why recurrence happens.
Can pelvic floor therapy help prolapse?
Yes, and for a lot of women it’s exactly the right first step. Some patients also benefit from looking at hip mobility, abdominal wall function, and movement patterns alongside it, since those can reveal contributors that pelvic floor work alone doesn’t always reach.
Can tight hips affect pelvic floor function?
Hip mobility shapes how the pelvis is loaded during daily movement, and a restricted hip can feed compensation patterns that put more demand on the pelvic floor. That doesn’t mean tight hips cause prolapse. It means they’re worth a look.
Can prolapse cause urinary leakage?
Prolapse and urinary leakage frequently coexist, though they don’t always share the exact same underlying cause. Leaking deserves its own individualized assessment rather than being assumed to resolve automatically once prolapse is addressed.
What should I do if prolapse symptoms return?
Have any new or returning prolapse symptoms evaluated by an appropriate healthcare professional, such as your gynecologist or surgeon. From there, a broader movement-based assessment can help identify whether other factors may be contributing.
Is shockwave therapy a treatment for prolapse?
No, and we’ll always tell you that upfront. Shockwave doesn’t reposition a prolapsed organ, and it isn’t a stand-in for medical management, pelvic floor therapy, or surgery when those are what you need. It can help address tissue restriction in the hip or abdominal wall as part of a bigger plan, and what that looks like varies by patient.
Can physical therapy help after prolapse surgery?
Physical therapy, including but not limited to pelvic floor therapy, can play a meaningful role after prolapse surgery. Prolapse physical therapy that also looks at hip mobility, abdominal wall function, and overall movement patterns may help address contributing factors alongside your surgical and pelvic floor care.
Sources
Kuittinen T, Mentula M, Tulokas S, Brummer T, Jalkanen J, Tomas E, Mäkinen J, Sjöberg J, Härkki P, Rahkola-Soisalo P. Recurrent pelvic organ prolapse after hysterectomy; a 10-year national follow-up study. Archives of Gynecology and Obstetrics. 2024;310(5):2705-2715. doi:10.1007/s00404-024-07615-x
