Pelvic floor dysfunction affects millions of American women — yet two of its most common symptoms, pelvic organ prolapse and urinary incontinence, are still rarely discussed openly. Many women spend years quietly managing leaks, pressure, and discomfort before they ever hear the words "pelvic floor physical therapy." And fewer still realize that prolapse and incontinence aren't separate problems. They're often two sides of the same coin.
We sat down with Dr. Melissa Harte, a women's health physical therapist based in Austin, Texas, with over fifteen years of clinical experience treating pelvic floor disorders, to talk about why prolapse and incontinence so frequently occur together — and what women can do about it right now. What follows is a candid, expert-led conversation that we hope gives you the language, the options, and the confidence to take the next step toward real relief.
Meet Dr. Melissa Harte: The Physio Who Wants Women to Stop Suffering in Silence
Dr. Harte's waiting room walls are covered in anatomy posters — detailed diagrams of the pelvis, the bladder, the uterus — all the structures that women are rarely taught to understand. "Most of my patients come to me after years of thinking this was just their life now," she says, settling into her chair. "They've had kids, or they've gone through menopause, or they've run marathons their whole lives, and now they're leaking. They're feeling pressure. And nobody told them there was anything to do about it."
That disconnect — between the prevalence of pelvic floor disorders and the almost total silence surrounding them — is what drives her work. According to the American Urogynecologic Society (AUGS), approximately 50% of women with pelvic organ prolapse also experience urinary incontinence. Yet the vast majority of those women never connect the two conditions, never seek pelvic floor therapy, and never learn that non-surgical options even exist.
For women navigating those early days of leaks and uncertainty, Orykas light leaks underwear can offer the kind of quiet, dignified protection that makes it easier to keep moving — to go to the gym, run the school pickup, or sit through a work meeting without anxiety. But Dr. Harte's deeper message is this: protection is a bridge, not a destination. Understanding what's actually happening in your body is the real starting point.
"Your Pelvic Floor Is a Hammock — And It Can Only Stretch So Far"
When Dr. Harte explains prolapse to a new patient, she starts with a simple image. "Picture a hammock," she says. "The pelvic floor muscles and connective tissue form a hammock that holds your bladder, uterus, and rectum in place. When that hammock weakens — through childbirth, hormonal changes, chronic straining, high-impact exercise over decades — those organs can start to descend toward or into the vaginal canal. That's prolapse."
Prolapse is far more common than most women realize. The NIH estimates that up to 50% of women who have given birth experience some degree of pelvic organ prolapse, though many cases are mild and asymptomatic. Symptoms, when they do appear, can include a feeling of heaviness or fullness in the pelvis, a visible or palpable bulge, lower back pain, and — critically — bladder and bowel dysfunction.
"Here's the part that surprises my patients," Dr. Harte continues. "When the bladder droops — which is a type of prolapse called a cystocele — it changes the angle of the urethra. That angle change can make it much harder to hold urine, especially under pressure. Coughing. Sneezing. Laughing. Jumping. That's why stress urinary incontinence and prolapse so often show up together. They're both downstream effects of the same weakened support system."
The American Urological Association (AUA) reports that stress urinary incontinence affects roughly 15 to 35% of adult women in the United States — and the overlap with prolapse makes the real number even harder to separate out. What's consistent, Dr. Harte emphasizes, is that neither condition is something women should simply accept as inevitable aging.
The Option Nobody Talks About: Pessaries and Pelvic PT
"One of the things I wish every OB-GYN in the country would tell their patients is this: surgery is not your only option," Dr. Harte says firmly. "There is a whole spectrum of conservative treatment that works extraordinarily well — and most women have never even heard of it."
At the top of that spectrum is pelvic floor physical therapy, a hands-on, evidence-based discipline that uses internal and external techniques to retrain, strengthen, and coordinate the pelvic floor muscles. Studies published in peer-reviewed journals, including those indexed by the NIH's National Library of Medicine, consistently show that pelvic floor muscle training reduces incontinence episodes significantly — in some trials by more than 70%.
The other often-overlooked option? Pessaries. A pessary is a small, removable silicone device inserted into the vagina to physically support the prolapsed organs. "It's been around for centuries," Dr. Harte says, "but somehow it's become this secret that only urogynecologists talk about. A well-fitted pessary can eliminate that dragging sensation and dramatically reduce leaking — without a single incision. For women who aren't surgical candidates, or who just aren't ready for surgery, it can be life-changing."
She acknowledges that managing prolapse and incontinence together, especially during the months of treatment and adjustment, requires practical daily solutions. For women dealing with heavier leakage during this period — particularly postpartum patients or those going through the hormonal shifts of menopause — she often recommends products like Orykas ultra-absorbent panties, which provide real protection without the bulk or shame of traditional incontinence products. "The goal is always to help my patients feel like themselves," she says. "That means taking care of the medical side and the day-to-day dignity side at the same time."
For women who have had prolapse repair surgery or other pelvic procedures, the recovery period brings its own practical considerations. High-waist styles that provide gentle abdominal support — like Orykas high-waist incontinence panties — can be particularly helpful during that post-surgical window when comfort and coverage both matter.
Why Women Wait — And What Finally Gets Them to Ask for Help
Dr. Harte has spent years thinking about why so many women delay seeking care. The answer, she says, is rarely laziness or indifference. It's shame — combined with a deep cultural conditioning that tells women their bodies' failures are personal failures.
"I've had patients cry in my office not because they're in pain, but because they're so relieved that someone is finally taking them seriously," she says. "They've been told to do their Kegels. They've been told this is just what happens after kids. And they've internalized that message so deeply that they genuinely believed they didn't deserve better."
The National Association for Continence (NAFC) estimates that the average woman waits six to seven years before seeking help for incontinence. Six to seven years of planning outfits around leaks, skipping workouts, avoiding long car trips, and quietly excusing themselves from situations that feel too risky. That statistic never fails to land hard in Dr. Harte's chest.
"What I tell every single patient is: the fact that this is common does not mean it is normal. You don't have to manage this alone." For women who want to feel put-together and confident while they work toward treatment — not waiting until they're "fixed" to dress the way they want — something like Orykas lace incontinence underwear offers that reminder that protection doesn't have to look or feel clinical.
Where to Start: Dr. Harte's Practical First Steps
For any woman reading this who recognizes her own story in these words, Dr. Harte offers a clear, concrete starting point. First, see your primary care physician or OB-GYN and ask — specifically — for a pelvic floor evaluation and a referral to a pelvic floor physical therapist. Use those exact words. "Ask for what you need," she says. "Providers respond to specifics."
Second, don't wait for perfect conditions to start taking care of yourself. Use whatever tools help you manage your symptoms while you work toward treatment — whether that's a pessary fitting, a PT program, or simply washable, comfortable underwear that lets you live your life. And if nighttime leakage is part of your experience, she recommends exploring options like a washable bed pad to protect your sleep environment without the expense or waste of disposables.
"Pelvic floor health is not a luxury," Dr. Harte says, leaning forward. "It's foundational. When your pelvic floor isn't working, everything downstream is affected — your bladder, your bowel, your sexual health, your mental health. Treating this is not vanity. It's medicine." She pauses, then smiles. "And it's about time we all started saying that out loud."
Frequently Asked Questions
Can prolapse cause incontinence — or does incontinence cause prolapse?
The relationship goes both ways, but most commonly, both conditions share the same underlying cause: a weakened or dysfunctional pelvic floor. When the supportive structures of the pelvis are compromised — due to childbirth, hormonal changes, or chronic pressure — the organs can descend (prolapse) and the bladder's closure mechanism can be disrupted (causing incontinence). They are rarely truly independent of each other. According to AUGS, approximately 50% of women with prolapse also experience some degree of urinary incontinence.
Is surgery the only treatment for prolapse and incontinence together?
Absolutely not. Pelvic floor physical therapy, pessary devices, lifestyle modifications (like weight management and reducing bladder irritants), and behavioral strategies like bladder retraining are all evidence-based, non-surgical options. Surgery is typically reserved for cases where conservative treatment has not provided sufficient relief. Many women achieve dramatic improvement without ever entering an operating room.
How do I know if I have prolapse if I've never been diagnosed?
Common symptoms include a feeling of pelvic pressure or heaviness, a sensation that something is "falling out," visible or palpable tissue at the vaginal opening, lower back discomfort, difficulty emptying the bladder or bowel completely, and increased urinary leakage. However, many cases are mild and symptom-free. A pelvic exam by your OB-GYN or urogynecologist is the only way to get an accurate diagnosis. If you're experiencing any of these symptoms, it's worth bringing up at your next appointment.
Can Kegel exercises actually help prolapse and incontinence?
Kegel exercises — pelvic floor muscle contractions — can be genuinely helpful, but only when performed correctly. Many women actually perform them incorrectly, which can sometimes worsen symptoms. A pelvic floor physical therapist can assess whether Kegels are appropriate for your specific situation and teach you proper technique. In some cases, the pelvic floor is too tight rather than too weak, and different interventions are needed. Don't self-prescribe; get evaluated first.
What type of incontinence underwear is best for women with prolapse?
The best choice depends on the severity of your leakage. For light stress incontinence linked to prolapse — leaks during exercise, sneezing, or laughing — Orykas light leaks underwear offers discreet, comfortable protection for everyday activity. For heavier leakage, particularly common in postpartum women or those going through menopause, Orykas ultra-absorbent panties provide greater coverage. Women recovering from prolapse repair surgery may also find the gentle support of Orykas high-waist incontinence panties particularly comfortable during recovery. Washable options are both eco-friendly and cost-effective over time.
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