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From Pain to Prolapse_ How a Clinical Shift Changed the Way I Treat Pelvic Organ Prolapse Featured Image

From Pain to Prolapse: How a Clinical Shift Changed the Way I Treat Pelvic Organ Prolapse

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“Is this prolapse? Why does it feel like everything is falling out?”
 If you’ve ever asked that question through tears, fear, or total overwhelm—you’re not alone. And you’re not broken.

Funny enough, this story doesn’t actually start with prolapse.
It started with pelvic pain—and a weird, brilliant shift in how we thought about it.

Years ago, we started exploring pelvic pain through the lens of the brain. At the time, this approach had only been studied in conditions like low back pain and complex regional pain syndrome… but pelvic pain? Nope. We were flying blind.

But once we included the brain in the conversation, things started to make sense. When fear entered the picture, the normal rules didn’t apply anymore. Logic took a back seat. A didn’t equal A. Oranges weren’t oranges.

We began to ask:
🧠 What information is your brain interpreting as dangerous?
🧠 What’s being flagged as safe?
Was it…

  • Sensory input? (touch, sound, vision?)
  • Thoughts and beliefs?
  • Movement?
  • Stress and trauma history?
  • Physical symptoms?

If the danger pile was bigger, the brain had a reason to protect you.
But if we could build up the safety pile, the brain could start to back off.

That framework shaped how I treated pelvic pain—and eventually, how I began to approach pelvic organ prolapse (POP).

The Fear Response That Follows a Prolapse Diagnosis

Imagine this: You’ve just delivered your baby. You feel pressure. Heaviness. Something isn’t right “down there.” Maybe you look for the first time (in the worst possible moment—swollen, stitched, and still healing). Then you hear the words:

“Your organs are falling out.”
 Cue panic. Cue Google. Cue Facebook group doom spiral.
Then your OB tells you not to run, not to lift, not to do… much of anything.

You try a Peloton ride out of desperation, only to end up with a 3-day flare so bad you can’t lift the car seat.

By the time you land in my office, your danger pile is sky-high.
Physically? You might be healing.
But neurologically? The alarms are still blaring.

What If the Problem Isn’t Just Physical?

What if your symptoms aren’t only coming from tissue damage or weakness—but from your brain doing its job trying to protect you?

This is especially true if you:

  • Had a history of high-tone pelvic floor (hello dancers and runners 👋)
  • Felt pain or tearing at delivery
  • Don’t have a clear understanding of what prolapse even is (spoiler: most of us don’t)
  • Already carry stress in your breath, shoulders, jaw, or gut

This doesn’t mean it’s “just in your head.”
It means your body is smart.
It’s protecting you.
And it might need a different strategy—not just more reps or more “squeeze your pelvic floor.”

How I Shifted My Approach: Calm > Fix

What I learned treating pelvic pain through graded motor imagery (think: small, safe exposures to build trust and tolerance) completely changed how I treated POP.

We:

  • Calm things down first
  • Stay below the “symptom ceiling”
  • Keep workouts below a 1–2/10 change in symptoms
  • Build tolerance before intensity
  • Stop obsessing over symptoms (yes, this includes Google)

We work with the nervous system—not against it.

This isn’t for every POP patient.
But if I sense a sensitized nervous system, a high-alert brain, or a pelvic floor that’s more clenched than weak?
This method works. And it works well.

What Needs to Change in the Big Picture?

We need better support. Earlier. Smarter.

👶 Can we offer early education before delivery so the prolapse diagnosis doesn’t feel like a bomb dropping?
🩺 Can we use pessaries earlier to deload tissue and calm the brain before symptoms spiral?
📊 Can we stop terrifying moms with Grade 1 prolapse diagnoses that may have existed even before pregnancy?

I don’t have the RCTs yet. I don’t have the flashy study to prove it. But I have a lot of lived experience, and conversations with seasoned clinicians seeing the exact same patterns.

So no, this isn’t just a prolapse post.
It’s a story of how we got here—from pain science, to POP symptoms, to a brain-body understanding that honors the whole person in front of me.

Let’s Talk About You

If you’ve ever been told your prolapse means “no more running,”
If you’ve ever panicked from a Facebook thread or a symptom flare,
If you’ve ever wondered if it’s all in your head (it’s not),

💬 What would’ve changed for you if someone explained this sooner?
Drop a comment or DM me—I’m here for the conversation.

#pelvicfloorPT #prolapseawareness #postpartumhealing #pelvicpain #pelvichealthmatters #runningwithprolapse #highalertnervoussystem #brainbodyconnection #gradedmotorimagery #postpartumtruth #drpagliano #paglianopostpartum #pelvicfloorthoughtleader #womenshealthPT #prolapseisnotanend #nervoussystemregulation #postpartumfitness #pelvichealthstrategy #notjustkegels #paglianorunning #paglianoprolapse

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IG Caption:

You got it. Here’s a sassier, detail-rich version of the Instagram caption—still under 2,000 characters, raw and real with a little edge, and loaded with SEO juice:

“Your organs are falling out. You should probably stop running.”
 Cool cool cool… thanks for the emotional trauma. 😑

If you’ve ever heard that from a well-meaning provider (or Google), I see you—and I was you.
The fear. The pressure. The “tampon falling out” sensation that makes you question everything.

Years ago, I evolved to treating pelvic pain through the lens of pain science: brain + body, not just muscles and joints.

Turns out… that approach works really well for some types of prolapse symptoms, too.

Because sometimes, it’s not just about tissue.
It’s about what your brain thinks is safe.

Prolapse symptoms flare? The alarms go off.
And once your brain tags something as dangerous (hello running, jumping, lifting, sneezing)…

Good luck doing it without a full-body panic.

But here’s what I’ve learned:
➡️ You don’t need to be “fixed” before you move.
➡️ You need to feel safe in your movement.
➡️ Calming the system > chasing perfection.

Yes, prolapse can be a structural thing.
But your brain plays a huge role.
And kegels alone won’t fix nervous system hypervigilance, fear of movement, or the trauma of being told “just stop running.”

We’re done with outdated advice and one-size-fits-all rehab.
We’re treating moms like athletes—because pregnancy, birth, and recovery demand nothing less.

💥 Want to run again? Lift again? Feel strong again?
Then stop accepting “don’t” as an answer.
You deserve a strategy that actually meets you where you are.  And this one might work for some of you.

💬 What’s the worst thing someone told you about prolapse? Join the conversation on Instagram.

#prolapseawareness #pelvicfloorPT #runningwithprolapse #postpartumfitness #pelvichealthmatters #drpagliano #paglianopostpartum #prolapseisnotanend #momrunner #postpartumtruth #youarenotbroken #highalertnervoussystem #pelvicpain #kegelsarenttheanswer #returntorun #strongmoms #paglianorunning #paglianoprolapse

You’re Not Broken. You’re Not the Problem. Featured Image

You’re Not Broken. You’re Not the Problem.

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(And I’m not here to fix you.)

“When we position ourselves as the expert and the patient as the problem, we risk robbing people of their agency in the healing process. That’s not help, it’s hierarchy.” — Chris Johnson, PT

Damn. That one hits hard.

When I first went into PT school, my dream wasn’t women’s health…(wasn’t even on the radar!)


I actually thought I’d be working with spinal cord injuries, stroke patients — “classic rehab stuff.”
I pictured myself diving deep into every little detail, getting my Neuro Clinical Specialty Certification, becoming the expert.
The person at the top of the hierarchy.
The one who knew everything.

Fast forward a couple decades… and life had other plans.
Today, I’m a women’s pelvic health physical therapist, Women’s Health and Orthopedic Clinical Specialist, Certified Running and Weightlifting Coach  — working with moms, runners, lifters, women navigating pregnancy, postpartum, prolapse, perimenopause and menopause.

And if I’m being honest?
The biggest thing that changed wasn’t just my specialty.
It was how I see myself in the healing process.

The best parts of what I do now?
They don’t happen when I rattle off a list of exercises and hand you a perfect little plan.

They happen when we sit down together and say:
“Ok. The kids are sick again. Work is blowing up. The daycare called — again. You’re exhausted. You still want to move your body and feel strong. How do we keep progressing with your symptoms AND make this doable, for real life?”

They happen when we talk about how motherhood feels like walking through a minefield every single day — and instead of pretending we’re “bad moms” for not checking every box, we expect the grenades, plan for them, and still find ways to take care of ourselves alongside the chaos.

They happen when we swap war stories about trying to get family support without losing our minds — and learn how to ask for what we need without guilt.

Those are the sessions that change lives.
Because they’re real. They’re messy. And they actually work.

When we work together, here’s what it looks like:

✅ I teach you to notice what’s happening — not just blindly push through.
(You can’t change what you don’t notice. But once you see it, you can’t unsee it — and that gives you power.)

✅ I explain what’s happening in your body — WHY you might be feeling pain, heaviness, prolapse symptoms — so your brain can stop spiraling into “emergency mode.”
(Fun fact: just understanding why symptoms are happening can turn down the volume of the flare.)

✅ We decide together:

  • Are you in a season where survival mode is the goal?
  • Or do you have a little extra capacity to push and build momentum?

Both are ok.
We meet you exactly where you are.

We build tiny habits, because tiny habits work.

Sometimes that looks like setting your yoga mat down next to the bathroom.
So when you get up to pee in the morning, you walk straight to the mat without thinking about it — and knock out three quick exercises that make your body feel better.

Sometimes it’s scripting the “baby’s awake” plan with your partner:
“If the baby cries in the middle of my second set, you’re on it. I need five minutes to finish.”

(Yes, you can ask for that.
No, you’re not selfish.
You’re building a system that supports everyone.)

We talk about seasons too.

Because sometimes you’re gonna be in a season where the goal is literally:
“How little do I have to do so nobody dies?”

And sometimes you’ll have more in your tank.
Both seasons are real. Both seasons are valid.

I share this story all the time:
When my kids were little, I used to pack my running shoes for every trip.
Not because I was sure I’d get to run.
But because I was practicing hope.
Hope that someday there would be space for me again.

And now?
Now my teenager sleeps late (thank the sleep gods), and I actually get to pack my shoes, plan the route, and go for the run.

It took years to get here.
Years of chaos, missed runs, exhaustion, tiny scraps of self-care.
And because of that, the runs feel that much sweeter now.

The exercises I give you?
They’re not commandments.
They’re experiments.

If they’re too hard, confusing, painful, or just not working — that’s not on you.
That’s on me to adjust, to find a better fit.

You’re not here to guilt trip yourself because you didn’t do your homework.
You’re not a bad patient because an exercise didn’t feel good.

You are the expert of your own body.

I’m here to listen, adjust, collaborate. 
Not lecture.

If you didn’t do your homework or an exercise didn’t help, it’s on ME to find what will make exercise consistent with your lift and find exercises that DO help and DO feel good for YOU!

I was taught to be a gatekeeper.
The keeper of “what’s safe” and “what’s dangerous” for women’s bodies.
If you didn’t do what I said?
You were “at risk.”
(Sound familiar? Because that’s exactly how marketing preys on moms…don’t lift in early postpartum, no planks, sit-ups or squats for your diastasis recti or your prolapse! All untrue BTW.)

But the truth is:
I know A LOT…a TON more than I knew 25 years ago.  But I don’t know everything, because research still doesn’t know everything.
 And the day I finally admitted that out loud to my patients was the day I became a better therapist.

Now?
I lay out everything we know together.
We talk about what can change, what might not.
We prioritize what matters to YOU.

We make a plan.
We stay flexible.
We treat setbacks like information, not failure.  (Did I mention no guilt trips?)

If you miss an exercise?
If a strategy doesn’t work?
If your prolapse symptoms flare again?

You don’t have to apologize.
You didn’t do anything wrong.

It’s just feedback.
It just means we look closer, refine the plan, and move forward.

Healing isn’t about grinding yourself into the ground.
It’s about finding the smallest changes that make the biggest difference — and actually feeling the results, so you want to keep going.

Because when healing feels possible — not like a punishment — that’s when you stay consistent.
That’s when you build something real.

🌟 What if healing your body didn’t mean changing who you are — but finally supporting who you’ve been all along?

#pelvicfloorphysicaltherapy #postpartumrecovery #prolapsehealing #prolapsejourney #pelvicorganprolapse #postpartumfitness #pelvicfloorPT #momstrength #postpartumhealing #womenshealthPT #postpartumrunning #prolapseawareness #reallifehealing #strongasamother