August 21, 2020

Exercising with Prolapse

Symptoms of pelvic organ prolapse can be confusing, scary and limiting. Does exercise make it worse? Can exercise make it better? Do I have enough strength? Should I do kegels? Should I try to hold my muscles in during running? Can everything just fall out down there? These are just a few of the questions pelvic health therapists hear when it comes to exercising with prolapse.

Symptoms of pelvic organ prolapse can be confusing, scary and limiting. Does exercise make it worse? Can exercise make it better? Do I have enough strength? Should I do kegels? Should I try to hold my muscles in during running? Can everything just fall out down there? These are just a few of the questions pelvic health therapists hear when it comes to exercising with prolapse.

So what is POP?

It can be helpful to first understand the definition of pelvic organ prolapse (POP), symptoms of POP and risk factors. Symptoms often present as vaginal pressure, heaviness, bulging or dragging.

Severity of POP anatomy does not necessarily correlate with severity of symptoms so having POP does not mean you will have symptoms and having troubling symptoms does not mean that you have severe POP. Regardless, POP is a problem when you experience symptoms that you do not want to experience.

Exercises to manage POP symptoms

Prolapse symptoms are often worse at the end of day, during or after exercise, or after a particular task like lifting a toddler. The following exercises can assist in reducing prolapse symptoms in a variety of ways.

  • The first is to improve mobility and expansion capacity of the ribcage and abdomen. This can reduce intra-abdominal pressure by increasing available volume.

  • The second is to use gravity-eliminated or gravity-assisted positions to temporarily reduce the demand on the pelvic floor.

  • The third is to strengthen the hip muscles, which support the pelvic floor.

  • The last is to acclimate impact in standing exercises in order to progress towards high impact activities like running.


Looking for help managing prolapse? Check out our 90-Minute Online Prolapse Course


Diaphragmatic breathing

  • Inhale, allowing the ribcage to inflate in all directions. Also allow the belly to inflate. Let go of any tension.

  • Exhale naturally.

  • Gradually slow and deepen the breath without strain. Work up to 4 second inhales and 6 second exhales.

 

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Bridges

  • Inhale to prepare. Exhale as you drive through your heels to raise your hips off the floor.

  • In the top position, squeeze your buttocks and gently hug your belly in.

  • Inhale back down. Exhale back up and repeat. Here’s an example.

Kegels in gravity-assisted position

  • This exercise can be helpful during times when you feel POP symptoms later in the day or after a specific activity. Rest with a yoga block, bolster, or pillows under the sacrum.

  • Inhale to prepare. Exhale and perform a kegel. To kegel, imagine gripping a blueberry in the vagina and lifting it up.

  • Inhale and relax. Allow the blueberry to drop back down to the vaginal opening.

 

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Kneeling hip thrust

  • Inhale to sit back.

  • Exhale and rise up onto your knees. In the top position, squeeze your glutes and gently hug your abs in.

  • You can do this with or without a band.

  • Watch the exercise in action.

Penguin walk

  • You can do this with or without a band. Here’s an example.

  • In a wide legged stance, rock side to side, alternately landing on left foot and right foot.

  • It may be useful to use a breath pattern where you exhale with each foot landing. Be aware not to hold the breath.

Returning to exercise

Keeping in mind that each type of exercise/sport may require its own unique strategies, below is a framework of guidelines for returning to exercise with prolapse, not in any particular order.

  1. If postpartum, the earliest recommended return to higher intensity exercise postpartum is three months, and longer if you have signs or symptoms of pelvic floor dysfunction. A window of 3-6 months can account for individual body and lifestyle needs. An earlier return is more likely if you remained active with your exercise/sport throughout pregnancy and do not have any birth injuries.

  2. Progress gradually to your highest level of activity, even if you feel good. If you recently had an injury, gave birth, or were experiencing prolapse symptoms, feeling good is a sign that you are healing well. But tissue healing and improvements to strength, endurance, coordination, etc. take time. Respect this process. Go gradual.

  3. Start with non-impact or low-resistance variations of exercises, and progress to light impact/resistance, then to high impact/resistance, moving on only as you can without increasing symptoms.

  4. Find your “threshold” of an activity: the intensity, duration, or number of repetitions of an activity that you can perform before the onset of symptoms. Train at this threshold for several weeks before progressing to a new threshold. You’ll want to allow time for your pelvic floor to acclimate to the demand before adding greater demand.

  5. Experiment with breath pattern to find one that helps reduce symptoms. For example, the general recommendation is to exhale on the effort (example: inhale down in a squat, exhale on the way up), but if you have symptoms, try modifying that. You can also try different types of exhales (pursed lips vs. hissing vs. open mouth exhale).

  6. Experiment with slight changes in posture and foot position.

The good news

Prolapse is actually fairly common and usually manageable. These exercises and guidelines provide a framework for managing prolapse, in addition to other holistic options for pelvic support. It’s always prudent to see a pelvic health physical therapist in person for individualized rehab programming. Or, try an online session, for advice tailored to your specific symptoms and exercise preferences.

Melissa Stendahl, PT is a pelvic health physical therapist with specialty certificates in the areas of prenatal and postpartum physical therapy. She has a unique approach with clients by promoting preventative care, active participation, education and understanding of their diagnosis and treatment plan so they feel empowered in their ability to achieve wellness. Melissa is a lifelong athlete, military veteran, and mom. She is the owner of Stendahl PT. Follow along on her Instagram.

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