Pelvic organ prolapse (POP) is something that many women find themselves managing after pregnancy and childbirth. In no way, does a diagnosis of prolapse mean that you cannot exercise or strength train. Some simple tweaks to your exercise program will allow you to workout safely and manage your prolapse effectively.

What is Prolapse? 

When you hear the word “prolapse”, we’re talking about pelvic organ prolapse (POP). This is when one, or multiple, pelvic organs (in the case of female anatomy) can droop down in towards the vagina and/or rectum.

While there are multiple types of prolapse, we’ll discuss the three most common types of prolapse that tend to affect postpartum women.

They are: cystocele, rectocele, and uterine prolapse. These are all vaginal prolapses, meaning that the organs fall towards the vagina.

1). Cystocele: is a prolapse of the bladder.

Cystocele 2

 (Photo found here)

2). Rectocele: is prolapse of the rectum

Rectocele

 

(Photo found here)

3). Uterine: is prolapse of the uterus.

Uterine Prolapse

(Photo found here)

Different Grades of Prolapse

There are different “grades” to diagnosing a prolapse. There are also different grading systems, but most often, prolapse is graded from 0-4. Read this article for more specific information regarding the grading system.

A “0” is no prolapse and the pelvic organs are in their normal position. A “4” is when the pelvic organ in question has descended to the furthest point and is bulging out of the body.

Estimates say that up to half of parous women (have given birth) could have some degree of prolapse. Most are extremely mild, asymptomatic, and very manageable.

That being said, unfortunately, some are not. Either way, this makes it incredibly important to do smart exercise and core training during pregnancy and after-baby.

AND, remember to see a pelvic floor physio postpartum for an internal exam!

What Can Cause Prolapse? 

Simply put, pregnancy and birth are risk factors of prolapse. Again, don’t this scare you. But as a woman, or someone who cares about a woman, you deserve to have this education so you can properly care for your body.

Normally strong, healthy fascia and connective tissue help to hold the pelvic organs in place securely. The pelvic floor muscles are another layer of support to help the stability and function of the pelvic organs.

In pregnancy: there are hormonal fluctuations (e.g. increased levels of relaxin) that cause our soft tissues to become more lax, combined with the effects of additional weight putting pressure on the pelvic organs and pelvic floor muscles, this can cause these tissues to become weakened.

During childbirth: there can be additional factors to increase the risk of prolapse, including a long pushing phase (2+ hours) of labour, use of forceps or vacuum, and perineal tearing.

Postpartum: Being on one’s feet a lot in the early days and weeks postpartum, returning to intense exercise too soon, high impact exercise early postpartum, and not performing proper core and pelvic floor strengthening exercises can lead to more severe prolapse concerns.

Signs and Symptoms of Prolapse

• Feelings of heaviness and/or downward pressure in the pelvis

• Pain or pressure in the lower abdominals and/or in the vagina (anytime, but may notice during or after exercise)

• A lump or a bulging out of the vagina (you may be able to manually feel this on yourself)

• Feeling like the bladder or rectum doesn’t empty fully when going to the bathroom (check out the Squatty Potty!)

• Pain, discomfort or less sensation during sex

• Frequent urinary tract infections

• Feeling of weakness or less support in the pelvic floor.

What NOT To Do In Exercise 

While exercising is a great means for managing prolapse, there are some definite things on the “should avoid” list.

1). Wide leg exercises: lateral lunges, sumo squats, lateral step ups, lateral shuffles

2). Be extremely cautious of weighted exercises that place downward pressure on the pelvic floor: barbell back squats, lat pulldown, overhead presses

3). A ton of “on your feet” exercises in workouts and daily life (especially early postpartum): be cautious of how much you’re on you’re feet early postpartum, even with housework and walking. Gravity can help a prolapse along early postpartum

4). Unsafe abdominal exercises: crunches, sit-ups, leg raises, pilates type “100” exercises, and front loaded exercises where a high amount of intra-abdominal pressure is created and not well-managed (front planks, pushups)

(Note: This type of abdominal exercise can cause pressure to be translated down onto the pelvic organs, pushing them down and out further. BIG “no, thanks!” in the case of prolapse)

5). High impact, plyometic exercises: running, jumping, burpees, etc = NO’s.

What TO Do In Exercise

1). Be aware of the effects of gravity: limit the amount of time on the feet after birth and in exercise in early postpartum

2). Focus on smart core and pelvic floor strengthening: in pregnancy and especially post-birth with a weakened support system, we need to re-train and re-strenghten properly (e.g. be sticky about alignment and form in workouts, train the body in ‘neutral spine’ positions, make sure you can breathe in your exercises)

3). Pay attention to the breath during exercises: no breath holding, exhale on the toughest part of your exercises (see the 3E Rule) to train the immediate support of the pelvic floor and core muscles

4). Vary exercise positions during workouts: prioritize supine (on your back), side lying, seated, and incline bench to limit standing exercises

5). Be cautious loading lower body exercises and overhead exercises: be aware of sensations in the core and floor, e.g. do you feel any heaviness or pressure?

Emily reverse lunge

(Weighted lower body exercises may not be appropriate depending on the severity of the prolapse, but there’s many other exercise variations you can use)

6). In early postpartum increase exercise time and intensity slowly: ensure there is no extra heaviness, pressure or pain during or after exercise sessions

7). Be extremely mindful of posture and alignment in your daily life: make sure you are doing your best to leave your bum behind you and to keep your ribcage stacked over your pelvis.

NOTE: No impact and plyometric type exercises until the pelvic floor physiotherapist has given the green light to reintroducing those things. At that point, we need to understand the cost vs. benefits to the prolapse and the woman’s life regarding adding those exercises back in. If we do re-add, we do so cautiously and keep the frequency low.

Examples of Prolapse-Safe Strength Training Exercises

• Lower Body Exercises:

– Pull variation: 1-foot and 2-feet elevated glute bridges, hip thrusts

Hip Thrust End

(Dr. Kate Durnin, of Peak Health & Performance in Calgary, demoing hip thrusts in pregnancy)

– Push variation: 1-leg squat to box

• Upper Body Exercises: 

– Pull: Seated cable row

– Push: Incline DB chest press

DB Incline Press

(I like to use incline presses with 1-Dumbbell, so my ladies can roll into and out of lying on their back = no crunching and sit-ups)

• Core Exercises:

– Anti-rotation variation: Tall kneeling pallof press

– Anti-extension variation: DB dead bugs

DB Dead Bugs

(You want to feel strong and supported in the dead bug, not belly bulging and pulling off the floor. I vary this exercise with the same leg and arm extending, and opposite arm and leg extending)

 Lastly

Don’t ignore the signs and symptoms of prolapse or be nervous to get assessed. It is absolutely the best choice you can make if you think something might be off and there is so much treatment to help you manage it.

More Resources

http://www.pelvicfloorfirst.org.au/data/files/Pelvic_Floor_First/What_is_a_prolapse.pdf

http://www.pelvicfloorfirst.org.au/data/files/Pelvic_Floor_First/16prolapse.pdf

http://www.aafp.org/afp/2010/0501/p1111.html

http://www.medscape.com/viewarticle/714986_3

http://www.ncbi.nlm.nih.gov/pubmed/16077995

http://www.ncbi.nlm.nih.gov/pubmed/18092333

http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/modernmedicine/modern-medicine-news/forceps-delivery-perineal-lacerations-ra?page=full

Exercise smart and safe!

JMG

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