Can I Exercise With Pelvic Organ Prolapse?

If you’ve given birth, whether vaginally or via C-section, you owe it to your current and future health to have a good understanding about prolapse.

What is pelvic organ prolapse?

In Pelvic Organ Prolapse, or POP, one or more pelvic organs have begun to lose their position in the pelvis and descend or “slump” downwards. This can happen when there is weakness or damage to the normal support of the pelvic floor. POP can be a result of pregnancy and childbirth. Other risk factors for POP include: prolonged labor, instrumental delivery of baby, episiotomy, chronic constipation, hysterectomy, and advancing age.

It is best to catch this as early as possible in order to treat it well with physiotherapy and specific exercises, and restore it as closely as possible back to its original position.

The pelvic organs that you’ll most commonly hear about in postpartum prolapse cases are:

• Bladder, called cystocele
• Rectum, called rectocele
• Uterus, called uterine prolapse

Prolapsed bladder, called cystocele | Image: www.healthwise.org

Prolapsed rectum, called rectocele | Image: www.healthwise.org

Uterus, called uterine prolapse | Image: www.healthwise.org

These are all referred to “vaginal” prolapse because they descend into the vagina or vaginal walls.

Not all POP is created equal

There are different “stages” of prolapse, ranging from minor to severe:

• Stage 0 (no prolapse)
• Stage 1
• Stage 2
• Stage 3
• Stage 4 (organ in question is bulging out of the vagina)

You can read more specific information on the stages of prolapse in this article from American Family Physician.

How do I know if I have POP?

The best way to determine if you have POP is to have an internal assessment performed by a skilled pelvic floor/health physical therapist.

POP can be tricky. Many women who have some degree of prolapse are unaware of it.

This could be because they’ve never had a thorough internal examination of the pelvis, they have no symptoms, or they’ve just simply never heard of it before and assume any symptoms they’re having are “normal.”

It’s also possible that other health care providers who perform an internal exam miss the prolapse. Thus, it goes undetected and undiagnosed.

For example, if your OB performs an internal exam post-pregnancy but only does so when you’re lying down on your back, it’s hard to know how the pelvic organs are responding under pressure from gravity when you’re standing up, not to mention when you’re loading your body with stress of exercise postpartum.

Signs and Symptoms of POP

Many women with prolapse have no symptoms at all! However, you may be experiencing:

• Urinary incontinence
• Difficulty with bowel movements
• A feeling of heaviness or pressure in your pelvic floor
• You can feel your pelvic organs bulging out of the vagina (e.g. you can push them back in with your fingers)

Can I exercise?

Yes, you absolutely can exercise safely with prolapse, or prevent it while your body is healing postpartum.

There are some things you need to keep in mind with your exercise programming, though. You need to exercise in a way that strengthens your body and supports your core and pelvis, but doesn’t create an environment where the pelvic organs are excessively stressed or have added pressure placed upon them.

Things to keep in mind:

• Limit the amount of time spent on your feet during an exercise session. Vary the body position: standing, seated, side lying, supine, incline, etc.
• Use caution with regard to the intensity of the load (weight) in certain exercises, especially lower body exercises such as squats, or overhead exercises such as overhead presses

You can lift weights. You can do weighted squats, lunges, etc if your prolapse is well managed, your physio gives you the all-clear, and you know what sensations to be aware of.

• Limit the amount of impact to the body during exercise. Running and jumping are not likely to be recommended.
• Pay close attention to the sensations in your pelvis. During and after exercise is there any heaviness or pressure in the pelvis/pelvic floor?

You really need to hone into these sensations. Are you working out at the end of the day and feel more heaviness? If yes, adjust the workout (for example: move to more seated, side lying, supine positions instead of standing). No ego here, please!

Prolapse Friendly Strength Training Workout

1 — Superset: Perform 3 - 5 sets

1A. Hip Thrusts with Bands

• Your upper and lower body move in unison as you lower and raise.
• Squeeze your glutes to lift your body, but only until it’s in a straight line at the top, no higher.
• Exhale as you lift, inhale as you lower.
• Perform 15-25 reps

1B. 1-Arm Incline Dumbbell Chest Press

• Roll from your side into the starting position on your back.
• Push the weight up, pull the weight down.
• Exhale as your lift the weight, inhale as you lower the weight
• Perform 8-12 reps per side.

2 — Circuit: Perform 3 - 5 sets

2A. Bodyweight Squat to Low Box

• Squat down and sit to a bench or box/step, going as low as you can while keeping good alignment through your lower back and pelvis.
• Squeeze your legs (quads and glutes) strong to stand up straight.
• Inhale to sit down, exhale to stand up.
• Perform 10-20 reps.

2B. Seated Cable Row

• Sit in good alignment on the sitz bones.
• Squeeze the back muscles and feel the shoulder blade travel backward, drawing the elbows to the sides of the ribcage.
• Exhale to pull, inhale to reach back in.
• Perform 8-12 reps per side.

2C. Half-Kneeling Pallof Press

• Kneel down on the knee closest to the cable or band attachment.
• Squeeze the glutes on the back leg and slightly lean your body forward while keeping your chest lifted and your torso tall.
• Press your arms straight out in front of you until they are fully straight, without letting your body turn inwards or outwards.
• Feel tension in your abdominals and hips to keep your body still.
• Exhale to press out, inhale to return back in.
• Perform 8-12 reps per side.

3 — Optional

Treadmill incline walking intervals

• Increase the incline for 30-60 seconds on the treadmill and walk at a moderate pace.
• Step off to the sides of the treadmill to rest, or lower the incline and walk slowly to recover for 30-90 seconds.
• Perform 5-10 sets total.

As you can see, you definitely can exercise with prolapse. Consult with your doctor before following any the guidelines in this article. So long as your POP is well-managed by you and your medical provider you should be able to exercise safely.

Resources and more information:

1. American Family Physician — Pelvic Organ Prolapse
2. Continence Foundation of Australia — Fact Sheet: What is a prolapse?
3. Continence Foundation of Australia — Don’t ignore the signs of prolapse. Seek help.
4. Contemporary OB/GYN — Forceps delivery, perineal lacerations raise risk of pelvic floor disorders