• Emily Reul, PT, DPT

Exercise & Prolapse

Hello friends, this week’s topic is exercising with prolapse! So many individuals deal with prolapse every day. In fact, 1 in 5 women suffers from pelvic organ prolapse! (Nygaard, 2008)


Pelvic organ prolapse is the descent of the bladder, cervix, or rectum into the vaginal canal due to lack of support from the pelvic floor muscles and other pelvic structures. To learn more about pelvic organ prolapse in detail, check out our Pelvic Organ Prolapse blog post.



Prolapse can impact every aspect of an individual’s life, including the way they move and the way they exercise. It can be scary trying to exercise with prolapse. You might be worried it is going to make your symptoms worse or make your prolapse more severe. You can exercise with prolapse! The type of exercise and the position you are in can impact your pelvic floor muscles and pelvic organ prolapse. The pelvic floor muscles need to be strong, flexible, and coordinated to provide the best support.


Let’s first talk about the way gravity can affect pelvic organ prolapse. Have you ever noticed that your symptoms are worse after being up and walking around all day? That’s because your pelvic floor muscles have been working against gravity to hold your pelvic organs up all day long, and they may be getting tired.


Maybe you are a runner and you notice that prolapse symptoms are worse after a run (especially longer distances). While running, your pelvic floor should act like a trampoline to support the pelvic organs, but if your muscles are weak or uncoordinated or if they are too tight, they may have a hard time providing support causing the prolapse to temporarily get worse.


But there’s good news: we can use gravity to our advantage too! Have you ever noticed that first thing in the morning your have little to no prolapse symptoms? If this is the case, it’s because you’ve been lying flat all night, and therefore gravity hasn’t been able to pull down on the pelvic organs!


There are a few ways to use this to your advantage. Let’s start by talking about the anti-gravity position. Lying on your back with your pelvis about your heart will get you into the “anti-gravity” position for your pelvic floor muscles. You can use any kind of support (like a pillow or blanket) under your hips to get into this position. This position puts your pelvic floor muscles on slack. It also helps to pull the pressure from your pelvic organs away from your pelvic floor muscles.


(Tip: If you’re prolapse symptoms are worse after being up all day, try lying in this position for 10-15 minutes and see if your symptoms get better!)



The same principles apply when talking about a gravity neutral position (flat on your back with your pelvis at the same level as your heart). Gravity actually helps pull the pelvic floor muscles to contract in the anti-gravity position, but it does not in the gravity neutral position.



Using internal or external supports can be a great option when exercising with prolapse. These options work with your pelvic floor muscles to provide extra support to the pelvic organs. Internal supports go into the vaginal canal to provide support to the vaginal walls. There are different types of internal supports like a pessary (which is fitted by a physician or nurse in the US) or something over-the-counter like the Poise Impressa. If you are uncomfortable using an internal support, that’s totally okay—external supports, like the V2 Supporter, are a great alternative. External supports are worn under your clothes to provide some gentle pressure to the vulva without going inside the vagina.



Exercise has so many health benefits—both physical and mental. Don’t let pelvic organ prolapse stop you from doing the exercises you love! If you are struggling to manage symptoms with prolapse, working with a pelvic floor physical therapist can help to make sure your pelvic floor muscles are strong and coordinated to support your pelvic organs with whatever activity makes you happy!


Here are some great resources to learn more about your pelvic floor and to help manage pelvic organ prolapse:


For providers, check our online courses to help your clients experiencing pelvic floor symptoms. Consider joining our Ambassador Program and most of our courses are included with your membership!


What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  


Written by Emily Reul, PT, DPT


References

1. Nygaard, I., et al. Prevalence of symptomatic pelvic floor disorders in U.S. women. JAMA. 2008;300(11): 1311–1316.

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This information is for awareness purposes and not individual medical advice. You should seek your own professional counsel for any medical condition or before starting or altering any exercise or fitness program.

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