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Is Exercise Good For the Pelvic Floor?

Hi friends! Have you ever wondered if heavy exercise is good for the pelvic floor muscles? Should you be lifting heavy weights? Should you be running and jumping? Or are these “bad” for the pelvic floor muscles and cause pelvic organ prolapse and stress urinary incontinence?


The short answer to these questions is: it really depends. There have been many studies done on exercise and its impact on the pelvic floor muscles, but they have shown varying results. This may be because other factors were not tested, such as intra-abdominal pressure management.


One study found that female athletes are three times more likely to have urinary incontinence compared with females who did not exercise (Bo, 2020). Another study showed that exercising women generally have stronger PFM strength and larger muscles compared to non-exercising women (Bo, 2020). Some evidence suggests that exercise may cause and worsen pelvic organ prolapse, but studies are inconsistent (Bo, 2020).


Don’t let these studies scare you away from exercising. Let’s start by talking about all the benefits of physical activity (Bo, 2020):

  • Reduced risk of dementia

  • Reduced risk of some cancers

  • Reduced risk of excessive weight gain

  • Improved cognitive function

  • Reduces progression of chronic conditions like osteoarthritis, high blood pressure, and type two diabetes

Most studies agree that mild to moderate physical activity, like walking, lowers the risk of urinary incontinence (Bo, 2020). However, you may want to do something more strenuous like running, jumping, and weightlifting. Are these types of exercise safe and beneficial to your pelvic floor?


To understand better, let’s first talk about pressure. Intra-abdominal pressure is the scientific term for the amount of pressure that is in our abdomen. The pressure inside our abdomen changes throughout the day with movements, changing positions, breathing, and contracting our abdominal muscles (Bo, 2020).

Managing intra-abdominal pressure is crucial to allow to pelvic floor muscles to do their job well (Bo, 2020).


The pelvic floor consists of both muscles and connective tissue (ligaments and fascia) that need to work together to support the pelvic organs and prevent urinary incontinence and pelvic organ prolapse (Bo, 2020). The ligaments and fascia can be damaged by things like childbirth and chronic straining, but strong pelvic floor muscles may be able to compensate for weak connective tissue (Bo, 2020). Dysfunction of the pelvic floor leads to common conditions like urinary leakage, fecal leakage, and prolapse (Bo, 2020).


Exercises that may increase pressure the most include strenuous strength training like weight and power lifting as well as high-impact activities like running and jumping (Bo, 2020). Even though these exercises increase pressure, other normal daily activities do as well. In fact, one study found that the average abdominal pressure was higher when standing from a chair than with crunches, sit ups, climbing stairs, and many lifting activities (Bo, 2020). Coughing creates the highest pressure in the abdomen (Bo, 2020).


The problem lies in the fact that studies have shown that the amount of pressure change with exercise varies greatly among individuals performing the same exercise or task (Bo, 2020). This may be why there is conflicting research on whether exercise is good or bad for the pelvic floor. The key to this may be how we exercise and not what we do.


Individuals who do not have urinary leakage, have pelvic floor muscles that contract before or with these activities that create large changes in our pressure (Bo, 2020). This helps them to prevent any urinary leakage and to properly support the pelvic organs. For women with an well-functioning pelvic floor, it is likely that exercise and physical activity improve the strength and function of the pelvic floor muscles. While those who have signs of pelvic floor muscle dysfunction, strenuous exercise may make symptoms worse (Bo, 2020).


One study of almost 4,000 participants showed that women lifting weights less than 15kg (about 33 pounds) were more likely to report symptoms of pelvic organ prolapse than women lifting heavier weights (Forner, 2020). Why might this be? While this is just a hypothesis, and more research is needed, this may be due to the fact that we often pay more attention to our form and abdominal bracing as we lift heavy weights to make sure we do not hurt ourselves.


What is proper form with lifting weights? There are too many details for us to explain in this blog depending on the amount of weight, the type of exercise, and other factors. What we will talk about is managing pressure. Learning how to brace your abdomen and coordinate your breath can decrease strain on the pelvic floor and improve any symptoms.


We can use our breath to help manage intra-abdominal pressure by breathing out as we lift or exert ourselves. Breathing in, or inhaling, engages the diaphragm muscle. Engaging both the abdominal muscles and diaphragm at the same time greatly increases intra-abdominal pressure (Hodges, 1985). This means that if we brace the stomach muscles and breath in at the same time we can significantly increase the intra-abdominal pressure. Breathing out will cause less of an increase in this pressure, allowing the pelvic floor to manage leakage and support our organs better.


If you are experiencing any signs of pelvic floor muscle dysfunction, like urinary incontinence or pelvic organ prolapse, it is best to see a pelvic floor therapist to help give you individualized advice and address any areas of concern. You can find one near you at www.mypfm.com/find-a-pt. A therapist can not only help you with the pelvic floor muscles, they can help you with any areas of weakness or tightness in the legs and spine that may be contributing to symptoms.


Remember, there is hope. While exercise may sometimes cause worsening of urinary incontinence and pelvic organ prolapse symptoms, there are ways to exercise that can actually improve your symptoms! Don’t let pelvic floor muscle dysfunction stop you from doing what you love, but make sure you’ve done the ground work first.


To learn more about your pelvic floor muscles, check out these great resources:


For providers, join our Ambassador Program and most of our courses are included with your membership!

  • Postpartum Return to CrossFit with Dr. Reg VanVelzen, PT, DPT, OCS and Dr. Emily Reul, PT, DPT

  • Introduction to Pelvic Floor Impairments in Runners with Dr. Amanda Olson, PT, DPT, PRPC

  • Pelvic Floor & Hip Complex: A deep dive into diagnosis and treatment of FAI and IT band friction syndrome with Dr. Amanda Olson, PT, DPT, PRPC

  • Pelvic Floor Dysfunction in Runners: Into to Running Gait Analysis with Dr. Amanda Olson, PT, DPT, PRPC

  • From the Foot to the Pelvic Floor: How to Progress Exercise in the Postpartum Runner with Dr. Amanda Olson, PT, DPT, PRPC


Written by Emily Reul, PT, DPT


References

  1. Bo K, Nygaard IE. Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Med. 2020;50(3):471-484.

  2. Forner LB, Beckman EM, Smith MD. Symptoms or pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. Int Urogynecol J. 2020;31(8):1551-1558.

  3. Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl

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