If you receive a prolapse diagnosis, I want you to know, you can (and should!) still exercise.
Exercising with pelvic organ prolapse requires that you learn a new skillset. But with the right tools, people with prolapse can move in all the ways they like to move.
If you’re worried that you have to stop doing all the things in order to keep your prolapse from getting worse, I’m here to to offer hope and actionable advice.
Prolapse feels like the end of a road. But your diagnosis is just the beginning.
Here’s are 10 considerations I strongly recommend as you get back to exercise and your active life:
1) Seek out pelvic floor physical therapy.
This is the first line, gold standard treatment. Don’t rely on advice from your OB (unless they refer you to a pelvic health therapist). Don’t start with a urogynecologist. Go to a pelvic floor therapist and learn about CONSERVATIVE (non-surgical) management options.
Your pelvic floor physical therapist is trained to evaluate your pelvic floor muscles, their strength and the placement of your pelvic organs. They’ll be able to tell you what type of prolapse you have (bladder prolapse, uterine prolapse or rectal prolapse) and to what extent. They can offer you manual therapy, strategic pelvic floor exercises and guidance around symptom management.
Pelvic prolapse is not just about pelvic floor weakness, and there’s a lot more to treatment than simply kegels.
If you work with a PT for a few months and you don’t feel improvement in your prolapse symptoms, try out another one. PTs are not a commodity. They’re human and they all practice from their lived and learned experience.
Different PTs practice differently and a different approach might suit you better. Don’t assume “PT didn’t work for me” if you try it once and don’t achieve raging success.
2) Consider a pessary.
A pessary is like a sports bra for your vagina. It’s a small rubber or silicone support device that is inserted into your vaginal canal (kind of like a tampon) and offers support to your pelvic floor muscles and organs.
They’re SUPER effective in reducing or managing symptoms of pelvic organ prolapse.
Important to know: They come in MANY shapes and sizes. If you find someone to fit your pessary and they only carry one style, and if it doesn’t work for you, find someone else who fits other styles.
3) Learn the boring basics of pressure management.
Pressure in your abdomen (called intra-abominal pressure) stabilizes your spine and torso.
When you engage in any activity, that pressure goes up. When managed well, that pressure is equally distributed and countered by all of the muscles of your core equally.
If mismanaged, it’ll pop out somewhere.
Here, we’re talking about what happens when it is disproportionately focused on the pelvic floor muscles.
Bring awareness to your body alignment and breathing tendancies. These impact how pressure is distributed within your core.
Learn the Connection Breath, one of the most effective pelvic floor muscle exercises, as a first step towards managing your intra-abdominal pressure and reducing strain on your pelvic floor.
The Connection Breath is one of the foundational exercises I teach every client of mine and I offer a complete tutorial in the No B.S. Guide To A Stronger, Drier Pregnancy & Postpartum.
4) It’s less about what you do than how you do it.
There are no perfect “pelvic floor safe exercises” that are going to work for every individual.
If you want to manage your prolapse symptoms and prevent your prolapse from getting worse, you need to learn HOW to exercise with your prolapse in mind.
Learn to coordinate your breathing with your movements to control pressure fluctuations and create support for your pelvic organs.
Explore a variety of breathing strategies. Find something that works well for you.
You don’t have to use the stock standard “exhale on exertion” that is a first-line option for a lot of folks.
5) But it’s a little about what you do.
When you first start exercising after noticing your prolapse, you might find that certain core exercises or exercises in which you take a wider stance create more symptoms of heaviness or bulginess.
Hold off on things like sit-ups, v-ups, crunches until you have a good handle on your pressure management strategies.
In general, Try narrower stance squats, deadlifts and lunges until you become more comfortable. You might find split stance or kickstand variations more comfortable than the standard versions.
For example, instead of a standard deadlift, try a single leg variation:
If you find that upright exercises are really triggering, exercise on your back.
For example, one of my favorite core exercises in postpartum is the Pallof press. You could do it in half-kneeling:
5) Thoughtfully and progressively overload.
When you first start managing a pelvic organ prolapse, lifting anything might trigger prolapse symptoms. As you develop strategies to manage lighter loads and simple movement patterns, you’ll gradually be able to raise the bar (literally and figuratively).
Strength training with prolapse starts with breathing exercises and simple movement patterns but over time, it converges with any of the heavy, sweaty stuff you love to do.
Don’t expect that you can necessarily start with the heavy stuff. But if you’re patient with yourself, you can work back in that direction.
6) Thoughtfully and progressively return to impact activities.
As you learn to manage load well, start to explore impact.
Start by learning to absorb force (learn to land well). A drop landing is a great first exercise to explore landing mechanics.
Finally, learn to breath during dynamic impact activities. Depending on how symptomatic you are, you can ease in with Bounces or you can try Pogo jumps.
7) Understand that symptoms will vary day to day, week to week, and month to month.
Pelvic organ prolapse can be a tricky bitch. I’m just going to say it.
Some days you might have no symptoms, some days it might feel unbearable.
It’s really common for symptoms to vary in concert with your menstrual cycle. Pay attention to whether you’re more symptomatic at certain times of the month.
While you might have to tolerate an uptick in symptoms during that time, it can be less anxiety provoking to know it’s coming.
It’s also really common for symptoms to flare during times of emotional stress or illness. These upticks are typically transient.
8) Learn a few strategies to manage symptoms during exercise or activities of daily living.
Your workouts are a laboratory to explore your changing body.
Use structured exercise to learn to manage pelvic organ prolapse symptoms so that you can live your life outside of the gym with more ease.
You can also explore exercises to relieve acute symptoms of prolapse during exercise or activities of daily living.
9) You have to move.
Symptoms of pelvic organ prolapse don’t correlate with it’s physical presenataion. That means, just because your symptoms feel terrible one day- doesn’t mean your prolapse suddenly got worse.
And (tough love, apologies), you might need to learn to tolerate a certain amount of sensation so that you can walk, lift groceries, play with your kids, go for a hike and not worry about your vag.
You might need help with this. I did!
Work with a pelvic health physical therapist, mental health therapist, personal trainer.
Professionals can offer 1:1 support and strategy to meet your body exactly where it’s at and progress you back towards the activities you’d like to be doing.
10) Above all, remember: You’re more than your pelvic floor.
You can, and need to, learn to live with your prolapse.
There is so much more to life than prolapse and your prolapse won’t get better just because you’re missing out on all the good stuff.
Pelvic floor dysfunction sucks. And, you’ve always got movement options. Sometimes it takes a little support to find that perspective and get going.
You can absolutely live a full, vibrant, active life with prolapse symptoms.
My mission is to make sure that having a baby is not a reason why you can’t do all the things.
Contact me with questions about exercise or pelvic health pertaining to pregnancy or postpartum. I offer customized, online pregnancy and postpartum personal training to folks locally (Seattle-area, Bellevue, Redmond, Kirkland) and beyond.