Can I reverse the grade of my prolapse?
One of the things I frequently see on social media is the idea that a certain programme or approach can change (improve the grade of your prolapse). Is this true? Can an exercise programme improve your grade or reverse your prolapse? And I love to hear all the stories but equally, we can have a wider view of what success means.
So, I am going to put upfront what I think the heart of this conversation is:
Everyone’s capacity for change is different.
Plus, I want you to feel there are all kinds of options and possibilities.
Firstly, let’s take a look at how the grade or stage system works for pelvic organ prolapse.
Understanding prolapse grades or stages?
Prolapse is graded on the Baden-Walker scale which classifies a prolapse into a grade or stage depending on the level of descent
Stage 0 – no prolapse
Stage or Grade 1 – more than 1cm above the level of the hymen
Stage 2: within 1cm of the hymen (above or below)
Stage 3: between 1-2cm below the hymen
Stage 4: more than 2cm below the hymen
Image: Courtesy of POPUpPro course 2019
Can you change or improve a grade/stage?
Anecdotally, you will find examples of women improving a grade or stage (and I have clients who done this), so it’s also a good idea to look at the research alongside anecdotal evidence or personal experience.
The POPPY study “pelvic organ prolapse physiotherapY” which was a mutli-centre randomised controlled trail study, showed that individualised pelvic floor muscle training was effective in reducing symptoms of prolapse and improving quality of life.
A study from 2010 by Ingeborg Hoff Braekken et al asked “can pelvic floor muscle training reverse pelvic organ prolapse and reduce symptoms?” found that pelvic floor muscle training helped elevate the bladder and reduced frequency and bother of symptoms.
Wider research shows WIDE variability in the potential for change over time. This makes it hard to draw any conclusions. But what it does show is that prolapse is the result of a dynamic system and does not have a predictable course. Indeed, many women with prolapse find the grade stabilises, even as they age. Which provides hope for anyone who is fearful that living their life and doing the things they love will make their prolapse worse. Percentages are higher for regression (i.e. reducing a grade) than progression (becoming more severe) when it comes to prolapse.
Why might improving a grade be challenging
Prolapse can be due to many factors (outside of simply having a weak pelvic floor and is therefore simply a case of improving support to “put the organs back”). There is both active and passive support of the pelvic organs that may have been compromised. Plus, the degree of grade may offer more/less potential for change.
Some people may improve a grade, some may not – even when they have done the same things! Or when someone has seemingly done ‘nothing’ versus someone who has done ‘all the things’ to improve their prolapse.
Wild, right?!
The following are factors that may contribute to the development of pelvic organ prolapse
Aging
Hormonal changes
Vaginal delivery
Forceps delivery
High BMI
Chronic cough
Chronic constipation
Family history of prolapse
Connective tissue issue eg hypermobility
Levator Ani avulsion (LAA)
Some of these may lead to a permanent change in the position of the organs, therefore it is difficult to say that the organs can resume their previous position. Or claim that an exercise programme (or one specific exercise) can.
What can we control when it comes to pelvic organ prolapse?
Rather than focusing on changing the grade and making this the measure of success, let’s consider what may be within your control.
I think these 3 are a good start.
Symptoms
We have way more control over improving symptoms than we do changing grade because symptoms are a combination of a change in position of the organs + the way we feel about that change. Yes, symptoms can be incredibly complex because they involve the nervous system as well, but I believe there is a wider scope to improve them:
For example:
- Improving support for the organs (this may be pelvic floor muscle training and/or a pessary) can help improve the feeling of heaviness and reassurance that you have strength and good function “down there”.
- Feeling educated about pelvic floor dysfunction and your body can in itself improve symptoms (and this is backed by research)
- Understanding what makes your symptoms feel worse as well as what makes them feel better (so you can do more of those things that make them feel better)
How you feel about your body (and what your inner voice says about it)
The feelings we have about our bodies can be incredibly complex. They can be informed by so many different inputs. if you have pelvic organ prolapse, one of those inputs may be the words or language that a health professional used. In addition, you may have been made to feel your body is broken and dysfunctional.
IT IS NOT BROKEN
AND YOU ARE NOT DYSFUNCTIONAL
Bodies change ALOT and I know prolapse can feel like the change you never wanted, asked for, or even knew about. But it is incredibly common and more people than you think are navigating and managing prolapse.
Taking action
Taking action is a great way to feel more optimistic, and to make progress. If you feel sidelined by your prolapse diagnosis and have felt stuck and isolated, I can highly recommend taking action. This may be seeing a physio, signing up for a pelvic floor course, or setting your self some goals.
In summary
So, maybe the takeaway is this; chasing a regression can be a goal, but potentially may be more unpredictable than focusing on symptoms and moving forward with understanding, compassion, and optimism.
Here's how I can help
If you are an active female with pelvic organ prolapse and you’re trying to find your way back to strength training, running or CrossFit, here are 2 ways I can help:
Beth Davies is an experienced coach and personal trainer based in Leamington Spa. She works with women when they are in key phases of life transition; pregnancy, post baby and perimenopause. As well as those clients who are experiencing pelvic floor symptoms such as leaking, prolapse and pelvic pain. Beth creates coaching programmes which combine much needed education about female bodies, strength training, nutrition and gentle mindset work.
She has been featured in women’s lifestyle magazines and websites, including Stylist, Metro, Woman & Home and Marie Claire UK
Beth’s personal training and coaching for women provides face-to-face personal training in Leamington Spa, Warwickshire, and online across the UK and Europe.