Recovery and Returning to Exercise after Prolapse Repair Surgery
Surgery (and even pregnancy and birth) can be an interruption to the whole core system (and the whole person!) in addition to the pelvic floor. However, for both birth and surgery, women are simply told to “take it easy” and then “ease back in”. Or given rigid lifting and exercise restrictions, which increases fear of movement, and long term will decondition and weaken the body.
Now, for my active clients, “ease back in” gives them zero direction. For them, the knowledge gap IS creating a foundation and then building back up to harder, more demanding, and more complex movements. In a way that mirrors their healing timelines. This allows for very gentle, early movement but gradually builds so by the time they are “cleared for exercise”, they have already created a strong foundation. To then start adding some load – not lifting a heavy barbell or doing a 5km right away, but potentially being able to start holding an empty barbell.
The main considerations for women undergoing pelvic surgeries include;
- Strain on the new stitches in early healing so limiting demand and strain on the pelvic floor is important in this phase
- Individualised instructions and guidance; taking into account their life, work, kids etc
- Level of activity prior to surgery and post surgery goals
2 ways to reduce strain on the pelvic floor in early healing
- Exhale on exertion
- Build strength and capacity pre-surgery
But first, a bit about healing timelines:
The first phase of healing is the early stage – the focus is on protecting the wound and the pelvic floor from strain. From an exercise perspective, this is where breathwork, gentle connection, gentle movement and rest fits in.
Over this initial 6-week period, this might look like:
- Pelvic floor exercises
- Breathing in different positions but mostly in lying, side lying, all 4’s
- Pelvic floor connection in low demand movement eg exhale before exertion
- Gentle strengthening exercises such as glute bridges, ball press in all 4’s, light resistance band work, partial squats
- Gentle mobility
- Building up gentle walking
- Rest as needed
This can also be different for different people, depending on how someone feels post their surgery.
The second phase is the strengthening phase where fascial strength is returning and by week 20, fascial strength return to approx. 73-93%. From an exercise perspective, this might include longer walks, recumbent bike if comfortable, building up key functional movement patterns with load to help support activities of daily life and returning to exercise.
What this might look like:
- Adding some load in supported positions and smaller range of movement eg kneeling squats/hinges, floor press
- Supported bar work e.g. band assisted hanging and eccentric work for Crossfitters
- Continuing core and pelvic floor work, but adding in modified harder core exercises eg band supported sit up (using higher resistance bands to start with, as these offer more support)
- Longer and brisker walks
My Prolapse and Pelvic Floor Rehab programme LIFTED! Incorporates both of these phases.
What can you be doing before prolapse repair surgery?
Before your prolapse repair surgery is a great time to build strength – both pelvic floor and full body. A study of 200 women undergoing surgery, saw that pelvic floor muscle strength was a predictor for being in an improved group when leaking was measured using a pad test.
In postmenopausal women and those with comorbidities, pelvic floor muscle strength was significantly associated with improved postoperative outcomes. Building full-body strength also helps reduce strain on the pelvic floor so both can be useful (Zhang et al). More overall strength means greater capacity which can help reduce strain on the pelvic floor.
Understanding intra-abdominal pressure
Pressure management may be one of the reasons that prolapse has occurred – repeated downward pressure on a system already under pressure!
So, understanding what it is (that we can’t avoid it), and how to manage it can be helpful both pre and post-prolapse repair surgery.
Core Coordination
This video called, The Breath & The Core talks about the relationship between the core, pelvic floor and the breath. This can be a great starting point to ensure you go into surgery with the ability to know what “connecting the core with the breath” feels like. Post surgery, this connection forms the basis of early rehab.
In my opinion, going into surgery strong and educated is a big win!
You can find more prolapse and gynae surgery blogs here
Check out my 12-week Rehab Programme for prolapse repair surgery, which starts with breathwork and gentle movement, building up to squats, deadlifts and core work.
Beth Davies is a highly experienced personal trainer and coach specialising in female pelvic health, pelvic organ prolapse and exercise. Her programmes educate, empower and support women back to training or their active life, eliminating symptoms and building strength and confidence. She has been featured in women’s lifestyle magazines and websites, including Stylist, Metro, Woman & Home and Marie Claire UK
Beth’s training and coaching for women with pelvic organ prolapse provides face-to-face personal training in Leamington Spa, Warwickshire, and online across the UK and Europe.