When so many women have been told to avoid strength training, here’s how it can help heal prolapse symptoms. Strength training as a stand-alone activity is well-researched, with many benefits for physical health. These include; reducing the risk of cardiovascular disease, maintaining muscle mass, and improving bone and joint health, alongside benefits for mental health. Additionally, when combined with pelvic floor muscle training, strength training has been shown to improve leaking in older women (60+). This study by Virtuoso showed the combination of strength training plus pelvic floor muscle training was superior to pelvic floor muscle training alone.
Strength training combines three fundamental principles—overload, specificity, and reversibility and we can use these principles to answer the questions about strength training and prolapse. Most importantly, it supports the evidence that strength training is great for all women, even with pelvic organ prolapse.
Strength training principle #1 Overload
Overload – all muscles, including those of the pelvic floor, need increased work to build strength and endurance. Research by Dakic et al shows this is crucial for individuals dealing with prolapse. Given the daily demands on the pelvic floor, and the fact that life is a loaded activity, understanding and building overload is important. Overload doesn’t necessarily mean adding lots of weight (although that can be the case), it may also be increasing the tempo of an exercise, more time under tension, or a more challenging position. It’s not overloading the body in the sense that the body can’t cope, but more that gradually increasing load or demand yields improvement in capacity and strength.
Strength training principle #2 Specificity
Specificity dictates that training a muscle group must mirror its functional use and intensity (Dakic, et al). Lying on your back and squeezing the pelvic floor muscles is a useful starting point but does not mirror the physical demands of everyday life. Or the fact that we don’t live life on our backs! We live loaded lives! Looking at an essential activity – whether that’s carrying a child, shopping or a physical job allows us to create a specific programme to train such specific movements.
Strength training principle #3 Reversibility
The principle of reversibility underscores that the benefits gained through muscle training can diminish without regular exercise (Dakic, et al). Consistent exercise is crucial for maintaining pelvic floor strength and endurance. It’s often the reason that women experiencing prolapse symptoms feel weak and de-conditioned – it’s because advice given to them has made them weaker and more de-conditioned!
What about the mental impact of symptoms?
Research by Drage et al suggests that symptom severity doesn’t necessarily correlate with the grade or stage of prolapse. Rather, it’s the psychological distress that plays a significant role. Increased distress often leads to catastrophic thinking about the future, creating a distressing feedback loop that is hard to break. Coupled with advice about avoiding or giving up joyful activities, can lead to many women feeling stuck, more symptomatic, and scared to lift, train or exercise.
Hyper-focus with the pelvic floor can intensify symptoms, and heighten sensations of structural change (even if those are not occurring). Exercise, and particularly strength training can help change this narrative. By engaging in weightlifting, individuals can redirect their focus, experiencing sensations like muscle soreness or fatigue rather than prolapse symptoms.
Resistance training, including lifting heavy weights, is safe for individuals with prolapse, as highlighted in Forner et al’s study. Those lifting heavy weights did not exhibit an increased prevalence of symptoms compared to those lifting moderate amounts. This information can be reassuring for women with prolapse who want to strength train (and perhaps a suggestion that a stronger body is a useful tool in improving prolapse symptoms). This is something I see from my experience.
How to get back to strength training with prolapse but without the prolapse symptoms
PROJECT STRONG is my 1:1 personalised programme for clients with prolapse, who want to strength train and lift weights. This 4 month programme combines the principles of strength training, as well as gentle coaching so that client can improve symptoms, lift weights and build strength and confidence. Interested? You can book a call here to chat about the programme
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 publications such as Stylist, Marie Claire UK, Woman & Home, and Metro