What are the best pelvic floor exercises for prolapse?
A contributory factor to pelvic organ prolapse can be the strength and support of the pelvic floor muscles, so it makes sense to look at some useful pelvic floor exercises if you have pelvic organ prolapse.
There are NO BEST exercises but we can consider the goal of 1) strengthening the pelvic floor and 2) helping the pelvic floor coordinate with the rest of the core & body
So, to begin with, let’s look at the role of the pelvic floor muscles.
The pelvic floor muscles have multiple roles:
- support of the pelvic organs
- keeping you continent
- relax to wee & poo
- relax and stretch to deliver vaginally
- for good sexual function
- support & stability within movement
And there are many reasons why pelvic floor muscles can weaken:
- pregnancy and birth
- age
- hormones
- occupational heavy lifting
- lack of support from other muscles and ligaments within the core and pelvis
Why do isolated pelvic floor exercises (e.g. Kegels)
There is a huge amount of research to support the role of pelvic floor exercises for pelvic floor dysfunction. I have added some of these below.
Contracting other related muscles is not recommended as replacement for Kegels
(Kruger et al, 2018)
Pelvic floor muscle training is still required to increase PFM strength and function
Not able to rely solely on physical activity or exercise to improve pelvic floor muscle strength
(Ludviksdottir et al, 2018; Middlekauf et al, 2016; Skaug et al, 2023)
Pelvic floor muscle training is an exercise that improves PFM strength, endurance, power, relaxation, or any combination of all of these (Bø et al, 2017)
Pelvic floor muscle training reduces pelvic floor muscle dysfunction in women participating in high-impact sports.
Pelvic floor muscle training improves maximal voluntary contraction and resting pressure. (Fukuda et al, 2022)
What's the issue with pelvic floor exercises?
As useful as pelvic floor exercises are, they do have some limitations, such as;
- they are only contracting and relaxing the pelvic floor muscles BUT we know that pelvic floor muscles also work with the rest of the core (and this works with the rest of the body)
- they are a long way from high impact or high load exercise and may not fully prepare the pelvic floor for this high level of demand
- they seem so simple yet can be so hard to do consistently especially if you are not seeing the progress you’d like or expect
So, it’s likely we might need MORE than just kegels – and this is totally ok!
Pelvic floor + functional exercises
Incorporating a pelvic floor exercise (aka Kegel) into a functional exercise can greatly strengthen other muscles alongside the pelvic floor. And we know that the pelvic floor is incorporated naturally into movement. We can do this by inhaling on the easiest part of the exercise and exhale (sometimes with a conscious and gentle lift of the pelvic floor) on or just before the hardest part of the exercise. For example:
Let’s illustrate this by using a banded squat.
With this exercise, I inhale as I sit back and come down into the bottom of a squat position.
Then exhale just before or as I return back to standing. The pelvic floor naturally engages but if you are re-training your pelvic floor, you may add a gentle and conscious lift of the pelvic floor as you come back up.
Using the hips, abs to influence the pelvic floor
A study by Ojukwu et al took twenty-one postpartum mothers with recent vaginal deliveries and performed six trials, including the typical Kegel’s exercise; two abdominal exercises (curl-up and abdominal hollowing); two hip adductor exercises (adductor ball squeeze and auto-resisted hip adduction); and a combination of abdominal, hip adductor and pelvic floor muscle contractions (combo).
Generally, the pelvic floor muscles were statistically significantly most active during the combo trial, compared to other trials. Comparing the two abdominals, Kegel’s and combo trials, pelvic floor muscles activity was least during the curl-up contraction. On the other hand, Kegel’s trial elicited the lowest pelvic floor muscles activity when compared with the combo and two adductor trials.
Abdominal and hip adductor exercises are recommended adjuncts of Kegel’s exercise but the combo maneuver was the most effective in activating the pelvic floor muscles.
Looking at the best pelvic floor exercises for prolapse means we need to consider both the pelvic floor alongside more functional movements.
If you would like to improve your prolapse symptoms whilst also improving your pelvic floor, core and whole body strength, check out my online rehab and exercise programme for pelvic organ prolapse.
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.