Which exercises are safe for prolapse?
You’ll often find discussions (especially online!) as to which exercises are ‘safe’ for pelvic organ prolapse. Here’s the thing, it totally depends! In fact of we were to compile a list of ‘safe’ exercises you might find they are all done in supine. Or all require you to engage the pelvic floor on every single rep. Or never introduce any weights. And this disregards how the pelvic floor actually works, the need to train in different positions (especial;ly standing) or the fact that load and muscle mass is super useful for the whole body and that includes the pelvic floor.
Before we dive into thinking about exercise, lets look at what pelvic organ prolapse is.
What is pelvic organ prolapse?
Pelvic organ prolapse is where the pelvic organs such as the bladder, rectum or uterus move position and bulge into the vagina. In the case of bladder or rectum (cystocele or rectocele) the lumps, bumps or tissue you see isn’t the organ itself but the vaginal wall. Alongside the subjective movement of the pelvic organs, there may also be subjective symptoms such as heaviness in the vagina, a feeling of dragging, a sensation that is similar to a ‘stuck’ tampon.
Causes of pelvic organ prolapse
The biggest contributory factor to the development of pelvic organ prolapse is a vaginal birth. And therefore pregnancy is also a risk factor for pelvic organ prolapse.
Other causes may include ageing, heavy occupational lifting, conditions with hypermobility, such as Ehlers Danlos Syndrome. Plus prolapse may also develop as a result of chronic coughing or constipation.
How do we decide which exercises are 'safe'?
Enter the term ‘it depends’ which I know is highly annoying but your body’s capability is your body’s capability. And this capability, capacity and strength can all be trained. So, rather than a binary list (which will differ for everyone), here are some considerations;
Pelvic floor strength and function
We want the strength, capacity and function of the pelvic floor to be able to match the demand placed upon it. It therefore makes sense to work on improving your pelvic floor function (if that is what is needed – a pelvic floor physio will be able to guide you on this). It is also important to remember that even if you have a strong pelvic floor, it needs to be able to:
- relax when needed
- contract when needed
- work automatically
- work as part of the core system
Your own experience and training history
If you are a seasoned lifter (like many of my clients), you are probably pretty good at lifting. It may be that no-one has ever told you how to incorporate the pelvic floor. Or how to avoid bearing down when you are bracing and lifting. Or how position, breathing and alignment may be useful tools for you when lifting weights.
You wouldn’t run a marathon (or any distance really) without training and the same goes for strength training. You wouldn’t pick up a heavy barbell without first learning how to do a bodyweight exercise, and then with dumbells before going on to heavier lifting.
When it comes to lifting weights with pelvic organ prolapse, you may benefit from working on lighter loads first. Or doing some lifts in supine before adding more load. This is a normal part of training and called ‘progressive overload’.
Your level of prolapse symptom 'bother'
Symptoms are highly subjective and complex! And 100% not always a reflection of the change in position of the pelvic organs. For example, you can have a grade 1 or 2 prolapse and have tons of symptoms or have a higher grade (such as a grade 3 prolapse) and yet be barely bothered by your prolapse.
For my clients with a high level of symptom bother, we generally start in supine and build up load, position and complexity. But there are no hard and fast rules! I am often guided by my clients in terms of what they feel comfortable with, their experience, desire to lift, symptoms and level of fear of movement.
Your ability to manage pressure
Changes in intra-abdominal pressure happen ALL THE TIME. You may find that some people will talk about avoiding intra-abdominal pressure to avoid ‘making your prolapse worse’. But this is nonsense as pressure changes due to speaking, movement, breathing and we can’t always be in control of these things. However, we do know that heavier loads lead to more intra-abdominal pressure or that high impact activities are also higher in intra-abdminal pressure. This doesn’t mean they should be totally avoided but consider how you can
- better manage pressure through breathing and bracing in a way that prevents bearing down
- build up loads and impact through gradual exposure
Conclusion for which exercises are safe for pelvic organ prolapse
It totally depends! But the great thing about training and movement is that we can increase strength and capacity of the whole body (as well as the pelvic floor). Load and exercises is not just a load on the pelvic floor but is shared load across the whole body! A stronger, more resilient and more capable body alongside a well functioning pelvic floor can better share this load!
Interested in finding out more about my 1:1 coaching? Click here to learn about my 1:1 coaching programme for weight lifters/strength trainers/gym lovers with pelvic organ prolapse by clicking here
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.