Can I exercise with Pelvic Organ Prolapse (POP)? There is a lot of information on the internet around POP, some of which can be overwhelming for a new mom trying to navigate symptoms and taking care of a child. The pelvic floor is incredibly complex. But in many cases, a well-designed training program can do wonders for helping prolapse mamas get stronger, decrease symptoms, and in some cases, decrease severity or heal the prolapse altogether.While google may be filled with yes / no exercise lists, I'm here to tell you that exercising with Prolapse is possible. Full body strengthening is a key component of Pelvic Organ Prolapse healing and symptom management, and that's where I come in as your coach ;)

What have you heard about heaving lifting with Prolapse and exercise?

• Don't push a stroller

• Don't lift your child

• Avoid standing exercises

This advice isn't accurate, and quite honest - not helpful. As moms we need to be able to squat, carry, bend, and do all the things in #momlife. Ultimately, avoiding exercise altogether may also make POP symptoms worse. Instead of focusing on specific exercises making prolapse worse, we should instead focus on lifting with good form and strategy. No movement is inherently unsafe. It's more about how the movement is performed.

What is Pelvic Organ Prolapse?

 Pelvic Organ Prolapse is the organ(s) descending down into the pelvic cavity from where they should be sitting. This can happen when there is weakness or damage to the normal support of the pelvic floor. Risk factors may include: pregnancy / childbirth, instrumental delivery, chronic constipation, hysterectomy, and advanced age.The pelvic organs we most commonly hear about with prolapse are:- Bladder (Cystocele)- Rectum (Rectocele)- Uterus (Uterine POP) 

Images: www.healthwise.org

There are different “stages” of prolapse, ranging from minor to severe:

Stage 1: Organs still fairly well supported by PF

Stage 2: Organs have begun to fall, but are still contained inside the vagina

Stage 3: Organs have fallen to, or beyond the opening of the vagina

Stage 4: Completely fallen through vaginal opening

What do POP symptoms feel like? Oftentimes mamas talk of a sense of heaviness, vaginal pressure, difficulty with bowel movements, and/or a feeling like something is falling out.Quite honestly, a POP diagnosis can be scary and confusing. Dr. Google doesn't help. If you're feeling unsure, the best way to determine if you have POP is to be evaluated by a Pelvic Floor Physical Therapist, and in different positions. Where and how do you experience symptoms? Get checked there too.

Some Prolapse early Postpartum can be normal. In the initial weeks following delivery the pelvic organs have "a little give" so to speak during the healing process. Many women do not even know they have a prolapse postpartum, another reason why seeing a Pelvic Floor Physical Therapist can be so helpful in the recovery process.Pelvic Floor heaviness can sometimes also be the result of pelvic floor tension rather than Pelvic Organ Prolapse. The pelvic floor is stretched during birth. In response the pelvic floor may guard / clench to help with the healing process. Another reason to focus on gentle movement postpartum, diaphragmatic breathing, and avoiding heading back to intense activity too soon while the body is healing

.How can a Pelvic Floor Physical Therapist help? Treating POP often takes a multifactorial approach. I love collaborating with a team (it takes a village) when working with mamas. A Pelvic Floor Physical Therapist can:

• Check for Prolapse

• Evaluate pelvic floor muscle firing

• Provide manual therapy for tissue release

• Check for imbalances, muscle firing, and total body strength and function that impacts the pelvic floor (Ortho PT can do this as well)

• and so much more!

Find a Pelvic Floor Physical Therapist near you. 

Do I need surgery with Pelvic Organ Prolapse? It depends. In many cases, if you do have POP, you CAN make huge improvements that do not require surgical intervention. If the first recommendation is surgery, I do recommend seeing a Pelvic Floor Physical Therapist to review your options for conservative treatment. Most mild to moderate prolapses can be managed.Even as symptoms appear, it is important to remember that symptoms provide us with information. How can we do something different to create an environment where we can train without symptoms or fear, but with confidence?

Building Strength can improve Prolapse symptoms

Being a mom is a contact sport requiring us to lift, bend, and move in all sorts of directions. If you google "exercise with Pelvic Organ Prolapse" you'll often see advice discouraging POP mamas from heavy lifting. But, the advice is not helpful.Instead of "lifting will make you worse," we can focus on strategies to lift without symptoms and in a way that better supports our bodies and pelvic floor. No movement is inherently unsafe. It's about how it is performed. We need to empower moms to move, lift, and do so with confidence - NOT fear. This is another reason why I don't like to provide yes/no lists. As a coach my goal is to give you the confidence to move and help you do so in a way that feels good.

Why continue strength training:

1. When we avoid exercise altogether everyday tasks become harder, often leading to pressure down on the pelvic floor.

2. The Pelvic Floor often compensates for weaknesses in other muscles around the pelvis. We can get stronger to help support our pelvic floor too! Learning how to breathe, manage pressure, and perform daily tasks + lift weights is a must to function well in #momlife.

A gentle reminder that your body is not broken. Sometimes we just need to give it a chance to work. As a coach I like to start with learning about pressure regulation, breathing with good rib cage movement, coordinating breath to movement, building strength, and over time - progressing.

Step One: Mastering the Breath

Optimal breathing is the foundation for core and pelvic floor function. The pelvic floor must learn how to relax. When the pelvic floor is too tight we cannot take the muscle through its full range of motion and get a great contraction, which limits its ability to build strength.

• Inhale breath: diaphragm expands down and the pelvic floor responds by lengthening downward. If we carry a lot of tension in the Pelvic Floor it can be challenging to get a good inhale DOWN into the body.

• Experiment with breath in different positions: supine / side lying, quadruped, seated, standing. Being able to establish breathing patterns in all positions helps prepare us to exercise in these positions.

• Vary your breathing strategies: Exhale on exertion is a great place to start, but may not work for everyone. Another example? Exhale through the entire movement.

Together we spend a lot of time on deep breathing and getting a good 360 umbrella breath. Why? A good inhale sets our pelvic floor up for a natural recoil on exhale. A win win for the pelvic floor and pressure regulation :) 

Step Two: Coordinating Breath to Movement and Adding Challenge

Once you have a good understanding of deep breathing, we can start experimenting with more challenging exercises that require additional control. Progressing too quickly without establishing a more optimal breathing pattern / diaphragm function can often lead to bearing down when an exercise is too difficult, something we want to try to avoid with Pelvic Organ Prolapse. As a coach I monitor pressure regulation and control as we progress through movements. Outside of our sessions I know mamas need to pick up kiddos, push strollers, etc., so mastering this coordination and control can be applied to ALL the things. When starting to add more challenge I encourage you to play around with different exercises and tune in to how your body responds. There is no one right way to breathe, load, or align the body that works for everyone. Below are a few breathing options for you as you start to progress strength movements.

1. Just Breathe: Sometimes this is the biggest piece of advice I can offer. When things become difficult often our go-to strategy can be to hold our breath.

2. Exhale on Exertion (hard part of the movement): exhale, and do all the things. A go-to strategy to avoid bearing down under load is to exhale on the harder part of the movement. BUT, there's one important piece - you also need to get a good inhale :) Getting an expansive 360 inhale will initiate the natural recoil of the pelvic floor to lift upon exhale. If you're unsure, I recommend seeing a Pelvic Floor Physical Therapist.

3. Exhale through Exertion: Exhale breath lasts through full range of motion. Begin exhaling before you start moving, otherwise referred to as "blow before you go" (Julie Wiebe).

4. Inhale on exertion: for some it may be appropriate to inhale on the exertion portion. I recommend consulting a Pelvic Floor PT

5. Breath hold: While a breath holding strategy is possible (typically with max lifts), this would be more advanced. You hold your breath, maximizing Intra Abdominal Pressure. When done correctly this does not lead to excessive pressure down on the pelvic floor.Know that different strategies work for different people. Once you've mastered the breath in different positions and experimented with a strategy that works for you as you add challenge, we can then move on to building strength!

Step Three: Building Strength

When exercising with Pelvic Organ Prolapse there are four things I like to keep in mind when planning workouts and programs. The goal is to strengthen the body progressively, and in a way that doesn't create a high stress environment (too much too soon) so we can better manage pressure distribution in the body.

Below are four tips to keep in mind as you plan your workouts:

1. Vary your position:

limit the amount of time spent on your feet during one session, especially earlier postpartum / in your healing journey. We can switch it up from standing, seated, supine, side lying, add an incline, etc.

2. Progressive overload:

You can lift weights, progressing over time as you build strength, body awareness, master pressure management / breath mechanics, etc.- Example: Squat progression: starting with a kneeling squat before moving to a supported standing option.

3. Pay attention to the sensations in your pelvis before, during, and after your workouts:

Do you notice any heaviness, pressure, or bulging? Which position or exercise brought that on? Note that symptoms are feedback. Just because one movement brought on symptoms doesn't mean that movement is a NO forever.

Things to consider:

- Volume: Example: 2 sets of 10 we feel great, but adding the third set brings on symptoms. Take note.- Time of day: perhaps symptoms ramp up later on in the day?- Cycle: where are you in your cycle? Many find symptoms flare up around their period.- Stress

Now is a great time to truly tune in and adjust. Be sure to voice up to your coach too!

4. Incorporate pelvic floor / core breathing + release in your sessions:

I love incorporating some mobility, pelvic floor release, and diaphragmatic breathing during sessions. Feet up, pelvis bolstered is a great way to reconnect, de-stress, and come back to your breath and self, especially if symptoms ramp up.

Strength focus with Pelvic Organ Prolapse

There are many different components to returning to exercise with Pelvic Organ Prolapse, but one of the biggest is around improving strength of the pelvic floor (not just about kegels) and managing intra-abdominal pressure in day-to-day activities. Pelvic Floor strengthening is full body strengthening. Learning to eccentrically lengthen, contract, and then release the pelvic floor + surrounding musculature (especially the glutes) is key. Our goal is to learn how to coordinate with the system as a whole, a big piece in supporting overall function.

Postpartum I love to give the hips + glutes a little extra love. Oftentimes the pelvic floor compensates for weakness in other muscles around the pelvis, so you will see full body strengthening and extra pelvic stability and glute work weaved into your programming.

The glutes and the pelvic floor are BFFs, so incorporating glute training (especially eccentric) AND learning how to unclench is an important part of the healing process.

Quick reminders:

1. Unclench the booty: A go-to strategy for many of us may be to clench the booty while in standing. Our body may be searching for stability, and oftentimes we're unaware the clench is even happening! Booty clench also typically leads to clenching of the pelvic floor as well + super tight external hip rotators. Do you often feel like your outer glutes feel tight ALL the time?

I share tips in this post too. 

2. Continue to tune in for symptoms: heaviness, leaking, pain, doming, bulgy feeling. If we experience any bearing down (exhaling down and out vs up and in), then we're increasing muscular force on the pelvic floor, which is something we want to avoid.

Prolapse Friendly Strength Training Workout

Below is a sample full body workout. When training clients with pelvic organ prolapse I like to incorporate gravity neutral positions throughout so we can minimize time on our feet.

1A) Banded Hinge or Bodyweight Hip Thrust: 3 x 15

1B) Incline SA DB Chest Press: 3 x 8-12/side

**Hips Elevated Breathing between sets: 5-10 breaths

2A) Supported Box Squat: 3 x 10-15

2B) Seated Band Row: 8-12

2C) Half Kneeling Pallof Press:  10/side

Questions about strength training with Pelvic Organ Prolapse? Drop them below. I'd love to support you in your journey mama.

xoxo,

Erica