First off - can you strength train with Pelvic Organ Prolapse? YES YOU CAN!

Exercise after a Pelvic Organ Prolapse diagnosis can be scary, and what you may read on google doesn’t help. That’s where having a Pelvic Floor Physical Therapist and Postpartum Fitness Coach (that’s me!) can help. A lot of moms I’ve spoken with are hesitant to move. Sometimes that fear in itself can ramp up symptoms. Part of my role is to help them move in a progressive safe way so they can get stronger, while also managing symptoms.

Telling moms to stop exercising (or stop moving their bodies) completely is bad advice. We need to provide moms with the right strategies to do so. Motherhood is a full contact sport. We have to twist, lift, walk, push, etc. in your day-to-day life. We generate pressure to help us perform these tasks. We generate pressure to help us produce force. Pressure isn't bad. But, we need to know how to manage it.

Exercising with prolapse requires learning new skills around breathing, pressure management, and lifting mechanics. But, once you have those foundational pieces in place, you should be able to move in all the ways you enjoy. Do not let your diagnosis define you.

The question should become - how strong can I get everywhere so I can support my pelvic floor?

Strategies to promote prolapse healing through exercise

1.Work with a Pelvic Floor Physical Therapist

Pelvic Floor Physical Therapists are musculoskeletal and neuromuscular experts, and they know all about the bones, muscles and nerves, and how they all function together. They are trained to evaluate your pelvic floor muscles, evaluate strength, and assess for different types of prolapse and other signs of pelvic floor dysfunction. A pelvic floor muscle assessment with them is way different than your experience with your OG/GYN. Learn more here.

A reminder too that addressing pelvic organ prolapse is more than pelvic floor weakness and kegels. A Pelvic Floor PT should be able to help you address POP from a whole body lens.

2. Learn the basics of pressure management

Pressure is not a bad thing. When pressure in your abdominal cavity is managed well, the pressure is equally distributed. The trouble becomes when that intra-abdominal pressure is mismanaged and we experience pressure “leaks” in the system.

Learning breath mechanics is one of the most effective ways you can work towards managing pressure and reducing demand down on the pelvic floor. I coach the connection breath, which includes coordination of the core and pelvic floor with our inhales and exhales. If we can get the ribcage moving and the thoracic and pelvic diaphragms coordinating together, we can better manage pressure flow. It will also feel really good :)

3. Tune in for bearing down

One of the biggest things you can do for your prolapse is understanding what it feels like to bear down. While there can be prolapse present because of tightness, POP can often appear from bearing down and a strategy of creating too much pressure. 

Not bearing down doesn't mean LIFT your pelvic floor all the time. This can sometimes lead to too much tightness. I often cue a tiny lift (~10% effort) to help with control, abdominal tension/connection, and support from below. The opposite of not bearing down is not tightening ALL the time. 

3. Bring awareness to body position, staying tall through the torso

Tuning in to your body position and tendencies can be very helpful for managing symptoms. Think of a puppet string on the top of your head and standing tall. Lengthen your torso equal front to back. A lot of POP mamas tend to be a bit scrunchy. Think about standing tall to help provide more support from below and taking that into exercise. Compressing the body from top to bottom compresses the canister and often pushes pressure down. 

Stand with confidence mama <3

4. Consider a pessary

A pessary is like a sports bra for your lady parts. They can be very helpful at reducing and managing prolapse symptoms. I encourage you to ask a URO-GYN and/or Pelvic Floor Physical Therapist if a pessary may be a good fit for you. They come in a variety of shapes and sizes.

5. Exercise Selection

Everyone is so different when it comes to exercise selection. I choose not to bucket exercises in “safe” versus “unsafe” when it comes to Pelvic Organ Prolapse. If you want to exercise with POP, we need to focus on the HOW vs the WHAT. Learning how to coordinate the breath, understand what bearing down feels like, and control changes and pressure in a way that supports our pelvic floor WHILE getting stronger are key.

I also encourage you to explore different strategies and what works well for you. We need to be able to inhale and exhale in a variety of ways under load, so perhaps exhaling in the concentric part of the movement isn’t the ONLY way ;)

Tune in to what exercise feel good in your body, and which ones ramp up symptoms. You may notice that certain exercises bring about heaviness. Hold off on those movements for now until you have a good handle on managing pressure in those positions and feel “safe.” Use your pelvic floor as the predictor of your current strength level.

Examples may be a wider stance squat, lunges, or more abdominal flexion movements like crunches. We can always explore other variations that do feel good in your body.

• Add props and/or references to help mom feel secure in a position.

• Play with position. If standing triggers symptoms, we can play around with half kneeling, tall kneeling, side lying, seated, prone (on belly), or supine (on your back) and progress over time.

  Remember this isn’t forever, just for now as we build up strength and confidence.

5. Working on the stack

Finding your body’s neutral position allows your thoracic and pelvic diaphragms to coordinate better and help manage pressure while under load. While I don’t expect you to go around all day in “neutral” (nor should you), focusing on finding that stacked body position sets the body up for success to respond to movement in any direction without compensation. Your core, diaphragm, and pelvic floor will be better able to do their thing!

More on the stack here and here.

7. Progressively Overload - Strength

The focus should become - how strong can I get everywhere so I can support my pelvic floor? Glutes, adductors, core, hip flexors, etc. We can take a progressive approach so we can build strength WITHOUT bearing down or doing too much too soon and wind up bearing down. Bearing down may be a strategy when things get too difficult, or when we haven't been taught how to breathe well. We have to learn how not to bear down, how to sense pressure, and how to manage it well (as noted above). Over time we can gradually begin to add resistance and challenge. Life happens standing, and motherhood often demands we lift heavy things (like a carseat), so over time we can progress.

Give yourself plenty of grace and time as you work through the process.

8. Progressively Overload - Impact

We can also think about progressing back to impact as well.

I like to coach:

• Taking off from the ground and generating the force to do so

• Landing: learning how to “yield” to the impact below

• Isometrics - generating stiffness and control, which can also be helpful for allowing the pelvic floor to let go

A great introductory movement is a 90/90 drop catch. We are sinking in and “catching” ourselves, but in a more supportive position. I also like a drop catch when more upright to explore landing with two feet. You can also place a bench behind you for a reference point.

When we think about “taking off” from the ground I love a sit to stand or sit to jump from a bench. You can use support or remove it. Over time we can build up to more dynamic activities in all planes of motion, adding mini hops, side to side movement, and single leg work. These are the types of movements I recommend exploring before heading out on a run too!

Remember that symptoms will vary for a variety of reasons: stress, point in your cycle, subsequent pregnancy, being on your feet for an extended period of time, stress, etc.

Working with a Pelvic Floor Physical Therapist, Personal Trainer, and a mental health professional can help you navigate the ups and downs of prolapse and management <3

I got your back mama. Questions on returning to exercise with prolapse? I’d love to chat.

xoxo,

Erica