“Tell me what exercises I can and cannot do!” my clients beg of me. I wish it were that simple.
You have been diagnosed with pelvic organ prolapse (POP), but you desperately want to get back to the gym, zumba class or your daily walk with the dog. You want answers as to what is safe for you to do, those exercises that will surely make prolapse worse and those that are OK identified so you can confidently get back to some sort of activity. As physiotherapists, we used to label some exercises bad/unsafe and others good/safe. As research, and therefore understanding of body mechanics, has progressed, we now realize that it is not so much about the exercise itself, but rather about how the exercise is performed. Is the exercise too strenuous or just the right amount of challenge? What is your form like? Are you recruiting the optimal muscles or compensating with less ideal muscle patterns? Are you holding your breath? Are you supporting your internal organs from below via pelvic floor muscle activation?
Two of the most important considerations when discussing exercise and POP are the breath and intra-abdominal pressure (IAP), which are really one and the same. The thing we want to avoid with POP is unnecessarily increased IAP, which is the pressure inside the abdominal cavity. Think of a balloon with a hand wrapped around the middle of it. Now imagine the hand squeezing the middle of the balloon. What happens? The balloon bulges wherever there is least resistance. In the case of the human body, when there is an increase in IAP, pressure is transferred to the pelvis and undue pressure is exerted on the pelvic organs, pushing them downward. If the pelvic floor muscles are not strong enough to sustain and counteract the load from above, they can become overstretched and unsupportive over time. This, combined with repeated stress and stretch on the ligaments holding the organs in place from above, can lead to POP. Repeated heavy lifting, chronic coughing or straining to pass stool are all examples of activities that increase IAP, placing repeated stress on the pelvic floor muscles and pelvic organs, eventually contributing to the development of POP symptoms.
Research has shown that two individuals performing the same activity may have vastly different IAPs. Studies have demonstrated that everyday activities such as rising to standing from a seated position can create more IAP than previously black-listed exercises. This fact alone demonstrates that exercise prescription, particularly with diagnosis of POP, must be done on an individual basis. Therefore, when considering what type of exercise is “safe”, one must understand if IAP increases during that activity for that particular woman.
One way to minimize an increase in IAP is to maintain a steady breathing pattern. Breath holding is advised against. Typically, you will want to exhale on exertion. For example, if you are doing bicep curls, you will exhale every time you bend your elbows bringing your weights toward your shoulders and will inhale as you straighten your elbows. One way to combat any increased pressure from above is by doing a pelvic floor muscle contraction (kegel) on exertion (which aligns with your exhale). Think of doing a squat. You inhale on the way down and then exhale and engage your pelvic floor muscles (kegel) as you use your glutes to propel yourself back to a standing position. Important: most women require an internal evaluation to determine if they are doing pelvic floor muscle contractions (kegels) correctly, so be sure to book yourself in with a pelvic health physiotherapist if you haven’t already.
Speak to your physiotherapist about your current exercise goals, pre-diagnosis fitness level, current fitness level, severity of symptoms and activities that aggravate your symptoms. A pelvic floor muscle training program and inner core regimen is imperative. So is gradual return to exercise. A good rule of thumb is that if any activity increases your symptoms, reduce intensity, reps, duration, frequency, or load; an increase in symptoms is a sign of mechanical breakdown and that your body is being taxed beyond what it is currently capable of. Scale back the activity until you can do it at least a few times without an increase in symptoms. Then slowly increase one variable at a time (frequency, reps, intensity, duration, load, etc).
Some women choose to use a pessary only during activity- Crossfit, daily walk, dance class. This helps decrease their POP symptoms, as well as gives them confidence that their pelvic organs are being better supported. Think of a pessary like a bra for the pelvic floor! Give us a call today if you would like to discuss pessary use during physical activity.
If you are unable to see a pelvic floor physiotherapist right away, a prolapse-informed online resource developed by a pelvic floor physiotherapist can be found at https://www.madeforwomenworkouts.com/. However, suggestion of this resource is not intended to replace an assessment by a pelvic health physiotherapist nor to undermine the gold standard of an individualized exercise protocol.
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.