I Have A Prolapse! What Exercise Can I Do?

So many of our patients diagnosed with a prolapse stop exercising. Exercise may exacerbate their prolapse symptoms, or they may be worried about making their prolapse worse. But exercise is so crucial to look after both physical and mental health.  One of the most common questions we get from our patients with prolapse is: what type of exercise am I able to do?
 

What is a Prolapse?

Pelvic Organ Prolapse is when one of the pelvic organs (bladder, uterus, rectum) moves out of its normal position and bulges into the vagina. Prolapse can occur in the front wall of the vagina from the bladder (cystocele), back wall of the vagina from the rectum (rectocele) and/or the top of the vagina from the cervix. Prolapse affects up to 50% of women. Learn more about Prolapse.
 

Common Symptoms Of Prolapse:

  • Sensation of a vaginal bulge
  • Dragging/heaviness in the pelvic area
  • Low back ache
  • Urinary or bowel problems such as leaking urine, difficulty emptying the bladder or bowels
     

What Type Of Exercise Can I Do If I Have A Prolapse?

In the past, many forms of exercise were considered ‘unsafe’ and not recommended for women with prolapse.  We know that low impact exercise is safe for all women who have a prolapse, regardless of the strength of their pelvic floor muscles.  Some examples include: 
  • Walking 
  • Swimming 
  • Seated cycling 
  • Low intensity water aerobics 
  • Low impact exercise classes 
  • Seated light weights 
  • Narrow squats and lunges 
To learn more about pelvic floor safe exercises, visit our blog 'Weak Pelvic Floor? 10 Safe Exercises To Get You Fit And Healthy!’ 
 
Recent research has investigating different types of exercise, and assessing exactly what is safe and what isn’t. Some forms of exercise such as Pilates was previously considered a risky type of exercise for women with prolapse. However, a recent study found that Pilates generates less pressure on the pelvic floor than every day activities like standing up and laughing!
 

Can I Lift Weights?

Until recently, weight lifting wasn’t recommended for women with prolapse.  However, another recent study1 by an Australian Pelvic Health Physiotherapist investigated this, and found that heavy lifting might not be as risky as once thought.  In some women it did exacerbate their prolapse symptoms, however in others, it actually helped their pelvic floor muscles and prolapse symptoms. 
 
The key message here is that women with prolapse should see a pelvic health physiotherapist to get their pelvic floor muscles checked, to make sure their muscles are strong enough to be able to support their pelvic organs sufficiently during weight training.  The level of strength needed can vary depending on the level of training you want to do, for example if you want to do heavy weights like Olympic lifting or Crossfit – your pelvic floor muscles need to be very strong! 
 

What About Running?

Running is a little more complicated. When running, there is pressure both from above the pelvis and from below the pelvis when your foot contacts the ground. Running requires co-ordination of the PFM and surrounding pelvic muscles, including abdominals and gluteal muscles. Running can be possible with prolapse, provided you have sufficient pelvic floor muscle strength to be able to counteract this force.  
 
Similarly to weight training, for anyone with a prolapse wanting to do regular running, it is recommended to have an individualised pelvic floor muscles assessment and high level strengthening program, to ensure your pelvic floor muscles are performing at a level that they can support your pelvic organs sufficiently during a run.
 

Can A Pessary Help?

A pessary is a device which is inserted in to the vagina to provide support to the pelvic organs and relieve prolapse symptoms. It can:
  • Allow you to return to exercise without feeling uncomfortable or bothered by the prolapse 
  • It can provide an option for those who may be at risk from running or heavy lifting to participate in these forms of exercise 
  • It may improve the effectiveness of pelvic floor muscle exercises
 
Your Pelvic Health Physiotherapist can assess, recommend and fit a pessary, if appropriate, in conjunction with your individualised pelvic floor muscle and general exercise program. It is important to note that pessary management is part of a shared care model with your General Practitioner or Gynaecologist/Urogynaecologist.
 

We Are Here to Help You Get Moving Again 

If you have been diagnosed with prolapse and are avoiding exercising, we are here to help.  Our physiotherapists will do a detailed assessment of your prolapse and pelvic floor muscles, and create a tailored exercise program just for you. We will work with you to achieve your exercise goals, and get you back to doing the things you love. 
 

References

Forner, L, Beckman E, Smith, E. Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey.  International Urogynaecology Journal 2020, 31: 1551-1558