Considerations for exercising with a prolapse

“Can I run if I have a prolapse?”

“Is it safe to workout if I have a prolapse?”

“Can I lift heavy stuff if I have a prolapse? Can I do CrossFit if I have a prolapse?”

If you have been diagnosed with a prolapse and found this blog, I feel it’s pretty safe to assume you have questions. Questions on whether or not moving and exercising will worsen a prolapse. Questions on whether or not it is even safe to exercise with a prolapse. If you found good ole google, you probably now think you need to avoid every movement in life— downward dog, running, lifting, squats, sit-ups, trampoline, ah heck no all of those are not
“pelvic safe”. Those will definitely make things worse… but will they? Fun fact, there aren’t really “pelvic safe” exercises. The good news is that MOST exercise is generally safe, even when you have a prolapse. Now, life everything in life there is a catch. You and I may be similar in a lot of ways, but we are also both different. So what works (and doesn’t work) for me, may actually work for you. The key to working out with a prolapse is find what works for YOU! Here are a few things to consider when exercising with a prolapse:

1. Am I ready? A lot of times mamas leave that 6-week check up and it’s like going from zero to sixty in 5 seconds flat. We go from a relatively low level of movement to returning to our pre-pregnancy exercise routine. While some women are able to do it, most mamas need to move slowly and rebuild. There’s a really awesome study that showed abdominal tissue following an abdominal surgery takes an average of 4 months for the tissue to return to 73-93% of its strength. Another study showed it takes about 4 weeks for the rectus abdominis to return to its normal length and 8 weeks for pelvic stability to return postpartum. Taking time to recover isn’ a sign of weakness, in fact it shows great strength to be able to move slowly and rebuild the body. Check out these two blogs about what it means to be cleared for exercise and how to jump back into fitness after having a baby.
   

2. What exercises do you WANT to do? Seriously, this is the most important question. I’m a little feisty right now because a patient just left the office after being told they couldn’t safely do any exercises except walk. This is a woman who loves to run, who loves to lift her children and play with them who was just told that she needs to remove things that bring her joy and frankly that’s BS. It isn’t my job to remove everything you enjoy doing and pigeon hole you into one type of movement. My job as a pelvic floor provider is to support you and help you optimize your body so that you can do what you love.  Think of it as the Marie Kondo of your exercise routine -do movements that bring you joy. Whether you want to lift 2x your body weight and run a marathon or just to pick up your kids and do yoga, my goal is to get you to reach YOUR goals.
   

3. Know what to look out for and listen to your body. If you find yourself leaking or passing gas at inappropriate times or you feel an increase in pelvic pressure or pain after exercise, those are signs it’s best to slow down and back off for now. Also, if you start to have burning or pain with urination, find yourself unable to empty your bladder or you frequently start and stop urination, then it is best to get evaluated by a pelvic floor provider. If you have an increase in low back pain, hip, groin, buttock pain or sciatica then getting personalized care is a great idea. If you’re worried about breastfeeding and exercising with a prolapse, check out this blog. The idea shouldn’t be to take any exercise away forever but instead develop a plan that is customized to your body, your mechanics and your goals that will help you get back to doing what you want to do. 

4) Working out with a prolapse isn’t about doing less. I don’t expect you to know the facts of exercising with a prolapse but I am okay if you call bull on other people who are trying to fear you out of moving. So here’s what the science currently tells us:
A) The pelvic floor is never “off” as it is always firing. The pelvic floor is considered tonic or active at “rest” which helps keep us upright…otherwise gravity would have us falling over. The pelvic floor also has an anticipatory action and will fire even before we move as well as a reflexive action in response to our movements.  Basically, this is a fancy way of saying that your pelvic floor is always working. Yes, it may benefit from improved strength or coordination or balance, or even from relaxing more but your pelvic floor isn’t a broken light bulb, it will continue to work.

B) The pelvic floor reflexive action actually increases with increased impact. A lot of times our bodies respond to the challenges we present to them. Think of this scenario: if you go and pick up a 45lb child without lifting anything the last three years then that kid will probably feel heavy to you and you will fatigue easily. On the other hand, if you have lifted this child from infancy and continued to do so for the last three years then the 45lb child probably doesn’t feel heavy because you have increased your strength and endurance over the last three years. Our pelvic floors really aren’t that different. The more we do, the more they respond. There have been a few studies that show running can improve a pelvic floor contraction and strength. Strenuous exercise (think CrossFit or HIIT) has also been shown to NOT increase prolapse. Additionally, regular exercises have been shown to have stronger pelvic floors. Often times when someone is diagnosed with a prolapse they are told to avoid lifting, avoid running and avoid a whole lot of movements but what’s more important is testing the limits.

5) Experiment and test the limits…find your new boundaries again and again. My four-year old is known for yelling at people, “how will you ever know if you don’t try” and gosh darn it, the girl is right. I know it can be scary at first but the best way to know what your body can do is to put it to the test. If your goal is to run a marathon, then start with a mile or two and build up. If your goal is to lift your body weight, start with mechanics, add a little weight and keep progressing. If your goal is to play with your kids, try it! Do whatever you want to do and see how you feel afterwards. The goal is to progress forward while respecting where your body is today. You may be a little sore and that’s okay! If you have 4-6/10 pain then go ahead and back down a bit. If you are a little sore but recover quickly, go ahead and test the boundaries. Pain isn’t a sign that something is wrong it’s actually just the brain recognizing there is something going on. There’s a really cool study that showed that the fear of pain may actually increase pain. So, instead of fearing pain or prolapse, I hope you feel confident in what your body can do and hopeful that you can continue getting stronger doing whatever you love.