Can You Exercise With Pelvic Organ Prolapse?

The short answer is yes!

Getting a diagnosis of pelvic organ prolapse can feel life-altering and scary. Does this mean surgery? Can I ever run again? Will things “fall out” if I lift something wrong? Can I pick up my toddler? Maybe you’ve also been told things like “you can never lift more than 10 pounds again,” which only added to the fear cycle. And while there’s absolutely a time and place for exercise and activity modifications, it does not mean you’re destined to never exercise again.

Interestingly, there was a recent study (Forner 2020) that showed that women who were sedentary or only lifted light weights were more likely to report symptoms than women who regularly engaged in heavy lifting. Yes, you read that right. Now, this doesn’t mean if you haven’t been lifting weights regularly that you should run out and start lifting heavy tomorrow. But what this does suggest is that strength may actually be protective against prolapse symptoms. We just have to be smart about how we get you there!

First, let’s do a quick review of what pelvic organ prolapse is. By definition, prolapse is the descent of one or more of the pelvic organs - bladder, uterus, or rectum - into, or beyond, the vaginal canal due to weakness or stretchiness of the support structures. Essentially, there’s a mismatch between the demands on the tissues and the amount of support they have. We can actively manage prolapse in a few ways, including increasing support and decreasing the pressure/pull on the pelvic organs.

So, how do we increase support? This might include strengthening of the core, hips, inner thighs, and pelvic floor, but it also might look like helping these muscle groups learn how to relax and lengthen under load so they can provide support through a full range of motion. Think of a trampoline: we need the springs and mesh of the trampoline to have give to them. When there’s force on the trampoline as the jumper lands, the trampoline is able to lengthen and descend; then the trampoline recoils back to a shorter position as the jumper enters the air again. If we only train muscles in a short position (think: kegels), then that trampoline gets rigid and can’t lengthen the way its supposed to.

How do we decrease the pressure (demands) down on the pelvic organs? Increasing pressure is unavoidable (eg. when coughing, lifting a laundry basket), but if we an give that force more area to be distributed through, then that means less pressure gets directed down through our pelvic organs and pelvic floor. Think of a balloon: if I squish part of the balloon while actively filling it with more air, the balloon is going to stretch in the part that I’m not squishing and that part might get stretched pretty thin, right? But if I let the balloon fill up and stretch evenly, I can put the same amount of air in the balloon but nothing is getting an unfair stretch. Things we may work on to increase the area / decrease pressure include: breathing mechanics, rib mobility, spine mobility, hip mobility.

You also might be a good candidate for a pessary, which you can think of like a bra for your pelvic organs. Pessaries can be a great option to exercise with peace of mind and fewer symptoms. This may allow you to get back to activities sooner or at a higher intensity than what your symptoms allow without pessary support.

At Terra Pelvic Health we believe that bodies are resilient and adaptable. If being active matters to you, then it matters to me. There are absolutely safe ways to exercise in the majority of mild to moderate stage prolapses - whether that’s working on improving strength, coordination, mobility, breathing patterns or more. You are not alone in this. Let’s get you back to living the life you love with confidence!