What Factors Increase Your Risk Of Vaginal Prolapse
The main risk factor for prolapse is having had one or more vaginal births, with specific risk factors including:
- Forceps deliveries
- Giving birth to a baby over 4kg
Prolapse is not limited to only those who have delivered babies vaginally, however, with other risk factors including:
- Pregnancy
- Chronic Cough
- Heavy lifting
The main reason that pregnancy and vaginal childbirth are risk factors is because of their effect on what is called the levator hiatus. This is the name for the space in the pelvis between the two sides of the pelvic floor, and is essentially the gap into which things can fall.
Studies on women who have recently given birth show that this gap in usually increased from normal for up to 4-12 months after having a baby. This is one of the main things that Womens Health Physiotherapists will assess for when doing a vaginal examination at a postnatal assessment, because it helps to determine your individual risk for prolapse occurring or worsening with return to higher load or impact activities.
This gap would be increased more significantly, and more permanently, if the woman experienced a birth injury called a levator avulsion. This means one or both sides of the pelvic floor muscle having a partial or full tear away from the pelvis bone. This can also be assessed for with a vaginal examination.
Pelvic Organ Prolapse Exercises
If you do pelvic floor exercises, you can help strengthen the muscles and reduce the symptoms. At OneRehab, we will take you through a series of pelvic floor muscle strengthening exercises. Once we perform a detailed assessment, we create a personalized treatment plan to manage the pelvic organ prolapse. With time, the pelvic muscles tighten and become stronger, which repairs the conditions.
Prolapse Treatment Without Surgery: Can Postpartum Prolapse Heal Itself
The human body is incredible in its ability to heal and remodel tissue. Ive seen impressive resolution of prolapse, and Ive also seen prolapse that remains unchanged over time. Some women have the potential to heal completely, others have the potential to heal some, and others can live life without worrying about their prolapse at all, even though the grade doesnt change. They have learned to manage it.
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Safe Exercise With Prolapsed Bladder
Many everyday exercises can increase pressure on your pelvic floor and worsen your bladder prolapse symptoms or even contribute to repeat prolapse after already having had prolapse surgery. You need to make sure that you are fully informed about the exercises that are suitable for you if you are living with a prolapse.
1. Fitness exercises that reduce pressure on the pelvic floor
Fitness exercise should be low impact to reduce pressure on the pelvic floor. This means choosing exercises keeping one foot at least on the ground with exercise. This is quite different to high impact exercise such as running or jumping where both feet are off the ground. Low impact exercises include:
- Cycling
- Swimming
2. Strength training and abdominal exercises
Many everyday strength training and abdominal exercises have the potential to increase the downward pressure on the pelvic floor. These are some exercises to avoid with a bladder prolapse:
- Intense abdominal strength exercises and abdominal exercise machines which have the effect of increasing pressure on the pelvic floor
- Specific strength exercises such as leg press and wide leg squats that increase pressure on the pelvic floor and prolapse
- Heavy lifting and straining when lifting weights
- Breath holding when lifting weights-breathe out with the effort of lifting, pushing or pulling
- Plus sit on a ball or a bench for all your strength exercises wherever possible to support your pelvic floor
Find The Right Muscles
Find your pelvic floor muscles. Try one of the following ways to find the right muscles to squeeze.
- Imagine you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a pulling feeling in your vaginal or rectal area, you are squeezing the right muscles.
- While urinating, try to stop your urine midstream. The muscles you squeeze to stop the urine flow are your pelvic floor muscles. Though this is an easy way to find the muscles at first, dont do Kegel exercises while urinating on a regular basis. Stopping your bladder from emptying completely could increase your risk for a bladder infection.
- Women: Insert your finger into your vagina. Squeeze as if you were trying to hold in your urine. If you feel tightness on your finger, you are squeezing the right muscles.
- Men: Insert your finger into your anus. Squeeze as if you were trying to hold in your urine. If you feel tightness on your finger, you are squeezing the right muscles.
Let your health care professional help you. Many people have trouble finding the right muscles. Your doctor, nurse, or pelvic floor therapist can let you know if you are doing the exercises correctly. They can examine you while you do the exercises to verify you are squeezing the right muscles. They can also recommend exercise aids, such as biofeedback, electrical stimulation, or special weights.
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Unsafe Exercises That Made My Prolapse Worse
#1. Carrying my heavy toddler for long periods of time when tired.
#2. Trying to hold a newborn and cook/multitask at the end of the day.
#3. Catching my toddler jumping off a high surface at the playground.
#4. Jogging slowly on flat ground.
#5. Pullups.
#6. Planks on the floor.
#7. Walking and pushing a stroller for longer distances while tired.
Will Pilates Exercises Strengthen Your Pelvic Floor
If your pelvic floor is weak, some intense abdominal core Pilates exercises can overload and further weaken your pelvic floor. Women with prolapse or after prolapse surgery need to know about potentially unsafe Pilates exercises.
Some women with pelvic floor dysfunction mistakenly believe Pilates exercises will strengthen their pelvic floor.
Intense core exercises will not strengthen your pelvic floor if your pelvic floor is weak and not working well.
The more intense core abdominal exercises women perform, the more downward pressure they place on their pelvic floor. Some women actually develop or worsen pelvic floor dysfunction as a direct result of intense core strength exercises.
Pilates exercises and classes can be problematic for women who have had previous hysterectomy, prolapse surgery and/or incontinence surgery. Women with or at risk of pelvic floor dysfunction should be screened prior to attending Pilates sessions and their Pilates exercises modified accordingly if the risk of pelvic floor dysfunction exists.
Mainstream Pilates is not always an appropriate form of rehabilitation exercise when recovering from their surgery after recent prolapse surgery or hysterectomy.
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What Are The Different Types Of Pelvic Organ Prolapse
Symptoms Of Bladder Prolapse
The symptoms of bladder prolapse depend on the severity of the prolapse, your level of physical activity and the presence of any other type of prolapse.They include:
- urinary stress incontinence leaking urine when coughing, sneezing, laughing, running or walking, or urge incontinence, which is urgently needing to go and leaking on the way
- needing to empty your bladder more frequently
- inability to completely empty your bladder when going to the toilet
- recurrent urinary tract infections
- protrusion of the vaginal wall out through the vaginal entrance
- needing to go back to the toilet immediately after finishing passing urine.
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Core Abdominal Exercise And Prolapse
Scientific research shows that traditional intense core abdominal exercises increase the downward pressure on the pelvic floor and cause descent of the pelvic floor in women with pelvic floor dysfunction. The risk of injury seems to be increased with these exercises in women with previous vaginal delivery.
Some unsafe core exercises with a prolapse include:
- Sit ups / abdominal crunches
- Fit ball sit ups and medicine ball sit ups
- The Hundred
- Fit ball or Swiss ball sit ups and
- Abdominal exercise machines.
How To Correctly Brace Abdominal Muscles
Appropriate abdominal activation is important to avoid pelvic floor overload in women with prolapse problems.
Abdominal muscles should be gently activated by drawing the lower abdominal wall in towards the spine and maintaining this gentle contraction. The deep abdominal core muscles are designed to work gently all the time.
Strong bracing of the abdominal muscles strongly is inappropriate for women with prolapse or with pelvic floor dysfunction. Strongly bracing the abdominal muscles increases the downward pressure on the pelvic floor.
If you are living with a prolapse or after prolapse surgery it is wise to avoid unsafe abdominal exercises that can overload the pelvic floor. Pelvic floor safe abdominal exercises for prolapse are those that are matched to a womans pelvic floor capacity.
If you apply these expert guidelines to your exercise program, you will be more likely to avoid unsafe abdominal exercises for prolapse and protect your pelvic floor from dysfunction.
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Did You Know That Kegel Exercises Are Also Helpful For Men
Its true. Men with certain health and sexual health issues can also benefit from doing Kegel exercises. In men, these exercises can:
- Help improve incontinence .
- Help manage prostate pain and swelling that occurs with prostatitis and benign prostatic hyperplasia .
- Increase mens sexual pleasure through greater control of ejaculation and improved orgasm sensation.
How To Choose Safe Prolapse Exercises
The key questions to ask when choosing exercise with a prolapse are:
These following safe exercise selection principles apply to all forms of pelvic prolapse including
- Uterine prolapse
- Vaginal wall prolapse and
- Rectal prolapse.
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How Effective Are Pessaries
Well-fitting pessaries can support the pelvic organs in a way that reduces bladder and bowel problems or even makes them go away completely. They dont fix prolapses. But women dont always find a suitable pessary that is effective enough.
The use of a pessary is considered if, for instance, a woman wishes to avoid or delay surgery. About half of all women who use a pessary get by with it so well that they use it for several years or more. Pessaries can also be a good idea if pelvic floor exercises dont help enough on their own.
What Not To Do At The Gym
1. Drinking excessive amounts of water.
This crazy idea that the more water you drink the better is a load of clever marketing bunkum. There is no evidence that drinking more water that what our thirst dictates has any health benefits. In fact, excessive fluid intake can do the opposite it can put strain on the heart and, in extreme cases, lead to hyponatremia , risking seizures and even death.
Overfilling your bladder is not a good idea for the long term either if you regularly overfill it, the continual stretching of the balloon-like bladder muscle causes it to lose its elasticity, and eventually, its ability to empty properly. Thirst is the best guide as to how much you should drink.
2. Doing aerobic exercises when your pelvic floor muscles arent strong enough.
If you leak when you jog, skip or play sport, youre not alone. Studies consistently show about 30 percent of women have the same problem. But just because its common, doesnt mean its normal or OK.
Bladder leakage is due to the lax supports of your bladder and weak pelvic floor muscles. If they arent strong enough to withstand the pressures of high impact exercise, they need to be strengthened, just like any other muscles in the body.
You can get your pelvic floor muscles into better shape by doing pelvic floor exercises every day.
3. Doing resistance or core strength exercises that cause you to strain down.
4. Being constipated.
5. Wearing panty liners.
6. Not relaxing your pelvic floor muscles.
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Exercises To Avoid With Prolapse
This is a very important list to generate for yourself, and it will look different from person to person.
From a clinical perspective:
- Ive seen women who can go to their CrossFit workout and their prolapse feels amazing afterwards.
- Ive also seen women who could go for a run if they were feeling symptomatic and it would help to resolve all their symptoms.
- On the other hand, Ive seen women where running or heavy lifting contributed to their prolapse and made it feel worse.
- Ive given out squats as treatment to help improve prolapse symptoms.
- Ive also taken squats out of someones lifting plan because they werent able to manage pressure well.
- Some women have a hard time sitting at work all day, and thats what makes their prolapse worse.
- Others can go for a run, but going to a spin class or for a swim makes them feel worse.
As you can see, safe is hard to define because its all in you do something, not you do.
I also find that just trying to live life can be much harder than exercise. Usually women are very mindful of pressure during their workout, but getting the stroller into the trunk or picking up a kid throwing a tantrum compromises their pelvic floor.
Let me give you an example of my list of things to avoid that made MY prolapse worse in the beginning.
Stages Of Bladder Prolapse
The severity of bladder prolapse can be measured in several ways. Terms such as mild, moderate and severe are not always completely accurate, as they depend on a persons opinion, but are often used in day-to-day conversations to help people understand the severity of the prolapse.A more commonly used grading is:
- Stage 1 the bladder protrudes a little way into the vagina
- Stage 2 the bladder protrudes so far into the vagina that its close to the vaginal opening
- Stage 3 the bladder protrudes out of the vagina
- Stage 4 most severe form, in which all pelvic organs including the bladder protrude out of the vagina.
Many gynaecologists now use the Pelvic Organ Prolapse Quantification system, which measures in centimetres where the prolapse is in relation to the vaginal entrance to ascertain the stage of prolapse.
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Ask The Doctor: I Have Pelvic Organ Prolapse What Types Of Exercise Should I Avoid
Q.I have pelvic organ prolapse and work out at the gym almost every day. Are there any forms of exercise that will make my situation worse?
A. Pelvic organ prolapse results from weakened muscles and ligaments of the pelvic floor, which allow your bladder or uterus to drop and press against the walls of the vagina. You didn’t say what type of exercise you do at the gym, but there are a few you should avoidlifting heavy weights, especially over shoulder height high-impact aerobic activities involving jumping or hopping and sit-ups. You should check with a trainer at the gym to see how you can modify strength training, core exercises, and aerobics to reduce stress on your pelvic floor.
Of course, there is one activity you shouldn’t avoidKegel exercises, which can actually strengthen your pelvic floor. To do them, squeeze as if you are holding in urine, hold for three seconds, and release. Repeat 10 times as often as you can. After a few months, you may find that your pelvic floor is strong enough to let you increase the types of exercises you do.
Anne Fabiny, MD
How Can I Reverse Prolapse Without Surgery
Pelvic organ prolapse may be reversed without invasive procedures like surgery. Working on your pelvic floor system in a functional way can begin to reverse the prolapse descent.
If I have not said it enough, I will say it again: always talk to your provider if you are experiencing symptoms that interfere with your daily routine and you are worried about.
Your doctor may recommend Kegel exercises as the only form of pelvic floor muscle treatment. Kegel exercises are the favorite prescription within the medical field for weakness in pelvic floor muscles but it is essentially an old school approach that fails to work for many and makes things worse for many others. We strongly believe in a more functional approach to the pelvic floor one that incorporates the whole body for healing and works on integrating your pelvic floor into the whole system of pressure, load and movement.
Got Questions ?
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Safe Exercises That Made My Prolapse Feel Better In The Beginning
#1. Sprinting uphill.
#2. Squatting and deadlifting .
#3. Walking without pushing a stroller.
#4. Heavy upper body lifting for mid back muscles .
#5. Lower abdominal exercises.
This list has changed and continues to change, and so should your list! In the beginning, moving was mentally hard. I had to retrain the way my body handled pressure. It was frustrating! But also worth it!
Do Pelvic Floor Exercises Make A Difference
It takes time, effort and practice to become good at pelvic floor exercises/Kegels. It is best do these exercises for at least three months to start with. You should start to see benefits after a few weeks. However, it often takes two to five months for most improvement to occur. After this time you may be cured of stress incontinence. If you are not sure that you are doing the correct exercises, ask a doctor, physiotherapist or continence advisor for advice.
If possible, continue exercising as a part of everyday life for the rest of your life. Once incontinence has gone, you may only need to do one or two bouts of exercise each day to keep the pelvic floor muscles strong and toned up and to prevent incontinence from coming back.
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