In my last post, I covered more general information regarding pelvic organ prolapse like what it is, the three types of vaginal prolapses, what causes a prolapse, and what are some possible signs and symptoms of one. If you missed that post, you can go here for some further reading.
For those of you that would like the quick and dirty explanation of what a prolapse is -basically it refers to a weakening of the pelvic floor which allows for the organs in the pelvis to bulge down into or even out of the vagina (depending on the severity of the prolapse). Some symptoms of a prolapse include a feeling a heaviness in the vagina, experiencing incontinence or constipation, or actually feeling the organs bulging against the vaginal walls or down into the vagina. There are numerous reasons why a prolapse can occur. You don’t have to have been pregnant or have had a baby, but most often it happens as a result of pregnancy and childbirth.
So if you are pregnant, recently had your baby, or it’s been awhile since you birthed your baby and you have been diagnosed with a prolapse, please know that this doesn’t mean it’s the end of the road for your workout program. You can actually continue to exercise and lift weights once you have been given the green light by your physical therapist. You will just need to make a few changes to your program to ensure that you are exercising in a way that will support and strengthen your pelvic floor, and we will talk about those changes. But first and foremost –If you have any of these previously mentioned symptoms going on during or after pregnancy, the most important thing to do right now is to seek the help of a physical therapist who specializes in pelvic floor health. Before you start trying to strengthen and repair your body, you need to know what’s going on, so that you can be sure you’re not injuring yourself further and you can allow for proper healing to take place.
Once you know that it is okay for you to return to exercise, it’s important not to just dive back in to your old routine because it could very well set you back to zero or further depending on the degree of your prolapse.
The biggest goal of both postnatal and postpartum exercise, especially when we’re working with prolapse, is to avoid exercises and positions that will place too much pressure on the abdominal wall and pelvic floor. Exercise can be a fantastic method for supporting and managing your prolapse (when done PROPERLY), so there are some activities like the ones listed below that your physical therapist may have you steer clear of or significantly modify :
Potentially Harmful Activities
- Inappropriate Abdominal Exercises: All of the following exercises create too much intra-abdominal pressure. That pressure has to go somewhere within the abdomen and that somewhere is out against the abdominal wall and down onto the pelvic floor as the pressure pushes the pelvic organs even further into the pelvic floor.
- Front-Loaded Type Abdominal Exercises (belly hanging towards the floor): these would be exercises like planks, push-ups, bird-dogs.
- Crunching Type Movements: these types of exercises include all crunching variations, sit-up variations including the CrossFit style ones like butterfly sit-ups, wall-ball situps, and knees-to-elbow.
- Leg–Lowering/Raising Type Movements: these variations include leg raises, double leg raises/lowers, Pilates 100, full dead bug or more advanced versions of the dead bug, toes-to-bar.
- Some Weighted Exercises: There are certain types of weighted movements that you will want to be very careful with because they too can place too much downward pressure on the pelvic floor. These include:
- Barbell back squats, overhead squat, and front squats
- Conventional deadlifts
- Barbell and dumbbell cleans and snatches
- Heavily weighted dumbbell or kettlebell squats and deadlifts
- Machine leg presses
- Kettlebell exercises with ballistic movement like swings, snatches and cleans
- Deep weighted lunges and high step ups
- Lat pulldowns, pull-ups, and chin-ups, and overhead presses.
- Wide Legged Exercises: These types of exercises include:
- Lateral lunges, and lateral step-ups.
- Sumo deadlifts, sumo deadlift high pull, and wide-stance squats
- High Impact Aerobic and Plyometric Type Exercises: These types of activities include:
- Running, sprinting
- Jumping, box jumps, and jump rope
- Bounding, burpees, and leaping exercises
- Exercising or Being on Your Feet A LOT: In the days following the birth of your baby, you will want to be mindful of how much you are on your feet throughout the day. I realize that caring for a newborn will keep you going and on your feet a lot, but try and get off of them as much as possible. The same holds true for your workout program. You will want to limit the amount of exercises where you are standing on your feet a lot. The effects of gravity can take over on a weak pelvic floor and pave the way for a prolapse to occur.
Prolapse Friendly Pointers
Phew! That was a lot -I know. You may feel a bit hopeless after reading all of that, but keep in mind that you do have options to still be able to get in a great workout! So here are some tips to keep you feeling safe and supported as you manage your prolapse and work towards becoming a stronger mama!
- Pay Attention To Your Alignment: I talk about this frequently because it is so important, as it is the first step to ensuring your core and pelvic floor are strong and supported. A few pointers to remember:
- Get your rib cage stacked nicely over the hips. No flaring of the rib cage or pulling it excessively down towards the hips.
- Get your pelvis in a nice neutral position. No excessive anterior pelvic tilt or tucking the bum under.
- Leave the nice soft inward curve of your lower back intact.
- Leave your bum behind your upper back.
- Learn to engage your transverse abs and pelvic floor: Focus first on strengthening your transverse abs and pelvic floor and contracting them in unison with your breath. This support system gets tremendously weakened during and after pregnancy and we need to re-train these muscles to properly contract and engage again. Once you have achieved this, then you can move on to more pelvic floor friendly core exercises that emphasize a neutral spine.
- Choose Gravity Friendly Exercises: Limit the amount of time you spend on your feet and choose more exercises in the seated, lying, and side-lying positions.
- Pay attention to your breath: You need to incorporate your breath with every movement whether that is in the gym or during activities of everyday living. You will want to â€œset the systemâ€ for exertion by first inhaling through your nose and expanding the rib cage in a 360 degree direction with your breath. Also on your inhale, let the pelvic floor expand and relax. Before you exert (pick baby up, climb stairs, lift weight off the floor, etc.), exhale through your mouth as if breathing through a straw, pull-up the pelvic floor (think Kegel) and contract your tranverse abs -then go.
- Re-introduce weighted exercises cautiously: As you begin to load your movement with weight pay attention to how you feel in the core and pelvic floor. Are you feeling any pressure or heaviness in the pelvic floor both during and after your workouts? As I mentioned earlier, weighted exercises may not be appropriate for you depending on the degree of your prolapse. However, there are many other safe and appropriate exercise variations that you can still use.
- EASE back into exercise after your baby is born: Remember -your abdominals have been stretched and your pelvic floor weakened a little bit from pregnancy, so you need to get back into your fitness routine with lower impact exercises, and like I mentioned above, make sure that you don’t feel any heaviness, pressure, or pain both during and after your workouts.
Prolapse Friendly Strength Training & Aerobic Exercises
Below are some examples of exercises that you can safely do once you are given the green light to return to the gym:
Strength Training Exercises:
Upper Body Push: wall push ups, incline dumbbell chest press (one or 2 arms), supine dumbbell chest press.
Upper Body Pull: seated band/cable row (1 or 2 arms), kneeling dumbbell/kettlebell row (once diastasis is healed)
Lower Body Push: squat to box, body weight squats, body weight lunges, moderately weighted squats and lunges.
Lower Body Pull: glute bridges (2 feet, single leg, feet elevated), hip thrusts (body weight, banded, single leg).
- Anti-Extension: heel slides, heel taps (one foot on floor), dead bugs (one foot on floor), bent knee fall outs, seated foot raises on stability ball
- Anti-Rotation: supine, ½ kneeling, tall kneeling pallof presses
- Anti-Lateral Flexion: side plank from the knees
- Walking (flat and incline walking), biking (watch forward leaning), swimming, rowing (watch forward leaning and keep intensity low), low intensity water aerobics
So to wrap things up, you absolutely can exercise once you are at a place where your prolapse is being well-managed and you have received the â€œokayâ€ from your doctor/physical therapist. Just realize that you will have to make modifications here and there, but that doesn’t mean AT ALL that you can’t get a great workout done! It just takes a little creativity and safer exercise selection to build a program suitable for your needs. First and foremost though, if you suspect at all that you may be experiencing any of the symptoms described above, DO NOT hesitate to see your doctor and please don’t feel ashamed or embarrassed about seeking help. I am always listening and would love to hear from you!