Being diagnosed with a pelvic organ prolapse can provoke mixed emotions, particularly if very little information is provided at the time of diagnosis or you have attempted self-diagnosis, and suspect you have the condition based on symptoms alone. The first year after having a baby can be particularly hard as improvements may be slow while your body heals from the amazing feat it just achieved – growing and bringing a whole new human into the world. If you suspect you have pelvic organ prolapse after childbirth, based just on your symptoms it is important to be assessed by a qualified practitioner. Symptoms such as heaviness in the pelvis or a bulge in the vagina can be common after having a baby and do not always mean you have a prolapse.
Women who are particularly active or want to start exercising after having a baby often find the changes in their pelvic floor difficult to process. There is inconsistent information and advice on the internet about what exercises are safe and not safe when you have a pelvic organ prolapse – it can be very confusing!
What exercises are safe with a pelvic organ prolapse?
The answer to these questions is not straightforward as it will be different for each individual. Research into appropriate exercise with pelvic organ prolapse is in the early stages. What we do know is that different women put different pressures through the pelvic floor while doing the same exercise. One person with a pelvic organ prolapse can run and not influence the prolapse, another woman might have worsening of symptoms and stage of prolapse after running.
Some factors that may influence the appropriate exercises include:
- Pelvic floor strength and dynamics
- Integrity of the supporting tissues around the pelvis
- Any other birth injuries or pelvic floor issues (e.g. bladder or bowel leakage)
- How long ago you gave birth
- Your obstetric history, including number of children
- What exercises you were doing before pregnancy, during pregnancy and after delivery
- Exercise techniques, posture and how much pressure is generated in the abdomen and pelvis through the exercise
- Breathing techniques during exercise
- Hormonal influences (e.g. breastfeeding, menstrual cycle)
- Genetic factors impacting on the strength and elasticity of the muscles and connective tissues
General guidelines are to avoid high impact exercises and heavy lifting as these exercises are more likely to challenge the pelvic floor and prolapse. However, this does not apply to everyone and may change through time. Some general exercises that you could try include:
- Walking, progressing to hill walking to get your heart rate up
- Seated cycling
- Light weights with more repetitions or lighter band work
If you have any heaviness or feeling of a bulge in the vagina during or after exercise, or if you experience any trouble controlling your bladder or bowel, this is an indication that your pelvic floor is not ready for that particular exercise just yet. Research suggests that general exercise alone does not strengthen your pelvic floor, so it is important to learn how to exercise your pelvic floor very specifically. The pelvic floor safe website provides some general recommendations, but they also suggest the best program is one specifically designed for you.
So what should I do if have a pelvic organ prolapse?
It is best to consult a women’s health physiotherapist who can assess the influencing factors mentioned in this blog and develop a suitable plan for you.
What can I expect at a consultation with a women’s health physiotherapist?
The pelvic floor physiotherapist will find out your specific challenges and what your goals are. With your consent, a vaginal examination will allow the physiotherapist to assess your prolapse, supporting tissues and pelvic floor muscle strength and dynamics to understand where to start. They can also assess your prolapse in upright positions and through some exercises to see how well you can support your prolapse with correct activation of the surrounding muscles. You will be given education to understand the examination findings and how this applies to you as an individual, information on exercise technique and advice on self-monitoring of your symptoms. Additionally, physiotherapists can often work with your exercise physiologist or personal trainer to put the plan into action. Through your transition back into exercise or towards your specific goals, your physiotherapist can monitor your prolapse and pelvic floor muscles to ensure you are on the right path. We are also able to answer any questions and reassure you along the way. If your initial management strategies are not working as you hoped, your physiotherapist can alter your management and refer to other health professionals as appropriate. A similar assessment and exercise plan can also be applied to women with pelvic organ prolapse at any life stage.
There is strong evidence to support the role of physiotherapists with additional training in women’s and pelvic health to treat a number of conditions across all life stages – from more commonly known pelvic health issues affecting women such as incontinence and prolapse, to pelvic and sexual pain concerns and also for helping children and adolescents with bed wetting or other bladder/bowel control concerns.
We hope the information in this blog has been useful and should always be considered in conjunction with an individual assessment with your physiotherapist and/or other health care provider skilled in the area such as a GP or gynaecologist.
We would love to help you manage your concerns and get you back achieving your goals worry –free!