Constipation and Prolapse Simple Steps for Success

Constipation and prolapse is all too often a cycle of ongoing straining and progressive prolapse worsening. A number of simple steps can help to break this cycle and improve bowel movements, particularly if you suffer from prolapse constipation.

Read on now to learn:

• Symptoms of constipation and prolapse; and
• 10 expert tips and solutions for better bowel movements.

Symptoms of constipation and prolapse

Constipation with a prolapse may be characterized by:

• Hard and/or lumpy pellet-like stool consistency;
• Long-term straining to empty the bowel;
• Sense of incomplete bowel emptying;
• Sense of rectal blockage and/or obstruction;
• Needing to manually support (using fingers) to empty; and
• Emptying the bowels less than 3 times per week.

10 Expert tips for better bowel movements

1. Get your stool consistency right

Managing your stool consistency is the first and vital step for improving bowel movements with a prolapse. If your stool if too hard, it will be very difficult to pass. Good stool consistency requires adequate fibre intake (30 grams/day). Some women with constipation and prolapse make the mistake of consuming too much fibre. Too much fibre can overload the gut, a little like blocking the pipes causing constipation to worsen.

Foods known to soften the stool include: fresh fruit with skins on, garlic, red capsicum, nuts, popcorn, greens (broccoli, spinach, green beans and cabbage) and spicy foods. Caffeine is a bowel stimulant and prune juice contains naturally occurring laxative.

Fibre supplements can improve stool consistency  if your fibre intake is inadequate. Speak with your pharmacist or doctor about stool softeners if you are unable to achieve the correct stool consistency through diet alone.

2. Adequate fluid intake

Ensure that your fluid consumption is adequate. Fluid consumption of 2 litres per day is usually recommended for most individuals. Be mindful of the fact that insoluble fibre (in skins and grains) and some of the bulk forming laxatives commonly available (e.g. Metamucil and psyllium husks) require adequate fluid intake to avoid these obstructing the bowel and worsening constipation and prolapse problems. Fluid intake can be increased simply by including soups, jelly and fruits high in water content into your diet.

3. Have breakfast and a hot drink

Eating stimulates bowel motility. Skipping breakfast is a missed opportunity to stimulate your bowels at the start of the day. Some women find that a warm drink and walking around helps to promote the urge to empty their bowels.

4. Obey the urge

When you first sense the urge to empty your bowels, do so at the earliest convenient time. Never defer the urge to empty your bowels. Some women with constipation and prolapse lose the ability to sense when they need to empty owing to stretching of the rectum. When this happens routine emptying is most important to avoid overstretching the rectum and losing rectal sensation.

5. Take sufficient time

Allow sufficient time to empty your bowels, try not to rush. Sometimes the simple action of taking 5-6 slow deep breaths can help to relax the pelvic floor and facilitate bowel emptying. If you find that after a minute or two of relaxed breathing and sitting on the toilet that your bowels don’t move then get up and return to your daily activities. Plan your return when you next feel the urge to empty. Sitting on the toilet for long periods of time durations without an urge increases the likelihood of straining the pelvic floor.

6. Bowel movement position

Position for bowel movements with a prolapse:

• Sit on the toilet seat, never hover above the seat;
• Knees should be higher than hips (use a wide stool or a toilet roll under each foot);
• Lean forwards at your hips; and
• Maintain the normal inward curve in your back.

7. Bowel movement technique

Technique for bowel movements with a prolapse:

• Make your waist wide and bulge your abdomen forwards (i.e. barrel shape);
• Hold the breath you have, don't take a new breath. This technique relaxes and opens the anal sphincter to allow the bowel movement to pass as shown in our  How to overcome bowel movement problems online video; then
• Lift and squeeze your pelvic floor muscles when finished.

Pelvic floor support

Perform regular daily pelvic floor exercises to improve pelvic floor support. During bowel emptying the pelvic floor muscles provide a firm platform of support for the passage of the stool from the body. Strengthening your pelvic floor muscles can improve the firmness of the pelvic floor and enhance bowel emptying. This is particularly important for women who have a long history of straining as their pelvic floor supports are likely to be stretched and weakened.

Manual support can also assist emptying with a prolapse. Some women find that simple hand pressure against the perineum (between the vagina and anus) can provide pelvic support where it is naturally lacking. This technique does not harm the pelvic floor and can be most useful to avoid straining. Femmeze is a simple device that can assist women with rectal prolapse to empty their bowels without straining. Femmeze provides prolapse support during bowel movements, eliminating the need to manually support using the hand.

If you consistently incorporate these 10 simple steps for better bowel movements into your everyday life, you be more likely to avoid worsening of your constipation and prolapse problems. You may even find that your bowel movements actually improve despite your prolapse!Pelvic floor release

Inadequate pelvic floor release with bowel emptying is one major cause of constipation and prolapse. The action of straining and drawing the abdomen inwards strongly increases downward pressure on the pelvic floor and actually increases tightening of pelvic floor muscles and closing of the anus. This is the direct opposite to the desired effect of releasing the anal sphincter. Pelvic floor release is promoted by bulging the low abdomen forwards and with relaxed deep breathing.General exercise

General exercise helps to stimulate bowel motility. Research has demonstrated that moderate intensity exercise such as cycling increases the movement of wastes through the gut regardless of fluid and dietary input. Try to include regular low impact exercise such as walking or cycling as part of your daily routine. Be mindful of avoiding exercises with the potential to overload and strain the pelvic floor.

If you consistently incorporate these 10 simple steps for better bowel movements into your everyday life, you be more likely to avoid worsening of your constipation and prolapse problems. You may even find that your bowel movements actually improve despite your prolapse!

"Constipation and Prolapse" is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author of the internationally acclaimed exercise guide for women Inside Out – the essential women's guide to pelvic support

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Yoga Prolapse- Professional Guidelines for Women

Yoga practice has numerous potential physical benefits for women. This health professional article aims to assist women to continue safely with their yoga practice and protect or prevent prolapse. It outlines Yoga poses and exercises to improve prolapse support and those poses that may worsen prolapse symptoms and increase the likelihood of pelvic floor dysfunction.

Read on now to learn:

• Can yoga fix a prolapse;
• Yoga prolapse poses to alleviate prolapse symptoms and promote support;
• Can yoga worsen a prolapse; and
• Yoga poses to modify or avoid with pelvic floor dysfunction.

Can yoga fix a prolapse?

No, the only way to completely repair a pelvic prolapse is via surgery. Appropriate exercise can however alleviate and in some cases eliminate prolapse symptoms in women with mild to moderate prolapse.

Prolapse occurs when the supportive tissues within the pelvic floor and around the pelvic organs (bladder, uterus and bowel) stretch beyond their limit and lose their elasticity. When the supportive tissues lose their elasticity they become thin, floppy and weak. While pelvic floor muscles can often be rehabilitated with exercise, the pelvic floor connective tissues having once failed and stretched beyond their normal limits, cannot recover with exercise.

Yoga prolapse exercises to alleviate symptoms and promote support

These Yoga exercises and poses that may assist women with prolapse by improving pelvic floor support and alleviating symptoms:

• Mula bandha ("the root" or pelvic and deep abdominal core muscle exercise)- If performed correctly this exercise in should promote improved support for the pelvic organs. Mula bandha can be practiced on its own or incorporated into other poses such as Mountain Pose for improved prolapse support. Avoid strong abdominal muscle indraw particularly if the pelvic floor is at risk. The abdominal activation in this exercise must be gentle, if forceful it may have the capacity to force the pelvic floor and prolapse downwards, particularly with pelvic floor muscle weakness.

• Pranayama (breath exercise) can be valuable for women with prolapse. Breathing is closely integrated with the function of the pelvic floor, in fact the pelvic floor moves up and down in coordination with the breath. Some women with pelvic floor dysfunction need to attend to the breath before they can contract and relax their pelvic floor muscles.

• Tadasana (Mountain pose) may be a beneficial posture exercise for women with prolapse and pelvic floor dysfunction. Posture affects the pelvic floor with slumped posture increasing pressure on the pelvic floor. The pelvic floor and deep core abdominal muscles that support the pelvic organs (and prolapse) work most effectively when using the postural muscles effectively and maintaining a natural slight inward curve in the low back. Mula bandha in Tadasana (Mountain Pose) is an ideal combination of exercises to promote pelvic support.

• Inversions (Upside down/incline positions) may help to alleviate prolapse symptoms such as bulging and dragging however not all inversions are appropriate. Wall Flower Stretch will take pressure of the pelvic floor by elevating the legs. Wall Flower Stretch has potential to aggravate low back conditions in some individuals and should be either modified using cushion support to elevate the pelvis off the ground or avoided by those with or at risk of low back pain. Sarvangasana (Shoulder stand) may also provide prolapse relief by simply revering the effect of gravity on the prolapsed tissues. Shoulder stand has the potential to place force upon the neck and should be undertaken with caution and avoided by individuals with or at risk of neck pain and neck dysfunction.

Can Yoga worsen a prolapse?

Some Yoga poses like many forms of exercises in group classes may have the potential to increase pressure on the pelvic floor and prolapse. Women can often be guided by their prolapse symptoms; increased prolapse symptoms during and/or following Yoga may suggest that the exercises performed increased pressure on the prolapsed tissues.

Yoga poses to modify or avoid with pelvic floor dysfunction

1. Yoga intense core abdominal poses and exercises

Intense core abdominal Yoga exercises should be avoided or modified with a prolapse. Strong activation of the upper abdominal muscles increases downward pressure on the pelvic floor (and prolapse). If the pelvic floor cannot withstand the associated pressure it is forced downwards. If repeated with intense force or repeated often this can result in weakening of the pelvic floor muscles and connective tissues. This is why prolapse symptoms can feel worse after performing intense core abdominal Yoga poses.

• Double Leg Lift (modify by raising one leg only);
• Boat Poses (modify raising one leg only);
• Plank (shown above- modify by weight bearing through knees rather than through feet); and
• Uddiyana bandha ("belly lock") - this bandha should be avoided by women seeking to avoid increasing pressure on their prolapse. The action of drawing the abdomen in strongly and simulating an in breath increases pressure within the abdomen which is transferred directly down onto the pelvic floor.

2. Deep squat poses

Avoid poses involving deep squats to reduce pressure on the pelvic floor including:

• Garland Pose; and
• Noose Pose.

3. Forward bends with wide legs

Avoid or modify wide leg forward bends which increase downward pressure in a vulnerable wide leg position such as Forward Bend with V-Legs.

4. Upper body weight bearing

Weight bearing through the upper limbs increases downward pressure on the pelvic floor with poses such as Crane Pose.

"Yoga Prolapse " is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author of the internationally acclaimed guide for women Inside Out – the essential women's guide to pelvic support

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

How to choose the best pelvic exerciser when starting out? Benefit from physiotherapist experience and knowledge with the following information.

Read on now to find out:

• What is a pelvic exerciser;
• How to choose the best exerciser for your needs;
• How to know which exerciser will best fit you; and
• How to choose a stength exerciser when first starting out.

Plus a ready user guide and checklist for choosing the best pelvic strength exerciser for your pelvic health needs.

What is a pelvic exerciser?

A pelvic exerciser is a pelvic floor device designed to promote strength and recovery of the pelvic floor muscles. Using a pelvic exerciser can help you strengthen, monitor your strength gains and help motivate you to keep exercising.

How to choose the best pelvic exerciser for you?

• To strengthen pelvic floor muscles- Choose pelvic exercise balls (shown right) or vaginal weights/cones;
• To learn how to contract pelvic floor muscles correctly- Choose a feedback device e.g. The Pelvic Floor Educator; or
• To activate very weak pelvic floor muscles- Choose an electronic stimulation device e.g. Pericalm.

How to choose a pelvic floor strength exerciser

It can be confusing to know which pelvic exerciser will suit you best for improving pelvic floor strength. You will need to choose between using pelvic exercise balls or weighted vaginal cones.

Your choice depends upon:

1. The strength of your pelvic floor muscles: and
2. The size of your vagina (to ensure that your exerciser fits comfortably and stays in position).

When starting out choose an exerciser that allows you to use a light weight. This will help to promote using the correct exercise technique and avoid overloading the pelvic floor. If you are unsure about your technique avoid using a heavy exerciser.

How to know which exerciser will fit best?

Pelvic exercise balls are ideal for women with a moderate to large sized vagina. The narrow cone exercisers (shown right) are more likely to move out of position when used by women with a moderate to large vagina and are better suited to women with a smaller vagina.

Your vaginal size is most likely to be moderate to large if you:

• Have had one or more vaginal deliveries;
• Use super size tampons; and/or
• Measure your vagina to be 2 finger spaces or more in width.

Guide to choosing a pelvic strength exerciser

Checklist for choosing a pelvic exerciser

When choosing an exerciser, ensure that it:

1. Is suitable for the size of your vagina - Small, medium or large;
2. Provides appropriate weight for your current pelvic floor strength - Weak, moderate or strong;
3. Is part of a progressive exercise set – Buying a set allows you to readily progress your resistance;
4. Can be progressed if not part of a set- Some exercisers can be purchased individually e.g. Laselle
5. Is manufactured from quality material – Some cheap poor quality exercisers will quickly erode;
6. Is manufactured from safe materials – Ensure that your chosen exerciser is safety approved;
7. Is easily cleaned- Ensure that your exerciser can be readily cleaned for hygiene after use; and
8. Trains the correct pelvic floor action – The exerciser should train an inward lift of the pelvic floor muscles and a squeeze. Some of the spring-loaded exercisers only train the squeeze action. Pelvic exercise balls and cones do train the correct pelvic floor muscle action.

For further information regarding how to choose a pelvic exerciser please contact us or visit our Pelvic Health Store.

"Pelvic Exerciser – Easy How to Choose Guide" is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author of the internationally acclaimed guide for women Inside Out – the essential women's guide to pelvic support

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Read on now to learn the answers to these prolapse exercise questions:

• What is prolapse exercise?
• What do prolapse exercises do?
• Who can benefit from prolapse exercise?
• How pelvic floor exercises for prolapse can help
• Can exercise fix my prolapse?
• What is the correct technique?
• How many exercises? How often?
• Mistakes to avoid with prolapse support exercise
• How long will it take to see exercise benefits?

  Download Prolapse Exercise guidelines as a user friendly PDF

What is prolapse exercise?

Prolapse exercise is exercise designed to improve prolapse support and protect a prolapse from worsening. Prolapse exercises are specifcally for the pelvic floor muscles and are known as pelvic floor exercises. Pelvic floor exercises strengthen and help to restore the pelvic floor muscles.

Prolapse occurs when the pelvic floor muscles and tissues weaken and stretch. This decreases support for the bladder, uterus and bowel (pelvic organs). When these organs lose support they can prolapse or bulge into the walls of the vagina (cystocoele, rectocoele), move down into the vagina (uterine prolapse) and/or protrude from the rectum (rectal prolapse).

What do prolapse exercises do?

Prolapse exercises train and rehabilitate the pelvic floor muscles. These exercises aim to:

• Increase the strength and thickness of muscles for prolapse support;
• Lift the pelvic floor to sit higher within the pelvis; and
• Increase the stiffness of the pelvic floor making it more resistant to strain.

Who can benefit from prolapse exercise?

Pelvic floor exercises can help to reduce and in some cases overcome prolapse symptoms in women with mild to moderate prolapse. It may well be that improving prolapse support can delay or avoid a  prolapse from worsening.

Women with severe prolapse are prescribed pelvic floor exercises to improve the outcomes of prolapse repair surgery by improving pelvic floor support. Women with severe prolapse may benefit from strengthening their pelvic floor prior to prolapse surgery rather than waiting until after it has taken place.

How pelvic floor exercises for prolapse can help

Pelvic floor exercises may assist prolapse sufferers in a number of ways:

• Reduce prolapse symptoms;
• Delay or avoid prolapse progression;
• Improve prolapse support following prolapse repair surgery;
• Improve bladder control; and
• Improve bowel emptying.

Will exercise fix my prolapse?

No, it is not possible to completely fix a prolapse with pelvic floor exercise. A prolapse is like a hernia of the pelvic floor tissues. The only way to completely repair a prolapse is via prolapse surgery. Exercises can however improve prolapse symptoms and restore pelvic floor strength and support.

What is the correct technique for prolapse exercises?

Pelvic floor exercises for prolapse involve lifting and squeezing the pelvic floor muscles. This feels like and involves a lift and inwards squeeze of all three pelvic openings (vagina, urine tube/urethra and anus).

Exercises for prolapse feel like:

• Lifting and squeezing in and around the anus or back passage as if trying to avoid passing wind;
• Lifting and squeezing inside the vagina; and
• Lifting and squeezing in and around the entrance to the urethra (urine tube) as if trying to stop or slow the flow of urine.

Tips for more effective exercises for women with a prolapse:

• Reposition your prolapse within your vagina before your exercises if it tends to protrude;
• Commence your exercises lying down to minimise drag on your pelvic floor;
• Attend to your posture, slumped posture decreases the effectiveness of pelvic support exercises;
• Practice your exercises at the start of the day when your prolapse will not be dragging as much as at the end of the day; and
• Using a vaginal pessary may help to lift the prolapsed tissues off the pelvic floor, thereby making pelvic floor exercises easier to perform with a prolapse.

How many pelvic floor exercises? How often?

• Pelvic floor exercises for prolapse support should be performed daily;
• Aim to perform up to 8 pelvic floor exercises in a row;
• Try to maintain each exercise for up to 10 seconds;
• Relax and rest your pelvic floor muscles between every attempt; and
• Repeat this up to 3 times daily for a maximum of 24 daily exercises.

When starting out

If your pelvic floor is weak it is unlikely that you will be able to initially perform this quantity of exercise. Focus upon using the correct technique and maintaining your pelvic floor muscle contraction for as long as you are able to do so. For some women this will initially be for 1-2 seconds a time. Gradually build up the duration of your pelvic floor muscle exercises and the number you can perform in a row as your strength improves over time.

Mistakes to avoid with prolapse support exercises

• Pushing the pelvic floor down rather than lifting it up;
• Breath holding during pelvic exercises – breathe normally throughout; and
• Squeezing the buttocks and thighs instead of the inner pelvic floor muscles.

How long will it take to see exercise benefits?

It can take up to 5-6 months of regular exercise to strengthen weak pelvic floor muscles. Some women start to notice that their prolapse symptoms start to decrease 3-4 weeks of daily pelvic floor exercise

Pelvic floor exercises for improved prolapse support will only benefit women with intact pelvic floor muscles. Women with prolapse who do not notice any improvement in their pelvic floor strength, and those who are unable to contract their pelvic floor muscles should seek pelvic floor rehabilitation treatment from a trained health professional.

"Prolapse exercise" is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author of the internationally acclaimed guide for women Inside Out – the essential women's guide to pelvic support

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

How to choose safe exercises, manage your weight and maintain your fitness if you've been diagnosed with a prolapse? These pelvic floor physiotherapist guidelines teach you how to exercise safely and protect your prolapse.

Read on now to learn about:

• Prolapse and pelvic floor weakness
• Can exercise make a prolapse worse?
• How to choose safe exercise for prolapse?
• Prolapse and fitness exercise
• Prolapse and resistance or strength exercise
• Prolapse and core abdominal exercise
• Prolapse and exercise classes

  Download this Prolapse and exercise professional article as a user friendly PDF

Prolapse and pelvic floor weakness

A pelvic prolapse can occur with any of the pelvic organs including the bladder, urethra (urine tube) uterus and rectum. A prolapse occurs when the pelvic floor supports weaken and stretch allowing the pelvic organs to bulge into the walls of the vagina (vaginal prolapse) or from the rectum (rectal prolapse). The pelvic floor supports include the pelvic floor muscles and the strong pelvic floor tissues that hold the pelvic organs in place.

A prolapse usually occurs in women (and men) who have weakened pelvic floor support. The pelvic floor is commonly weakened and prolapse caused by:

• Inappropriate exercise;
• Pregnancy and childbirth;
• Obesity and overweight;
• Chronic straining with constipation;
• Chronic coughing;
• Menopause and ageing; and
• Previous pelvic surgery.

Can exercise make prolapse worse?

Yes, some forms of exercise can weaken the pelvic floor and worsen a prolapse.

If you have a prolapse you are likely to have weakness in your pelvic floor muscles and supportive tissues. This makes your pelvic floor more prone to injury since it is less resistant to pressure and strain. Exercise places downward pressure on the pelvic floor (shown right) If the pressure is too great for the pelvic floor to withstand, the pelvic floor muscles becomes stretched, weak and floppy and less able to support your already prolapsed organs. This is how prolapse can become mere severe with inappropriate exercise that is not matched to the existing strength of the pelvic floor.

How does a prolapse become worse with inappropriate exercise?

Prolapse and weak pelvic floor supports ⇒ inappropriate exercise causes pelvic floor strain ⇒ progressive stretch and damage to pelvic floor tissues ⇒ progressive weakness of pelvic floor ⇒ decreased prolapse support ⇒ prolapse worsens in severity

How to choose safe exercise for prolapse?

The key questions to ask when choosing exercise with a prolapse are:

1. How much downward pressure and/or strain does your chosen exercise place upon your pelvic floor?
2. How strong and well functioning is your pelvic floor? How well can your pelvic floor provide support to counteract the associated downward pressure?

These following safe exercise selection principles apply to all forms of pelvic prolapse including;

• Uterine prolapse;
• Bladder prolapse;
• Vaginal wall prolapse (cystocoele/rectocoele); and
• Rectal prolapse.

Prolapse and fitness exercise

High impact fitness exercise involves exercising with both feet off the ground at the same time. The impact of landing forcefully increases the downward pressure on the pelvic floor and prolapse. The pressure of body weight is transferred to the pelvic floor and lower body. This is why prolapse symptoms often feel worse inappropriate fitness exercises such as running and jumping. When repeated over extended duration, high impact exercise can progressively stretch and strain the pelvic floor supports.

High impact exercises that may compromise the pelvic floor include:

• Running;
• Jumping;
• Skipping; and
• Some dance exercises.

Fitness and weight loss/management exercise can be readily modified to protect the pelvic floor and remain highly effective. Low impact exercise is the key to reducing impact on the pelvic floor. Low impact exercise is exercise with at least one foot in contact with the ground at all times.

Low impact exercises that are pelvic floor safe include:

• Walking;
• Cross trainer;
• Road cycle;
• Spinning or indoor cycle classes(stay seated and chose low gears);
• Water based exercise;
• Low impact fitball classes; and
• Low impact fitness classes.

Prolapse and resistance or strength exercise

Safe strength training with a prolapse is very feasible, however traditional strength training programs are designed for men and often fail to apply pelvic floor safe strength training principles

Pelvic floor and prolapse worsening during strength training is more likely with:

• Heavy lifting and straining;
• Specific strength training exercises; and
• Unsupported positions when lifting (i.e. standing).

Strength exercises that increase pressure on the pelvic floor:

• Wide leg deep squats;
• Smith machine squats;
• Leg press (seated and incline); and
• Weighted abdominal core strength exercises.

Prolapse and core abdominal exercises

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.

Potentially unsafe core exercises with a prolapse include:

• Sit ups / abdominal crunches (shown right);
• Fit ball sit ups and medicine ball sit ups;
• The Hundred (Pilates);
• The Plank;
• Fit ball or Swiss ball sit ups; and
• Abdominal exercise machines.

Prolapse and exercise classes

Some general exercise classes include exercises that may increase the risk of prolapse worsening with increased pelvic floor pressure. General exercise classes are designed for mainstream, not for women with pelvic floor prolapse. This means that exercises general exercise classes may be unsuitable for prolapse and require modification. The temptation in general exercise classes is often to perform intense and unsuitable exercises with the potential to worsen a prolapse.

Tips for exercise classes and prolapse:

• High impact exercise classes – many of these exercises can be modified to be low impact.
• Strength training/resistance classes can include inappropriate strength exercises and techniques. These can often be modified or alternative pelvic floor safe strength exercises performed.
• Core training classes-intense core exercises will increase the likelihood of pelvic floor and prolapse strain. Core exercises can also be modified using techniques to reduce the intensity of the exercises on the upper abdominal muscles in particular.

If unsure about any exercise either leave it out or speak with your instructor for alternative exercises. Be mindful of the difficulty of catering to a large number of individuals with wide ranging abilities and expectations with pelvic floor safe exercises in group exercise.

"Prolapse and exercise" is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author and presenter of the internationally acclaimed Inside Out Pelvic Floor Safe Exercise Program for Women consisting of Inside Out – the essential women's guide to pelvic support and Inside Out pelvic floor safe workout DVD.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

Read on now to learn all about:

• Prolapse and pelvic support
• Prolapse and running- who is at risk?
• Will my prolapse get worse with running?
• Tips for how to reduce the pelvic floor impact of running
• Tips for how to improve pelvic floor support for exercise

  Download Prolapse and running article as a user friendly PDF

Prolapse and pelvic support

Pelvic prolapse results from inadequate pelvic floor support.  Lack of pelvic floor support is caused by weakness in the pelvic floor muscles and connective tissues. When the pelvic floor muscles and tissues weaken, they become less able to support the pelvic organs (including the bladder, uterus and rectum). The direct result of this lack of support is pelvic prolapse when the pelvic organs protrude into the walls of the vagina (cystocoele, rectocoele), descend into the vagina (uterine prolapse) and/ or out of the rectum (rectal prolapse).

Prolapse and running – who is at risk?

Some runners are more at risk of prolapse problems than others including individuals with:

• Pre-existing prolapse;
• Previous pelvic surgery;
• Pelvic floor muscle weakness and dysfunction;
• Long distance runners; and
• Road runners.

Some women are more at risk of prolapse with running including those:

• During postnatal recovery from childbirth;
• Previous vaginal delivery;
• Following previous traumatic vaginal delivery; (forceps, breech);
• Multiparous (multiple births);
• With menopause and beyond;
• Obese and overweight;
• Suffering chronic constipation and straining;
• With chronic cough; and
• Family history of prolapse.

Is a prolapse made worse with running?

Running with a prolapse can further weaken pelvic floor muscles and tissues potentially worsening prolapse severity. The degree to which running impacts upon a prolapse is determined by factors including; body weight, running distances and strength of the pelvic floor.

If you have a prolapse is highly likely that your pelvic floor support is already weakened. The combination of repeated downward pelvic pressure and a lack of pelvic floor support can contribute to prolapse worsening.

Running is a high impact exercise. The impact and pressure associated with body weight landing on a hard surface is transferred down through the pelvic floor and lower limbs to the ground. When repeated over time, the impact of running repeatedly forces the pelvic floor (and prolapse) downwards. When strain is placed upon the pelvic floor, the pelvic floor muscles and tissues stretch and weaken especially if the pelvic floor lacks the strength to withstand this strain. Individuals with prolapse usually have pre-existing pelvic floor dysfunction, so that they lack the capacity to withstand the pressure of high impact exercises like running.

Tips for how to reduce pelvic floor impact and prevent prolapse

This information is not provided to encourage individuals with prolapse towards running. This information recognises that some committed runners will continue to run despite having a prolapse. This information can help prevent prolapse, protect and reduce prolapse symptoms.

Strategies to reduce the impact of running:

1. Alternate running surfaces – Avoid constant running on hard surfaces such as roads and concrete pavements. Try to mix up running sessions to include softer running surfaces such as grass, gravel and sand. Water running is an excellent form of low impact running.
2. Avoid downhill running- Running on flat surfaces reduces the physical impact when compared with running downhill. Downhill running increases impact and jarring on the pelvic floor.
3. Limit running distance- The longer the running distance, the more repeated the impact upon the pelvic floor. Try to avoid running long distances particularly  on a regular basis.
4. Reduce stride length- Shorter stride length may help to reduce some of the physical impact associated with running. This may allow your heel to strike the ground less forcefully than with a long stride.
5. Mix up workouts- Alternate running workouts with other low impact forms of fitness exercises. These include cross trainer and elliptical machines, cycling and spin classes.
6. Manage your weight- The more body weight you carry, the more you load the pelvic floor when you run. Pelvic floor strain is more likely in obese and overweight individuals with running, just as lower limb strain is more prevalent amongst overweight runners. Overweight individuals with a prolapse who run greatly increase their likelihood of worsening prolapse.
7. Trial Contiform for bladder leakage- Contiform is a user friendly device to help women reduce bladder leakage with running. Contiform is a simple device that sits within the vagina and helps to restore normal bladder position for bladder control with exercise.

Tips for how to improve pelvic floor support for exercise

1. Pelvic floor exercises- Regular daily pelvic floor exercises will optimise the condition of pelvic floor support in order to withstand the pressure associated with a variety of fitness exercises. A strong well supported pelvic floor will better withstand the pressure and impact associated with running when compared with a weak dysfunctional pelvic floor. Commitment to regular ongoing pelvic exercises is an essential to ensuring and optimising long-term pelvic floor support.
2. Consider a vaginal pessary- A vaginal pessary is a discreet pelvic floor support device that sits within the vagina and supports prolapsed vaginal tissues. A vaginal pessary is a useful assistive device for women who seek to continue running despite having a prolapse. Well fitting pessary devices can reduce prolapse symptoms and allow a woman with pelvic floor dysfunction to continue her regular exercise routine. Gynaecologists are usually trained to fit vaginal pessary devices for prolapse support and management and it can be worth discussing your suitability for a pessary.
3. Ensure post natal recovery- Before recommencing running, ensure that your pelvic floor is recovered from pregnancy and childbirth. Strengthening for weak muscles can take 5-6 months.  Pelvic floor muscles do not function as well during breast feeding owing to the lower levels of circulating oestrogen, so this is important to be mindful of when planning your return to running after childbirth.

"Prolapse and running" is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author and presenter of the internationally acclaimed Inside Out Pelvic Floor Safe Exercise Program for Women consisting of Inside Out – the essential women's guide to pelvic support and Inside Out pelvic floor safe workout DVD.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

Prolapse symptoms

Prolapse symptoms vary in type and severity, often depending on the type of prolapse. This pelvic floor physiotherapist information provides women with information regarding the main symptoms of pelvic  organ prolapse.

Read on now to learn:

• What is a pelvic prolapse?
• Do prolapse symptoms indicate prolapse severity?
• 4 main categories of prolapse symptoms are described :
  • Vaginal and pelvic symptoms
  • Bladder symptoms
  • Bowel symptoms
  • Sexual dysfunction symptoms

  Download Prolapse Symptoms as a user friendly PDF

What is a pelvic prolapse?

A pelvic prolapse is a bulge of one or more of the pelvic organs into the vagina. The pelvic organs include the bladder, uterus, and rectum. A prolapse occurs when the walls of the vagina and the supports for the pelvic organs become weakened and stretched.

Different forms of pelvic organ prolapse are defined as follows:

• Cystocele is a bladder prolapse into the front wall of the vagina
• Rectocoele is a prolapse of the large bowel (colon and/or rectum) into the back wall of the vagina
• Uterine prolapse is the descent of the uterus and cervix down into the vagina (illustrated below)
• Urethrocele is a urethral prolapse/bladder beck into the front wall of the vagina
• Rectal prolapse is a prolapse of the rectum through the anus.

These different types of prolapse may have unique symptoms that are particular to that specific type of prolapse for example a rectocoele is typically associated with bowel symptoms.

Do prolapse symptoms indicate prolapse severity?

No, prolapse symptoms do not necessarily indicate prolapse severity however there are some general trends in terms. Women with mild prolapse usually (but not always) experience minimal symptoms. Women can be completely symptom free despite their prolapse and are often surprised to learn of its existence after routine gynecological exam. Those women having a severe prolapse usually describe more noticeable symptoms.

Symptoms of a prolapse

Most symptoms of a prolapse can be grouped into the following four main categories:

1. Vaginal and pelvic symptoms
2. Bladder symptoms
3. Bowel symptoms
4. Sexual symptoms

There are also other possible medical causes of these symptoms so having one or a number of these symptoms does not conclusively indicate the presence of a prolapse which needs to be medically diagnosed with physical internal examination. 

The following general symptoms of pelvic prolapse can exist either in isolation or some women may find that they have a number of the following prolapse symptoms.

Vaginal and pelvic symptoms associated with a prolapse

These particular symptoms often become worse with prolonged standing, over the course of the day and with straining to use the bowels.

• Bulging sensation in the vagina
• Heaviness or pressure within the vagina
• Sensation of a bulge protruding from the vaginal entrance (this may be visible sitting at the entrance of the vagina)
• Low back ache and/or pain
• Low abdominal pressure and/or pain
• Visible bulge at the entrance to the vagina
• Difficulty inserting a tampon or tampon moving down the vagina once inserted.

Bladder symptoms associated with a prolapse

• Increased bladder frequency (bladder emptying)
• Bladder urgency and associated bladder leakage (strong urge to empty the bladder)
• Problems with the flow of urine which may be slow to flow, prolonged duration to empty, hesitant or stop/start urine flow
• Incomplete bladder emptying (which can contribute to chronic bladder infections and associated symptoms)
• Needing to manually reposition the vaginal prolapse to allow the bladder to empty
• Bladder flow changed according to the position of the body.

Bowel symptoms associated with prolapse

• Difficulty emptying the bowel including problems commencing emptying, needing to strain throughout and a sensation of incomplete bowel emptying
• Constipation requiring straining or manual assisting using the fingers to provide pressure against or within the vagina to manually assist
• Incontinence of stool (including liquid stool and staining of underwear)
• Sensation of constantly needing to pass stool or rectal pressure
• Poor wind (flatus) control
• Bowel urgency
• Discomfort during and/or after emptying the bowel.

Sexual symptoms associated with prolapse

• Vaginal pain or vaginal discomfort during or after penetrative sexual intercourse
• Difficulty with penetration with more severe prolapse
• Bladder leakage with intercourse
• Decreased sexual satisfaction
• Decreased sexual arousal
• Sexual disinterest.

"Prolapse Symptoms' for women is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author and presenter of the internationally acclaimed Inside Out Pelvic Floor Safe Exercise Program for Women consisting of Inside Out – the essential women's guide to pelvic support and Inside Out pelvic floor safe workout DVD for women.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

Bladder exercises are also known as pelvic floor exercises. They are performed using muscles inside the pelvis known as pelvic floor muscles. These muscles are located in and around the area where yousit. Pelvic floor exercises for incontinence can effectively reduce and overcome bladder leakage.

Read on now for the following physiotherapist information and exercise guidelines:

• What is incontinence?
• Causes of incontinence
• Are bladder control exercises effective?
• How do bladder control exercises work?
• Physiotherapist guidelines for bladder control exercises
• How to get immediate bladder control

  Download Bladder Exercises guidelines as a user friendly PDF.

What is incontinence?

Urinary incontinence is a common condition with 1 in 3 women experiencing this problem. Urinary incontinence is defined as the involuntary loss of urine (bladder leakage). Some women with mild incontinence leak small amounts of urine occasionally, whereas others with more severe incontinence experience daily bladder leakage and need to wear pads and/or change their underwear frequently.

Bladder control exercises are most commonly prescribed for two types of urinary incontinence:

1. Stress urinary incontinence

The most common type of incontinence in women is called stress urinary incontinence. Stress incontinence is bladder leakage with exertion or increased pressure on the bladder for example with a cough, sneeze or with high impact exercises such as jogging. Stress incontinence is most prevalent on its own in younger women and women going through menopause (peri menopausal).

2. Urge urinary incontinence

Urge urinary incontinence is the leakage of urine associated with a strong urge to empty the bladder and the inability to reach the toilet to prevent leakage. Mature women are most likely to experience a mixed pattern of stress incontinence and urge urinary incontinence.

Are bladder control exercises effective?

Yes, the highest quality scientific studies have shown that exercises for incontinence (pelvic floor exercises) can reduce and/or cure stress incontinence in women. Pelvic floor exercise is now recommended as the first line of intervention for treating stress incontinence before surgery is considered.

Treatment of urge incontinence treatment with bladder control exercise has not yet been proven effective in the research. Women can often train their pelvic floor muscles to overcome the strong urge to empty the bladder. Bladder control exercises are frequently prescribed to treat urge incontinence in clinical physiotherapy.

How do bladder control exercises work?

Bladder control pelvic floor exercises work in two ways:

1. Pelvic exercises improved the support and stiffness of the pelvic floor muscles. This increases the height of the bladder and the closing pressure of the urine tube (urethra).
2. ‘The Knack’ is a special bladder control exercise technique that lifts the pelvic floor supports and helps to effectively prevent or reduce bladder leakage with increased pressure e.g. sneeze or cough. This technique is outlined further in this article.

Physiotherapist guidelines for bladder control exercises

1. Techniques for locating your pelvic floor muscles

Finding and feeling your pelvic floor muscles working is a vital step for effective bladder control;

• Try to stop or slow the flow of urine. Practice this technique a maximum of once a week to avoid interrupting the normal flow of urine.
• Lift and squeeze the ring of muscles in and around your anus is if trying to avoid passing wind.
• Lie on your side with your knees slightly bent. Place your index finger against your perineum (the area between your anus and vagina). You should feel this area lift inwards away from your finger with correct technique.

2. Practice your pelvic exercises daily

Correct bladder control exercise technique feels like a squeeze and inward lift of your pelvic openings; vagina, anus and urethra (urine tube).

• Contract your pelvic floor muscles for up to 8 seconds at a time
• Relax your pelvic floor muscles having once contracted them and allow them to rest and recover briefly
• Repeat this set of pelvic exercises up to 8-12 times in a row for one set of exercise
• Practice a total 3 sets of exercises throughout the day
• Commence with the number of pelvic exercises and the hold duration that you can correctly perform and gradually build up over time.

3. Progress your strength and bladder control exercises

• Aim to perform increasingly stronger exercises over time
• Challenge yourself to exercise in upright positions. Some women commence their exercises lying down. Pelvic exercises need to be progressed to sitting and standing for increased strength and control.
• Strengthening may take 5-6 months for women with weak pelvic floor muscles. Allow your pelvic floor time to fully strengthen by committing to regular ongoing pelvic floor exercises.

How to get immediate bladder control

1. Use ‘The Knack’

'The Knack' is a highly effective technique for reducing or eliminating unwanted bladder leakage. ‘The Knack’ is a strong inwards lift and squeeze of the pelvic floor muscles before and during any increase in pressure on the pelvic floor. For example lift and squeeze your pelvic floor muscles before and during every cough, sneeze and/or lift. Always use 'The Knack' before any increase in pelvic pressure to control your bladder.

2. Use a continence device

Contiform is a discreet reusable continence device that sits comfortably within the vagina and supports the bladder and urethra. Contiform has been shown to effectively reduce and/or cure bladder control problems in some women with stress urinary incontinence. This device (shown right) can be used as required and is often helpful in assisting women who are just commencing exercises for incontinence. It can also be used by women seeking to exercise without bladder leakage and those women seeking to avoid bladder repair surgery.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au

Read on now to learn:

• What is vaginal prolapse?
• Vaginal prolapse symptoms
• What causes vaginal prolapse
• Vaginal prolapse and pregnancy
• Vaginal prolapse treatment
• Can pelvic exercises reverse pelvic prolapse?

  Download What is Vaginal Prolapse as a user friendly PDF

What is vaginal prolapse?

Vaginal prolapse is a general term for a bulge or protrusion into the vagina. This occurs when the vaginal walls and supports become thin, weakened and stretched.

There are 3 main types of vaginal prolapse:

1. Bladder prolapse (cystocele) – when the bladder bulges into the upper front wall of the vagina (shown below)
2. Bowel prolapse (rectocele) – when the rectum and or colon bulge into the lower back wall of the vagina (shown below)
   

   

3. Uterine prolapse – when the upper vagina, cervix and uterus move down into the vagina (shown below)

A vaginal prolapse can involve any one of these types of prolapse and they can also occur in combination with each other for example a woman may be diagnosed with a prolapse of both the front and back walls of the vagina (bladder and rectal prolapse).

Vaginal prolapse symptoms

Vaginal prolapse may present with a variety of different symptoms depending upon the type and severity of the prolapse. Some women with mild prolapse are completely unaware of even having a prolapse and have no symptoms.

Vaginal prolapse symptoms include:

• A bulging feeling at the entrance of the vagina
• A sensation of a lump coming down in the vagina
• Heaviness within the vagina particularly towards the end of the day
• Constipation or incomplete bowel emptying needing to manually assist bowel empty
• Bladder problems including slow flow and incomplete emptying
• Chronic bladder infection
• Discomfort with sexual intercourse
• Difficulty inserting tampons
• Ongoing low back pain.

What causes vaginal prolapse?

There are a number of potential causes of vaginal prolapse and the incidence increases with menopause and increasing age. The following factors all increase the likelihood of pelvic organ prolapse.

1. Pelvic floor injury during pregnancy and childbirth
2. Decreased oestrogen levels with menopause
3. Long-term straining  to empty the bowels with constipation
4. Chronic coughing associated with smoking and lung disease
5. Obesity and overweight
6. Inappropriate exercise that overloads the pelvic floor
7. Heavy lifting
8. Ageing and associated thinning of pelvic floor muscles
9. Previous incontinence and/or prolapse surgery.

Vaginal prolapse treatment

There are a number of strategies used by physiotherapists to treat prolapsed vagina. These strategies are usually most effective for women with mild to moderate prolapse. Women with severe vaginal prolapse will usually require surgery to alleviate their prolapse symptoms.

1. Pelvic exercises are usually at the forefront of non-surgical treatment for prolapsed vagina. This involves prescription of progressive pelvic floor exercises to improve pelvic floor muscle support. Pelvic exercises are often prescribed before and after prolapse surgery in an effort to prevent recurrent prolapse and preserve the repair for as long as possible.
2. Modification of  lifestyle factors that may be increasing pressure upon the pelvic floor. This can include instruction in bowel management and correct bowel emptying techniques to avoid straining, modification of unsafe exercise practices to pelvic floor safe exercise programs and assistance with pelvic floor safe weight reduction exercises.
3. Pessary for prolapse support can be an excellent non-surgical option for supporting prolapsed vaginal tissues during pelvic floor rehabilitation and in situations when surgery is not desirable or indicated. A vaginal pessary sits high inside the vagina and is usually fitted by a gynaecologist. Vaginal pessary can provide very useful support for women with pregnancy and childbirth-related prolapse during their recovery.
4. Medical referral for vaginal oestrogen treatment to improve the condition of oestrogen-deficient vaginal tissues.
5. Prolapse surgery is usually offered to women with severe prolapse and those women who have ongoing symptoms despite conservative physiotherapy treatment. Vaginal prolapse surgery repairs the vaginal walls and/or vaginal supports within the pelvis. Following prolapse surgery women are usually advised to avoid or modify those lifestyle factors that originally contributed to their prolapse to minimise the risk of recurrence.

Vaginal prolapse and pregnancy

Pregnancy is associated with steadily increasing downward pressure onto the pelvic floor as pregnancy progresses and weight increases. Hormones that prepare a woman’s body for childbirth allow the pelvic supports to stretch. The combination of increasing strain on the pelvic floor and decreased support cause the pelvic floor muscles to progressively stretch and weaken.

Vaginal delivery is associated with a large degree of pelvic floor muscle stretching.This has been found to be most commonly associated with prolonged second stage of labour and forceps delivery. Pelvic floor structures can become damaged during the process of vaginal delivery including pelvic floor muscles and the pelvic nerves supplying these muscles. As a result some women experience prolapse immediately after or in the weeks following difficult labour and vaginal delivery. Recovery is possible for some of these women with postnatal healing, pelvic floor muscle recovery and return to normal hormonal status.

Can pelvic exercises reverse pelvic prolapse?

No, pelvic prolapse cannot be reversed by pelvic floor exercises. Prolapsed vaginal walls are like a hernia of the bladder or bowel into these thinned and weakened walls. The only way to repair a hernia is via surgery.

Pelvic exercises can increase the strength, and thickness of the pelvic floor supports in addition elevating the pelvic floor higher within the pelvis. Some women with mild to moderate prolapse find that after 3-5 months of dedicated pelvic exercises, their prolapse symptoms are minimal and/or disappear altogether.

We welcome your comments below

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.

Copyright © Pelvic Exercises.com.au