12 Unsafe Abdominal Exercises for Prolapse and After Prolapse Surgery

Concerned about unsafe abdominal exercises injuring your pelvic floor?

Unsafe abdominal exercises include exercises common place in gyms and exercise classes.

This Pelvic Floor Physiotherapist information from Michelle Kenway helps women avoid unsafe abdominal exercises with prolapse and protect their pelvic floor from re injury after prolapse surgery. unsafe core exercise

Read on now to learn:

  • 12 abdominal exercises to avoid with prolapse
  • How to modify abdominal exercises
  • Safe abdominal exercises to choose
  • How abdominal exercises can cause pelvic floor problems
  • How to identify unsafe abdominal exercises for prolapse
  • Will core abdominal exercises flatten my stomach?
  • Will Pilates strengthen my pelvic floor?
  • How to correctly brace your abdominal muscles

PDF Download “Unsafe Abdominal Exercises For Prolapse” as a user friendly PDF by scrolling down.

12 Unsafe Abdominal Exercises with Prolapse Problems

Intense abdominal exercises should be avoided or modified by women with or at risk of pelvic floor dysfunction to minimize the risk of pelvic floor strain and injury, particularly after prolapse surgery and with poor pelvic floor support.

These intense abdominal core exercises will have the potential to overload the pelvic floor in women with pelvic floor dysfunction:

1.  Traditional abdominal curl or sit-up exercises (shown right)unsafe abdominal exercises
2.  Incline sit-ups
3.  Intense abdominal exercise machines
4.  Oblique sit-ups
5.  Oblique machine
6.  Exercise ball sit-ups
7.  Exercise ball leg raises
8.  Bicycle legs
9.  Double leg raise
10. Hanging knee raise
11. Pilates Table Top or The Hundred
12. Intense core Plank or Hover exercises.

How to Modify Unsafe Abdominal Exercises?

Many intense upper abdominal core exercises can be readily modified to reduce the load on the pelvic floor.

Modify Abdominal Exercises

How to modify abdominal exercises video

Techniques to modify abdominal exercises are demonstrated in this short abdominal exercise video (right)

To reduce pelvic floor loading with abdominal exercises:

  • Breathe out with the effort
  • Avoid resisted or weight loaded abdominal exercises
  • Avoid overbracing the abdominal muscles during exercise
  • Reduce the number of repetitions
  • Modify the intensity of abdominal exercises

Choose Pelvic Floor Safe Abdominal Exercises

Safe core abdominal exercises

Learn 5 Safe Abdominal Core Exercises

Ideally choose pelvic floor safe abdominal exercises that place minimal pressure on your pelvic floor. These are core abdominal exercises that help you tone and strengthen your deep abdominal core muscles.

These 5 safe core abdominal exercises will help you get start your safe abdominal exercises for prolapse now.

Intense Core Abdominal Exercises and Pelvic Floor Problems

Intense core abdominal exercises particulalry those exercises involving the upper abdominal “six pack” muscles increase downward pressure on the pelvic floor. Recent studies confirm that when women with pelvic floor dysfunction perform sit-up exercises, the pelvic floor is forced downwards.

When repeated, intense core exercises can stretch, strain and overload the pelvic floor muscles and potentially worsen prolapse symptoms. It is vital to avoid overloading the pelvic floor with unsafe abdominal exercises with a prolapse and after prolapse surgery.

How to Identify Unsafe Abdominal Exercises for Prolapse?

Avoid  upper abdominal muscle exercises that involve raising both legs off the ground at once and/or exercises involving raising your head and shoulders off the ground whilst lying down on your back. Both these types of exercises will increase the downward force on your pelvic prolapse and pelvic floor. These exercises require strong pelvic floor muscles to counteract the associated downward pressure and are not appropriate abdoiminal exercises for prolapse.

Will Abdominal Exercises Flatten your Stomach?

No, this is a myth. Unfortunately our society has a culture of abdominal strengthening and women are often led to believe that the more abdominal muscle exercises they perform, the flatter their stomach will appear!

It’s not possible to spot reduce fat; to flatten your stomach you probably need to lose fat. Regardless of how many sit-up or abdominal strength exercises you do, they will never flatten your stomach. The way to flatten the appearance of your stomach is to lose body weight by reducing your fat intake and perform more appropriate safe core abdominal exercises.

Will Pilates Exercises Strengthen your Pelvic Floor?

No, if your pelvic floor is weak, intense abdominal core Pilates exercises can overload and further weaken the vulnerable 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.

Abdominal strength exercises or intense core exercises will not strengthen the pelvic floor if the 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. Women having undergone recent prolapse surgery or hysterectomy need to understand that mainstream Pilates is not an appropriate form of rehabilitation exercise when recovering.

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 (contracting) 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 woman’s 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.

PDFDownload these  “Unsafe Abdominal Exercises for Prolapse” as a user friendly PDF

Inside Out Book & DVDABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support, along with Dr Judith Goh Urogynaecologist. The Inside Out exercise DVD and book show women how to strengthen the pelvic floor and exercise effectively with pelvic floor safe exercises.

Comments

  1. Anne Jakus says:

    I am a physical therapist with no experience in treating pelvic floor dysfunction. I live in a small town, and our women’s clinic is interested getting a PT trained to treat pelvic problems. I am interested in becoming trained, but am not sure who offers the best courses. My background is more orthopaedics. Your article was very informative, so I thought you might be able to steer me in the right direction. Can you suggest good continuing education programs for the treatment of pelvic floor problems (or do you offer any).
    Thanks you so much for any advice you might be able to offer.

    • Michelle Kenway says:

      Hi Anne
      I completed my continence and women’s health post grad training at Curtin University in Perth, Western Australia. They run a fantastic post graduate women’s health program through the physiotherapy department there. I studied as an external student and travelled there as required. They provided wonderful support and continue to do so for overseas students. I hope this information helps you with your further studies Anne
      Michelle

  2. I have just suffered a uterine prolapse and believe that several months of pilates exercise classes leading up to the prolapse “moment’ and beyond have exacerbated this condition. my doctor says that the ligaments that keep the uterus in position have stretched and my belief is that the sorts of exercises i was encouraged to do in Pilates are ones i should have, in fact, avoided. I have no idea, at this stage, how to go about getting my uterus back where it should be and ligaments tightened….. I think that Pilates instructors should pre-screen their clients much more closely than they currently do.

  3. Michelle Kenway says:

    Hi Jo
    Thanks for your message, it will no doubt help other women to understand that some Pilates exercises can place pressure on the pelvic floor – and yes I agree pelvic floor screening is needed before women perform particular exercises in Pilates classes. This could be a simple as a couple of screening questions. Thanks Jo, Michelle

  4. Hello! I am three days post-op from uterine prolapse surgery and a TVTO for my bladder. Thank you so much for this information. I’ve been thinking about how to exercise again when it’s safe, and this article has been very helpful.

    Lisa
    USA

    • Michelle Kenway says:

      Hi Lisa
      Thank you for your input. I am so glad that this article has improved your understanding about exercises to avoid after uterine prolapse surgery. I think it is also important that you mention the TVTO surgery also as this is such a quick operation and I think many women are unaware of the need for their tissues to grow through the tape for full healing. It would seem to make good sense to avoid too much downward pressure on the tape especially with the wrong kind of abdominal exercise, especially while you are healing (i.e. the next three months!). Hope you have a good recovery and a great outcome from your pelvic surgery.
      Michelle

  5. Hello, Ive had a vaginal prolapse for year I am 41 3 kids 5 miscarriages and had it all relatively under control but after an allergy sneezing fit have found I can feel bulging again, but my main concern is the constant pelvic ache and back pain, I am booked in to see a specialist Physio but need to wait 2.5 weeks to get in. Can I get a brace or something to support my back from feeling sparks of pain if I move too fast?

    I am also 15 kgs over weight what can I do to shift it and safely not put on the pelvic pressure? I can swim, ride, walk, already doing this though, but I love weights and am now feeling they might not be the best idea, cerrtainly can’t do them whilst I have this flare up, any advice?

  6. Hi 6 months ago I had a vaginal hysterectomy, suspension anterier repair,and TVT surgery. I have had a lot of pain over the last week. Is it possible that I could have the prolaps back again.

    • Pelvic Exercises says:

      Hi Alice
      There are many potential causes of pelvic pain and your pain needs to be need to be assessed by your specialist. For your information usually a vaginal prolapse is not painful unless it is very large. Pelvic floor muscle spasm is also a very under recognised and at times poorly diagnised source of pelvic floor pain after pelvic surgery. Many women become very frustrated at ongoing pelvic pain which is not diagnosed and often we find levator spasm or pelvic floor muscle spasm is the cause. This is only one possible cause of pelvic pain after surgery.To determine the cause of your pain you need to visit your specialist as soon as are able to do so. Michelle

  7. I am in a little bit of panic mode right now, I just returned from my OB appointment. I had a hysterectomy approx. 5 years ago and had to have my bladder attached to my vaginal wall with 2 stitches. My doctor said everything looked good, but warned me against weight training basically saying I could cause my vaginal wall to fall. Just a little scary!
    I started to weight train a few months back and am doing the Body For Life program. I love to lift and it didn’t occur to me that I might cause more damage to myself than good. I am a little stressed and frustrated now, because I don’t want to give up my weight training or interval running on the treadmill, but don’t know my options. I have ordered the Inside Out Book today, but was hoping that there might be some exercises I can do while I wait for its arrival. I don’t want to stop working out. I am down 10 lbs and am really starting to feel myself gaining strength. I really enjoy weight training and am praying it is not something I have to give up all together. Besides the book are there other resources I can check into for more information. I just turned 40 and don’t want to see myself slip with my health or start to have POP issues.

    Thank you.
    Lisa

    • Pelvic Exercises says:

      Hi Lisa
      Thanks for your email. I think you express the concerns of many other women regarding staying fit and strong and weight training with safe exercises for your pelvic floor. I am not familiar with the program you are currently doing however I will say don’t panic and that there are plenty of safe strength exercises that women can perform and minimise pressure on your pelvic floor. I would siggest that while waiting for Inside Out to arrive read these articles at pelvicexerises.com.au in the prolapse library on how to protect your prolapse when strength training and also have a look at our strength training and abdominal exercise videos at this link. Finally your copy of Inside Out will give you detailed lists of exercises to avoid and those to choose to protect your pelvic floor, plus an illustrated gymworkout. Unfortunately to my knowledge there is little information on this important topic. My knowledge is from my post grad uni studies reading the research and years of exercising with women after prolapse surgery. I hope this info helps you Lisa, Michelle

  8. Dawn Altmeyer says:

    Hi,

    I am a personal trainer and have a client who had prolapse surgery 15 years ago. She has What abdominal exercises would you recommend? Also, she has trouble doing any kind of squat or split leg exercises. Would you advise using any of the universal machines? What about kicking a punching bag. She is very limited since just about anything makes her hammock drop.

    • Pelvic Exercises says:

      Hi Dawn
      This is a general reply to your great qns as it is not possible to be specific about your client.
      1. When working with women who want to do abdominal exercise after surgery it is best that they avoid intense core work and upper abdominal (rectus abdominis and external obliques) in particular. Rule of thumb keep at least one leg on the ground and head and shoulders on the ground if doing lying down abdominals as demonstrated in our video on safe abdominal exercises for pelvic floor dysfunction Also good to read this article on 12 abdominal exercises to avoid after prolapse surgery Appropriate seated fitball exercises are a great safe way to promote safe core exercise after prolapse surgery see our video on safe core exercises.

      Some seated universal machines will place less pressure on the pelvic floor such as seated row, bicep curl, calf raises. Leg press and lat pull down should be avoided with pelvic floor dysfunction. Once again seated fitball weights are a great option and there is plenty that can be done with minimal pelvic floor pressure(see full appropriate work out with pelvic floor dysfunction in Inside Out – the essential women’s guide to pelvic support. Probably avoid high kicks in kick boxing opting for low impact stationary cycle & walking. Hope this information helps you with your prolapse clients, Michelle

  9. Lauren Cope says:

    I think I’ve made a connection to bladder prolapse with a new biking position. I ride about 100 miles a week. The new position has taken my speed and ability to a new level, which is very exciting (I am much faster due to being very aerodynamic, in other words very low from seat to handle bars on a road bike). I am not sure if it is coincidental, or if the prolapse would get better if I go back to a more upright position. I am purchasing your book today, but would appreciate your thoughts.

    • Pelvic Exercises says:

      Hi Lauren
      Interesting question about cycling with a prolapse. I am imagining that your new position involves you leaning right foward on your bike is this correct? Cycling is a great low impact exercise for women with a prolapse – I always suggest avoiding standing in the saddle and high gears (which probably means hills) which increase pressure on the pelvic floor. Leaning foward is a little like bending foward. It increases the pressure in the abdomen which is in turn transmitted to the pelvic floor- a little like squeezing an upside down sauce bottle if this makes sense. If you are leaning forward more than you normally do, I imagine this would increase pressure on your pelvic floor. An easy way to test would be to monitor your prolapse symptoms and comparing them after a ride over the same route on different days using the different positions. But don’t forget the big impact of high gears and standing in the saddle on your pelvic floor. Hope this helps you keep cycling well Lauren, good luck Michelle

  10. Hi,
    After developing a grade 2 vaginal prolapse 6 months after the birth of my first daughter I came across your book and religously undertook pelvic floor exercises and modified my gym routine to prevent further severity. It did aid in lessening the symptoms and I was delighted to go most days without ever thinking about it. I have since fallen pregnant a second time and although the obgyn mentioned in the early days that the prolapse shouldn’t become any worse (as long as I keep up the diligent pelvic floor exercise) I have noticed that the feeling of heaviness and bulging has returned, similar to, if not worse than before. I am now 18 weeks and am wondering whether I can expect it to get worse throughout the remainder of the pregnancy as the baby grows and is there any other exercises that I should be including in my routine now that I am pregnant? Pelvic floor exercises have become increasingly difficult as the weight has increased since beginning of pregnancy.
    Thanks, Kate.

    • Pelvic Exercises says:

      Hi Kate
      Thanks for your question. Yes this is a commonly asked question and valid concern of women who are pregnant with a prolapse and wishing to exercise safely.

      As pregnancy progresses pelvic floor or kegel exercises become increasingly important (yes and difficult too). As the weight of your baby increases so too does the stretch on your pelvic floor muscles and tissues which makes your pelvic floor progressively weaker. To make pelvic floor exercises easier with progressing pregnancy there are a number of things women can do:

      1. Choose antigravity positions such as lying down, or on all fours even resting on elbows to make the exercises easier

      2. Do pelvic floor or kegel exercises early in the day. By the end of the day the pelvic floor muscles are fatigued and prolapsed tissue is further descended in to the vagina. Try to do kegel exercises in the morning and rest if possible in the afternoon to take pressure off the pelvic floor especially as pregnancy progresses.

      3. Women are advised to perform pelvic exercises approximately 3 times daily, holding each contraction up to 10 seconds where possible for 8-12 repetitions

      4. The best pregnancy fitness exercises are low impact for women with (and without) vaginal prolapse – such as cycling (stationary). Water based exercise such as walking is an excellent way of exercising with a prolapse as the body is supported and the impact is low which is pelvic floor friendly.

      5. Also ensure against constipation and straining with progressed pregnancy is also an additional important factor in protecting a prolapse during pregnancy.

      So the key elements for prolapse and exercise in the latter stages of pregnancy are: doing kegel exercises or pelvic floor exercises in antigravity positions, resting the pelvic floor when possible by taking the load off your feet, choosing low impact general exercise (and avoiding constipation). After delivery pelvic floor exercises will be a very important part of rehabilitation and exercise will need to remain appropriate with cautio especially in the early days post natally when the pelvic floor muscles are stretched and very weak.

      Good luck Kate Michelle

  11. Hello Michelle
    What are hanging knee raise, plank or hover?
    > Also I was watching the abdominal exercises and Michelle said to keep the curve in your back, I was taught when doing the pelvic tilts
    to flatten out the back?
    > Do you by chance know of any gynacologist in the US that is fully aware of pelvic floor dysfunction?
    I have been doing some core exercises and I knew not all of them strengthened, some did make me feel weaker.
    > Thank you and God bless

    • Pelvic Exercises says:

      Hi Sherry
      Hanging knee raise is a gym machine (also called Captain’s Chair) where the body is supported upright through the forearms and elbows. Then you bring your knees towards your chest and lower them down. This is an intense abdominal exercise to be avoided with pelvic floor dysfunction. The plank or hover is a very commonly performed gym exercise (also in Pilates classes and Yoga classes) a little like a push up but resting on your forearms not your hands. This is also an intense core exercise that will increase the pressure on the pelvic floor. Hope this helps, Michelle

      • Pelvic Exercises says:

        Hi Sherry

        To correctly activate your core or deep abdominal muscles (and pelvic floor muscles) the spine should have an inward curve. Some great studies have shown that with an inward curve in the back, these muscle groups work better than when the spine is flattened (unfortunately this advice is still sometimes given in Pilates classes). So the spinal position for activating your deep abdominals most effectively regardless of lying down, sitting or standing is with an inward curve in your spine. This is why posture is so important in good core muscle control exercise.

        Yes it can be very difficult to correctly locate the deep abdominal muscles, especially if you are accustomed to drawing the upper abdominal muscles in strongly. This is a common mistake when learning to activate your core muscles. Try lying on your side and let your abdomen or belly completely relax. Place your hands inside your uppermost pelvic bone or over your lower belly. Gently draw in the lower abdominal area by again gently tensing the area under your knickers a little like pulling your navel towards your spine just a little. Keep breathing normally and hold this deep abdominal or core muscle contraction.You should not see your upper abdominal (six pack) muscles draw in. This is a very subtle indraw of your lower abdomen. Once you can do this in side-lying try it on your back (more difficult) or ins standing which is sometimes asier than when lying down. Let me know how you go with this technique, cheers Michelle

  12. Hi Michelle
    I asked the question above, and I have been trying to do the gentle core exersice you show in the video but I am confused. I place my hand under my pubic bones by the end of my underwear but I do not necessarily feel anything. I do sometimes feel my upper stomch, under my rib cage getting involved and Ihave to correct that. And I also feel my lower back when releasing, so I am not sure if I am doing it right. Can you help further?
    Sherry

  13. Josephine says:

    I am freaking out over this prolapse thing. I just discovered that I probably have a uterine prolapse. I didn’t really know what it was until I watched Dr Oz yesterday and he discribed it. I have slight bulging soft tissue at the opening to the vagina. I am 47 years old, have had two very large babies and I am overweight. I have lost 35 pounds since January but have a long way to go with that still. What can I do to correct this or prevent it from becoming worse? I have been kegaling like a crazy woman since yesterday. LOL But I have been doing kegal exercises for years now. Please ease my stress about this. I am horrified!!

    • Hi Josephine
      First of all take a deep breath and know that you are one of literally hundreds of thousands of women world-wide with this issue. Not that this eases things for you but sometimes it is nice to know that you not the only one with a uterine prolapse, sadly this is not spoken about enough in public and that there is much that can you can do to self manage this is addition to getting specialist help if you require it.

      I suggest you start by reading some of our articles on how to manage a prolapse such as How to manage a uterine prolapse see http://www.pelvicexercises.com.au/2010/uterine-prolapse/ and some of the prolapsed bladder information at http://www.pelvicexercises.com.au/2010/manage-prolapsed-bladder/ as many of the same principles for prolapse management apply. Yes kegels can help with uterine prolapse symptoms if the prolapse is mild to moderate so you need to make sure you are doing your kegels correctly. Have you discussed the possibility of a pesary to support your uterus, with your specialist? This is often a great easy non surgical option for managing a prolapsed uterus.

      Let us know how you go, hoping this information helps you and other women.
      Michelle

      • Josephine says:

        Thank you for your reply. I haven’t seen a specialist yet for this but I will make an appointment. Thanks for the links to the articles. I will read them today when I get home from work.

  14. Hi Michelle,

    Would you be able to advise safe abdominal exercises for the pool after prolapse repair? Thanks.

    • Hi Kathy Re: prolapse surgery and aqua exercises

      After prolapse repair selected pool exercises are ideal after approval from your specialist to exercise in the water. This is important to avoid infection before your internal wound is fully healed. Also consider the depth of the water, ideally around bust level – the more shallow the water the less buoyancy and the greater the impact. Furthermore start at a slow pace, the faster the pace the greater the water resistance.
      When recommencing pool exercise after prolapse surgery ideally start with a basic pool walking program of forwards, backwards walking and side steps. Listen to your body, back off any water-based exercise that causes any discomfort and gradually progress duration walked and speed as fitness levels gradually improve. Water walking provides an ideal platform for exercise usually from weeks 6-12 for most women. During this time upright noodle cycling (noodle placed between legs like a saddle with cycle legs and breaststroke arms forwards and backwards). Alternatively in deeper water this can be performed with a buoyancy vest and gentle cycle legs forwards and backwards. Kickboard lying in the back with the board across the chest and very gentle kicking legs may commence comfort permitting at around 8-10 weeks.

      Water exercises requiring caution in the first three months at least after prolapse repair surgery:
      Recumbent cycling (lying backwards cycle legs), water running (especially in shallow water), jumping such as star jumps and bunny hops jumping and bringing knees to chest. Take care with traditional strokes such as freestyle and breaststroke which involve quite a bit of stretch and should be avoided until well healed at around 10-12 weeks. Obviously no butterfly stroke following prolapse repair – I would suggest avoiding this indefinitely. Also avoid using fins/flippers for the first 12 weeks at least post-op as these increase pressure within the abdomen. Be cautious using water resistance devices for the upper body for abdominal exercises and upper body exercises which also recruit the strong upper abdominal muscles.

      Hope this helps your return to fitness Kathy and thank you for your comments
      Michelle

  15. Hi Michelle
    What is the difference in technique or feeling when you do the deep lower abdominal contraction and a pelvic tilt?
    Thanks
    Sherry

    • Hi Sherry

      Re: Deep abdominal contraction and a pelvic tilt
      Thanks for this question, I think this is a confusing issue at times…
      1. A deep abdominal contraction is performed by gently activating the lower abdominal muscles (also known as core muscles or TA muscles). This is achieved by gently drawing in the area under your knickers towards the spine. You should feel a gentle tightening of the lower abdominal area. A very common mistake made when isolating these muscles is to draw them in too hard. These muscles have been shown to work most effectively with the low back arched or in its neutral resting position.
      2. A pelvic tilt is an exercise that involves flattening out the curve of the low back. If you lie down and try to flatten out the low back you will usually find that your pelvis tilts backwards. This is quite different to a deep abdominal muscle contraction and this uses different muscles (the hip flexors). We know that flattening out the back curve will not help but in fact hinders the ability to activate the deep abdominal muscles.
      Hope this helps Sherry, let me know if this is still not clear.
      Michelle

  16. Hi. I am 56yrs of age & have had a complete hysterectomy 10yrs ago & 2 cystocele, rectocele & prolapse repairs in the last 2 years. The last one was a mesh repair 12 months ago. At the moment I am walking/exercising for 30min or more each day. I also am doing kegel exercises. Is this enough at this time or could I be doing more?

    • Hi Kay
      Kegel exercises should be performed daily when strengthening, 3 sets of up to 8-12 repetitions of 10 second holds when this is possible. When doing kegels to maintain pelvic floor muscle strength, a woman should aim to perform her kegel exercises on at least 2 days a week. Also remember the importance of using your pelvic floor muscles to protect before and during a cough/sneeze/lifting. Also remember not to do kegel exercises when walking. They should be preformed when standing still and the pelvic floor muscles need to be fully relaxed between each contraction.
      Regards
      Michelle

  17. Hi Michelle – Was grateful for your help before my extensive pelvic floor repair 9 months ago. I need your advice on aquarobics. I used to do it suspended with feet off the bottom of the pool wearing a belt. Much of the class involved raising legs using abdominal muscles. (“seated row” etc) I am concerned this is now contraindicated, although I would love to do the classes again. Many thanks Linda


    • Re Aqua aerobics after Prolapse Surgery


      Hi Linda

      Lovely to hear from you, I hope you are well.

      Yes I think you are spot on in identifying some deep water aqua exercises as potentially stressful upon the pelvic floor. The lovely thing about deep water aqua is the fact that it is low impact which is what we advocate for pelvic floor safe exercise.

      Despite this I think there is some potential for some intense core work in some deep water aqua exercises. Particularly with exercises bringing your knees up to your chest and some of those involving resistance devices in the water for example resisted triceps push downs using paddles or flotation devices. Also consider those exercises lying on your back once again bringing your knees to your chest like cycle legs.

      Aqua aerobics has the potential to be an ideal exercise for pelvic floor protection. As for many forms of group exercise I think it’s a matter speaking to the instructor up front and advising him/her that you need to be avoiding specific exercises and modifying others so that you are not performing intense abdominal exercises for your own health reasons. Attend classes where you know your instructor will understand your desire to modify, and perhaps assist you in doing so during the class. Start at a beginners level so that you can progress gradually. Modify where you can and if in doubt always leave it out.

      As always don’t forget the importance of your pelvic floor or kegel exercises on an ongoing basis. Remember you are capable of doing what your pelvic floor can withstand. This is reduced owing to your previous surgery. It is in your interests to have your pelvic floor muscles functioning for support in their best possible condition to help your long-term safe general exercise. Similarly staying fit, strong and within a healthy weight range will help reduce the load off your pelvic floor as I am sure you are aware.

      Stay in touch Linda I will be very interested to hear how you go.
      Cheers
      Michelle

  18. Hi I’m 38 and have a prolapse of the womb. I’ve recently started using a hula hoop. It doesn’t seem to be making my prolapse any worse. Do you think it is safe to use?

    • Hi Kerry
      Yes I would think that the hoola hoop would is not an exercise that would place a lot of pressure on the pelvic floor. If you think about the muscles used during hoolahoop, they are trunk muscles but not so much the strong upper abdominal muscles that increase pressure down upon the pelvic floor when they contract. I also think symptoms are quite often give a clear indication that an exercise may not be appropriate.
      Enjoy your hoola hoop Kerry
      Michelle

  19. I was told I had suffered a minor prolapes a few weeks ago, the doctor was not very helpful and said just come back if it gets worse. I asked about exercises, as I am obese, I exercise alot and have lost 105lbs already, the only thing the doctor told me was no heavy lifting and do pelvic floor exercises and that I could continue with all my other activities. I have been feeling a lot better, as before, but I think I may have done myself harm over the last week by doing proper sit ups. I’m not sure what to do now, I’m not in any pain, but I am worried.

    • Abdomial exercises, weight loss and prolapse

      Hi Andrea

      Thank you for your comment. Yes managing a prolapse and weight loss is potentially tricky. It is really a matter of understanding those exercises that are suitable and those to avoid.

      First and foremost sit ups will not and never help you lose weight. For some reason there is some crazy myth that sit ups flatten the abdomen. They don’t. It is not possible to spot reduce fat through exercise. Lean people have flat bellies and “six pack abs” because they don’t carry fat that covers their abdominal muscles.

      What sit ups will do if your pelvic floor is weak, is to push your pelvic floor down with every sit up you perform. This will progressively weaken and stretch the weak pelvic floor and increase the likelihood of a prolapse progressing further. So I would suggest that anyone with pelvic floor problems avoid sit up exercises at least until they are very confident in the strength of their pelvic floor muscles to counteract the associated downward pressure.

      Andrea there is a lot to this issue, so much so that I have written Inside Out on exercise and pelvic floor with a chapter entirely devoted to weight loss and pelvic floor safe exercises so it is very difficult for me to summarise in a couple of lines.

      What can be said briefly is that to protect the pelvic floor and perform weight management exercise:
      Perform low impact exercises (at least one foot on the ground)
      Perform appropriate resistance training exercises and techniques
      Avoid those specific exercises that increase pressure on the pelvic floor
      Vary your exercise program and your daily exercise routine regularly

      I hope this helps a little Andrea and keep up your great work. A prolapse diagnosis is no reason to stop your great weight loss efforts which will help greatly to decrease the pressure on your pelvic floor and prolapse.
      Michelle

  20. Hello,
    Thank you for this important information. I am 5 weeks out from vaginal cystocele repair (without mesh but with permanent prolene sutures), rectocele repair, and hysterectomy. I was progressing nicely but two days ago walked up a steep hill carrying about 5 lbs of groceries. I had a small amy of bleeding and now feel that I’m back at about week 3 with pressure upon standing and mild pelvic pain. I’m supposed to go back to work half time in 1 day. My job is part sedentary part walking down halls. Should I wait one more week before returning? I’m going to buy your book now.
    Thanks!
    Laura

  21. Hi, i am 4 months post hysterectomy for a prolapse. I have received my copy of Inside Out & have found it very informative & interesting. One of the reasons why i bought a copy is because i want to return to the gym & want to know which of the resistance exercises to avoid & which ones i can do. Whilst the book is very informative, i’m not entirely confident of putting myself in the hands of an instructor & so would like to ask if it is possible to have a few more of the exercises clarified for me please. The ones that i would like to know if are ok to do are:- leg adductors & abductors; seated good morning with barbel across the shoulders; deep squats (no weights) as i thought the gluts did the work.

    Thanks

    Jane

    • Gym exercises after prolapse and hysterectomy surgery

      Hi Jane
      Thanks for your questions regarding gym exercises after hysterectomy and prolapse repair.

      1. Do you mean lying down abductors/adductors Jane? What type of exercises do you do here and in what position? The lying down adductor/abductor machines will place minimal pressure on the pelvic floor.
      2. Seated good morning with barbell across the shoulders is an exercise warranting caution: legs wide open position and forward bend will increase pressure on the pelvic floor and at the same time place the pelvic floor muscles in a position that is difficult for them to work. This is also a potentially dangerous exercise in terms of the possibility for spinal injury.
      3. Deep squats: will increase pressure greatly on the pelvic floor owing to the depth of the squat, legs wide apart and legs wide open position. Can you see the photo and instructions for pelvic floor safe squat on p51-52 of Inside Out? There is no additional benefit to be gained by going into a deep squat as opposed to the squat illustrated, which places far less pressure on the pelvic floor.
      Squat exercises involve the quads, hamstrings (front and back of thighs) and the gluteals (buttocks). This is not the issue with the squat exercise – the issues being the depth of the squat, where the weight is placed on the body, and the width the legs are placed apart.

      Hope this helps Jane
      Cheers
      Michelle

  22. Hi Michelle, thanks for clarifying those exercises for me. The leg abductors & adductors are done seated at a weights machine aimed at toning the inner thighs. The exercises are carried out by having knees together & using the inner thigh muscles to move the ‘weight’ outwards and then from outwards to together. I’m guessing from what you replied earlier that maybe they might not be suitable due to having the legs wide apart. Thanks again, it’s great to be able to ask these questions & feel confident with the replies. Jane

    • Hi again Jane
      The seated abductor adductor should not place a great deal of pressure on your pelvic floor. Regardless of the position of your legs, there is minimal downward force on the pelvic floor as long as this exercises is done lying back with head against the supporting chair and not straining with the exercise. Enjoy your workouts Jane!
      Michelle

  23. Hi I am hoping you can provide me with some advice on yoga and prolapse. I have grade one uterus prolapse but had been having difficulty emptying bladder and subsequent kidney infections. Seeing Physio and have managed to improve pelvic muscle strength from 3 to 4 in a month. But after a yoga session last night I feel a lot more pelvic discomfort than the last few sessions. We did a half shoulder stand which I thought would help as gravity in other direction, also have slight cold at moment. Examined and doesn’t seem to be physically much worse, possibly a little bit but I could be panicking?? Appreciate any advice, thanks,

    • Re Yoga and Prolapse

      Hi Michelle

      First of all don’t panic. I think that with any increased pelvic discomfort you are best advised to visit your medical practitioner especially in view of the fact that you report that have a history of bladder infections. Yes I would think that the shoulder stand itself would not be the issue, perhaps the action of raising your legs into the shoulder stand? Or perhaps something else during the class you were not aware of? Furthermore if you are coughing and sneezing your pelvic floor could be compromised with increased pressure or simply from the fatigue associated with being unwell. There are many possibilities. Best to see you general pracitioner for a review and meanwhile remain diligent with your pelvic floor exercises. If all is clear from your doctor, next time observe what happens if you repeat a shoulder stand – can you use the wall to help you walk your body into the stand?

      Hope this helps
      Cheers
      Michelle

  24. Hi
    I had a vaginal operation during July 2011 for a moderate/large rectocele prolapse. My prolapse is slowly returning thankspartly to a bad cough and a job that involves lots of walking and carrying(non-smoker); will the excercises in the “Core and the Floor” DVD be suitable for me or can they make the prolapse worse? Thankyou for any help,
    Clair

  25. Hi. In a couple of weeks I am having a hysterectomy with bladder and rectal repair due to prolapse. I am an artist (potter) and regularly lift 25 to 50 lb boxes of clay. Will I be able to return to my work after 6 weeks? Would a treadmill be beneficial for excercising? I just ordered your book. I stand a lot more than sit because I make slab built pots.

    • Return to work after a hysterectomy and prolapse repair

      Hi Sandi

      Thanks so much for your question regarding lifting and return to work after hysterectomy and prolapse repair. This is an involved question and warrants a detailed explanation. I have summarised key points at the end for you.

      First of all in relation to safe return to work you are best advised by your treating specialist as he/she is the person who performed your surgery and understands your overall rate of recovery. Always be sure to clearly outline the exact nature and requirements of your work when discussing your return to work with your surgeon.

      It is well understood that a number of factors can increase the likelihood of prolapse because they increase pressure on the pelvic floor. These factors definitely include heavy lifting. It is also important to recognise that after a hysterectomy the risk of prolapse may be increased, and after prolapse surgery the risk of recurrent prolapse is known to increase. So it is evident that there are a number of potential risk factors operating in your situation.

      Complete healing from hysterectomy and prolapse surgery takes 3 months for most women. At 6 weeks many women do start to resume activities however this does not mean that healing is complete.

      The other factor related to return to activity is the ability of the pelvic floor muscles to withstand that activity. If the pelvic floor is functioning well then pelvic support will be optimised. If the pelvic floor muscles are not in good shape, then the pelvic floor tissues are again more vulnerable to injury. It is almost impossible to tell a woman how much she can or can’t lift postoperatively long-term without really understanding the amount of pelvic floor support she has, including pelvic floor muscle function. A woman with a poorly functioning pelvic floor will be far less able to withstand pressure on her pelvic floor than a woman whose pelvic floor muscles are strong and functioning as they should.

      In summary following your pelvic surgery:

      1. Discuss your return to work with your specialist
      2. Recognise that full healing takes on average 3 months
      3. Commence pelvic floor exercises when permitted by your specialist
      4. Use your pelvic floor muscles before and during every lift when you do return to work
      5. Minimise the amount you lift as much as possible long-term
      6. Consider the height from which you lift (lifting from ground height places more pressure on the pelvic floor than from waist height)
      7. Consider options to carrying such as trolley wheeling and recruiting the assistance of others where possible
      8. Consider alternatives to prolonged standing when returning to work, is it possible to sit on a high stool for example?
      9. Attend to regular exercise as appropriate during your recovery to prevent or minimise physical debilitation. This is usually walking exercise after hysterectomy and prolapse repair. Slow treadmill walking on no incline is usually a suitable walking exercise after hysterectomy and prolapse repair for women to undertake when permitted to do so by their doctor.

      I hope this information assists in your hysterectomy recovery and safe return to work Sandy.

      Kindest regards
      Michelle

      • Hi Michelle. Thank you for the info earlier. I have had my vaginal hysterectomy with bladder and rectal repair 2 weeks ago and I have not had much pain.  I had confidence in my Dr. and saw her 2 days ago for followup.  Will see her again in 3 weeks. She said I can lift up to 20 lbs now.  I am walking for exercise but do get very tired.  I am leaking more now than I did before and am wondering if I will continue to have this problem.  I will have to contact my dr.  I have been doing the kegals, any other suggestions? Thank you.

  26. Hi
    I had a vaginal repair operation during July 2011 for a moderate/large rectocele prolapse. My prolapse is now slowly returning thanks partly to a bad cough and a job that involves lots of walking and carrying (non-smoker), but also the dragging sensation never really went away so maybe the surgery didn’t work. I’m trying other approaches now, will the excercises in the “Core and the Floor” DVD be suitable for me or can they make the prolapse worse? I’m asking because I attended pilates for several months prior to my surgery and it got worse due to my and the teacher not realising that some exercises were not appropriate. Thankyou for any help,
    Clair

    • Hi Clair

      Thank you for your question regarding safe exercise after pelvic prolapse repair. The beginner exercises in Core and The Floor were originally designed for women 4-5 weeks following childbirth. They are designed to be kind to the pelvic floor and at the same time strengthen the body. The pelvic floor exercise component of the DVD would also be a useful exercise component of this DVD for you to be performing regularly also. So for women who have had approval to return to general exercise after initial recovery the beginner exercises in this DVD provide a pelvic floor friendly option.

      I will also add that the stronger your body is generally, then the less pressure you are likely to place upon your pelvic floor during everyday activities such as your regular lifting. So that sensible whole body exercises using pelvic floor safe exercise techniques will also help to protect your pelvic floor too. For example if you practice safe lifting exercises such as seated biceps curls using dumbbell weights, then your lifting muscles will be stronger to take some of the load you lift and reduce the chance of you straining your pelvic floor. For this reason safe strength exercises are a valuable adjunct to management of pelvic floor dysfunction.

      I hope this information assists you Clair. If there are any specific exercises that you are not sure about, please don’t hesitate to send them through for evaluation.

      Kindest regards
      Michelle

  27. Michelle,
    Thankyou so much for your helpful reply, you really provide a wonderfully kind service here.
    Thanks again,
    Clair

  28. Hello Michelle
    I am 61 years. At age 43 I had a hysterectomy, since then I have had 3 prolapse repaires. The last one was 3 months ago.
    After each of these ops I was always told not to do heavy lifting & exercise etc.. I always rested well & practiced the pelvic floor exercises & then gradually got back into my regular exercises after the 3 months.
    After reading all of your information ( a friend just advised me to) I now feel that I may have caused the last 3 prolapses my self. I never knew that I should not go back to doing all of my yoga & aquaarobic exersises. Plus last year I took up cycling.
    I miss & want to go back to my classes now, I guess I should speak to the teachers & ask them to let me do other things while the rest of the class are doing any bearing down exercise? Also how safe is riding my bycicle for me now?
    Thank goodness I enjoy walking, that can not be harmful?
    Kind regards
    Janice
     

    • Hi Janice

      First and foremost don’t be hard on yourself- there may well have been other factors at play in relation to the causes of your prolapse. Before you return to your exercise classes I think that you would benefit from really equipping yourself with knowing what to do and what to avoid, particularly in relation to core exercises.

      I also feel that exercise has so many wonderful benefits and that it is very possible to exercise and protect your pelvic floor, I understand your concern and apprehension but don’t despair in this regard.

      Have you read the articles and watched the videos in our exercises after prolapse repair library http://www.pelvicexercises.com.au/exercise-prolapse-surgery/ ? Have you access to Inside Out? I am not sure which country you are in worldwide, however you may in fact be more aware of this issue than your instructor so the better informed you are the safe you will be with your general exercises. Don’t assume that your instructor understands your pelvic floor risk and management.

      I don’t see an issue with cycling using appropriate gears/intensity and pelvic floor safety unless there is a nerve entrapment problem which is related to pelvic pain. Otherwise sitting on the seat, using low gears and riding flat surfaces should be a lovely low impact low strain exercise.It is wise to avoid standing in the saddle and using high gears.

      Please let me know if can assist any further Janice.
      Best wishes
      Michelle

  29. Wow Michelle,
    Thank you for such a speedy reply Michelle (I live in England by the way). Your advice & hepl is so useful, I will now look into where I can purchase your book from 'Inside Out'. 
    I find it hard to understand why your advice is not given to us when needed from the hospitals. For 3 of my ops I did use the English N. H. S. but I also had private for one of them. Apart from the superior bedroom & food conditions in the private hosp. I was still not given any of your advice other than the first 3 months.
    Your book should be advised to be read by the hospitals if they do not have the time to teach the patients. I feel like going into the wards & pasting posters up about your book to make sure that other  ladies can be informed.
    Thank you once more
    Janice

    • My pleasure Janice, thank you for understanding this issue and recognising the importance of this kind of information for women.
      Best of luck, enjoy your exercises and stay in touch!
      Michelle

  30. Hi Michelle
    I was just wondering what sort of wieght limit you reccomend for lifting?  I am 29yrs old have had 2 quite large babies and have a grade 2 uterine prolapse with a grade 1 cystocele.  Every where i look for information it just says limit heavy lifting thats not really very helpful as i work in a job that requires lifting of anywhere from 5 to 15kg.  I saw a gyno at a public hospital here in qld and he suggested not lifiting any more then 3kg for the rest of my life.  This is really unrealistic with a 5mth old baby that already wieghs about 8kg.  what sort of job am i going to be able to do with those sort of restrictions?  I feel utterly lost in regards to what steps to take to not worsen my prolapse and feel at my age that my life is over.  Any suggestons would be greatly appreciated.  Thanks very much for your time.  Katie of brisbane.

    • Hi Katie

      Can you describe the type of work you do for me in addition to your work as mother of 2 children? There are factors in addition to the weight lifted that are worth discussing in relation to your good question. Let me know so I can respond to this in detail and help you more.

      Cheers
      Michelle

  31. Thanks michelle for your very quick reply.  I work in a bakery  at coles so we carry a lot of boxes with frozen dough weighing roughly 12kg each and boxes of packaging that can weigh upto 15kg. I have not yet returned to work but was planning to do so first week of jan 2012.  The doctor didn't suggest a pessary which i would of liked to give a go.  My job as a mother is just the usual housework no gardening.  My eldest is 4yrs so i don't lift him at all. I have been seeing a womens physio for 2mths  and have managed to get a grade 2 cystocele down to a grade 1 but no improvment with the uterine prolapse.  She dosen't fit pessaries there so i was going to try to get a appointment with sue croft as i saw on her web page that she fits pessaries.  Do you think if it worked ok that i would be able to lift a bit more then the 3kg?  Thanks so much for replying to me.

    • Safe lifting with a prolapse

      Hi Katie

      Thank you this gives a good overview of your physical demands. It is great that you are seeing a women’s health physio for pelvic floor rehabilitation. I agree it is an excellent idea to determine your suitability regarding a pessary, there are some great user friendly pessaries now that can be used as required, and some that are fitted for up to six months at a time.

      Regarding safe lifting with a prolapse – the amount that can be lifted varies form woman to woman. Some specialists advise their patients to avoid lifting any more than 10 kg post operatively long term. The amount a woman can lift will vary from woman to woman depending on many factors such as physical strength, history of previous prolapse surgery and pelvic floor function and capacity to withstand downward pressure.

      There are many factors that come into play in determining how much a woman can safely lift with a prolapse for example a mature woman who has had a number of prolapse operations with poor pelvic floor function would be capable of lifting far less than a strong young woman with good pelvic floor capacity and no history of prolapse surgery.

      The amount that can be safely lifted with respect to pelvic floor dysfunction can really can only be accurately assessed in the clinic using real time ultrasound to look at what happens to the pelvic floor during lifting i.e. does it descend? Or does it hold up as it should? Once again other factors can come into play such as lifting frequency, the height from which lifting occurs and whether or not the pelvic floor is well braced before and during lifting.

      Tips for safe lifting with a prolapse

      1. Keep the object close to your body
      2. Breathe out as you lift
      3. Brace your pelvic floor muscles before and during lifting
      4. Use lunge rather than squat position whenever you can to lift from a low height and avoid wide legs deep squat position
      5. Try to keep lifting from waist height- the lower the height from which you lift the more pressure on the pelvic floor
      6. Never lift a weight that makes you strain
      7. Try to minimise the weight you lift wherever possible e.g. ask cashier to pack your goods into smaller loads at the supermarket
      8. Try to reduce the frequency of lifting heavy loads
      9. Consider alternatives to lifting and carrying e.g. sliding rather than lifting, using a laundry trolley
      10. Employ the assistance of others wherever you can
      11. Avoid lifting when your body is fatigued- your pelvic floor muscles wont function as well
      12. Discuss your lifting restrictions with your employer if possible and work together to determine suitable alternatives or supports such as trolleys and better lifting heights

      More tips to help…
      • Regular kegel exercises/ pelvic floor exercises
      • Discuss your suitability for a pessary with your gynaecologist
      • Wear good quality support briefs when on your feet for extended time
      • Stay physically strong with regular appropriate resistance exercise – the stronger your body is physically the less pressure on the prolapse with lifting.

      There’s a lot here Kate but this is a big issue for you to manage. I do hope this information gives you some idea and direction to help you work and self manage.
      Michelle

  32. Thankyou very much for your very informative reply.  I am so very grateful to you that you took time at of your day to give me some advice.  I think i have decided to look into other options for work as i really don't think my job is really suitable anymore for me.  I think the frequent lifting will prove to be to much and i really don't know if i am willing to make my prolapse worse.  I will be looking into making an appointment for a soon as i can for a pessary fitting and see if this option will work for me even just to give me support when lifting my bub and day to day chores.  I will look into some sort of further study so i can find a job a bit less physicaly challenging and then go from there.  I am trying to delay any sort of surgery as i am too worried about causing myself further problems. Thanks again Michelle.

    • My pleasure Katie, I really do hope this helps you in your life and in caring for your little family
      Best wishes
      Michelle

  33. Hi Michelle,
    I am a personal trainer and a ZUMBA Instructor with a history of fibromyaelgia I have worked hard to rebuild my life, and health after going through early menopause (40) and gaining over 10kg.  I am finally at a time in my life that I am the fittest,and happiest and am at within 1kg of my ideal weight.  And then I had a prolapse afew days ago.  I am currently waiting to see a specialist. 
    My life and my livelihood is exercise – at the moment I feel that I am hovering on the borderline of depression just thinking about how helpless I felt in the decade of my 40's (I am now 51) and I cannot bear the thought of going down that path again.  I work at Curves a womens gym which is a circuit of hydraulic equipment.  I wonder if you wouldn't mind logging onto http://www.curves.com and checking out the equipment.  We have hundreds of thousands of women (many post menopausal) who are members and I would greatly appreciate your views on the equipment so that I can confidently adapt their (and my) workout.  Also I know the answer to this in my heart but how much pressure is placed on the pelvic floor during a zumba class?  After a hysterectomy how much time would I need befor I can resume my zumba teaching? I have ordered the inside/out book and aim to educate as many of my members as I possibly can about this condition.  Many thanks

    • Curves, Zumba and prolapse

      Hi Teri

      Thanks so much for your email.

      Yes I do understand your fears, first and foremost I will say that it is very possible to exercise for fitness, weight management, emotional and mental wellbeing without compromising the pelvic floor. It relation to exercise and prolapse, this is a matter of being informed about appropriate exercise, avoiding those exercises with the potential to place strain upon the pelvic floor and at the same time working long-term to increase and maintain pelvic floor support with pelvic floor/kegel exercises.

      As far as Curves go, yes there is a big postmenopausal population with many particioants at-risk of pelvic floor dysfunction with inappropriate exercise. Ideally women should be be screened before commencing their exercise program in order to determine their individual risk of pelvic floor dysfunction with the wrong type of exercise, and exercises prescribed accordingly. I prefer not to comment on Curves exercises or any specific exercise chain or program. Rather to say say that some exercises and resistance training machines do have potential to impact upon the pelvic floor – you will read more about these exercises under the circuit training information and general strength equipment and exercises to avoid in Inside Out. Specific exercises for caution include weighted squat machines, leg press machines and abdominal exercise machines.

      Prolapse surgery may be performed with/without a hysterectomy according to your medical specialist’s diagnosis. In the past hysterectomy alone was sometimes performed for prolapse treatment and we now know that this was ineffective for some forms of prolapse. This is because removing the uterus in the hysterectomy procedure does not repair the vaginal walls through which prolapse often occurs. When you can return to exercise will depend on the surgery performed, your specialist’s preferences and your recovery post-op. It usually takes 3 months for full healing after prolapse or hysterectomy surgery.
      Zumba exercises need to be kept low impact to be pelvic floor safe. This means maintaining contact with one foot on the ground throughout, as opposed to high impact exercise where both feet are off the ground. Use your judgement in relation to the higher impact exercises and modify them to low impact for pelvic floor protection.

      Good luck Teri, if you have any further comments/questions please send them though.
      Kindest regards
      Michelle

  34. Hi Michelle, I am 50 years old and I had a complete hysterectomy almost 6 months ago. My husband and I are thinking of purchasing a stepper or an elliptical exercise machine and I am wondering are either of these safe for me to use?

    • Elliptical machine and stepping machine exercises and hysterectomy

      Hi Diane

      Thanks for your question regarding the choice of appropriate exercise machine long-term after hysterectomy recovery.

      Unfortunately I am unable to say what is safe for you to use specifically in terms of your general health and well being. However I can say that the stepper and the elliptical machines are both low impact machines that will usually place minimal pressure on the pelvic floor during exercise. Both machines will provide a good cardiovascular workout and assist with weight management. Low impact exercise is the exercise of choice long-term after a hysterectomy for most women.

      When using either piece of equipment there are a couple of further considerations.

      When using a stepper it may be that a larger stepping action that is permitted with some stepping machines can perhaps slightly increase pressure on the pelvic floor as opposed with a smaller step height. In addition large steps will undoubtedly increase pressure on the knees so are not the ideal choice for women whose knees are at risk. Some stepping machines also increase resistance with increased speed so that a slower speed will often promote less resistance and pressure than a faster stepping speed. Ideally keep steps small and slow to minimise pressure on the pelvic floor.

      The elliptical machine usually has less height involved in the alternate lower leg movements as the foot supports/pedals usually rotate through a reasonably small circumference. This would in theory create less pressure on knee joints and the pelvic floor when compared with a large stepping machine action. The arm supports that are pushed back and forward when using the elliptical would I suspect increase upper abdominal muscle activity which may somewhat increase pressure on the pelvic floor. This could be readily accommodated by moving the arm supports gently rather than forcefully using the upper body.

      There are no comparison studies done on the effect of either machine on the pelvic floor to my knowledge. I am merely speculating here from my understanding of the muscles and forces involved. I do hope this gives you a little information with which to assist in your decision.
      Thanks again Diane
      Michelle

  35. Hi, Michelle.  I reread some of the posts from other hysterectomy and prolapse repairs about how soon to return to walking and exercise.  I am going into my 3rd week from surgery and think i have overdone it.  I have limited my lifting and no heavy housework but when I grocery and other shopping it takes about 2 hours of driving, shopping, pushing carts etc. and I am exhausted when I return home.  How much should I limit the time on my feet at  a time?  Is sitting to do tasks better than standing?  and is laying down better than sitting?  I am (or was) a very independent  person (artist-potter).  I feel well, no pain, just get tired easier.  I am 60.  So in a nutshell, in a 12 hour period, how much time should i spend on my feet, sitting, and laying down?  I surely don't want to undo the surgery.  Thank you.  Your website has been very informative.
    Sandi 

    • Fatigue after a hysterectomy/prolapse repair

      Hi Sandi

      Finding a good balance for rest and activity during hysterectomy recovery/prolapse surgery recovery can be really difficult and is a very individual thing. Women typically vary in the amount they can do post op. This can be due to factors such as the type of surgical procedure performed, age, pre-operative fitness strength and fitness levels and post operative complications.

      What many women do describe is feeling very tired (and being surprised at this), and this fatigue can continue for quite some time post op. Unlike some other forms of surgery, with pelvic surgery such as some forms of hysterectomy and prolapse repair there are often no external signs of the surgical procedure while internally there can be quite a deal of repair and recovery taking place.

      There is usually no hard and fast rule for most women regarding how much time to spend upright/doing activity owing to the vast differences among women and surgical procedures. However we do know that the least amount of pressure on the pelvic floor occurs laying down, when compared with upright. Sitting involves less pressure on the pelvic floor than standing. When recovering from hysterectomy and/or prolapse surgery it is wise to really listen to your body and rest regularly so that you avoid becoming really tired. The position of least pressure on the wound (lying down) will help promote healing so some time should be spent on a regular daily basis lying down. Activity is usually best varied between laying down, sitting as tolerated and short walks as tolerated, again all very individual.

      If you are concerned about fatigue levels, then always discuss this with your specialist or your general practitioner. Sometimes there can be other medical factors contributing to excessive fatigue for example as anaemia can be an issue for women who have undergone hysterectomy, particularly when performed for heavy menstrual bleeding pre operatively.

      To optimise early healing after a hysterectomy and minimise fatigue:
      -Rest regularly throughout the day
      -Plan short outings only wherever possible and only when you feel up to it
      -Eat well choosing a variety of fruit, vegetables and protein for healing
      -Balance a small amount of daily exercise (usually walking) with rest
      -Choose to sit rather than stand as tolerated, in the case of prolapse repair some women find it more comfortable to lay down with a pillow under their knees
      -Listen to your body and act accordingly, some days will be better than others
      -Gradually progress the amount of activity/exercise you can do according to how you feel
      -Always speak to your medical practitioner if you have concerns about your fatigue levels.

      Best of luck with your recovery Sandi, hope this information helps a little,
      Michelle

  36. Hi Michelle,
    I had a complete hysterectomy and I read in your book, that squats were bad to do. I was wondering if I need to get down low, for example to pick something off the floor or get into a low cupboard or gardening, what is the safest way to get down low without hurting myself and putting my pelvic floor at risk?  
    Diane

    • Safe lifting after hysterectomy

      Hi Diane

      Yes you are correct, after a hysterectomy or pelvic prolapse surgery women should try to avoid deep wide leg squats. These place pressure on the pelvic floor especially when squats are deep and even more so if carrying a load. A much safer option is to use a lunge position with legs in long stride position. Lower your body down by bending your legs and then push back up into standing using your leg strength as much as possible and helping with your arms leaning on a nearby object such as an armchair if necessary. We have a free video on how to lunge with safe lunge exercise technique that may be of interest to you. Some of the research suggests that more pressure is placed on the pelvic floor with lifting from a lower height so the more lifting can be kept to waist height the better.

      Thanks for your great question Diane
      Michelle

  37. Hi Michele,
    You have encouraged me that exercising the pelvic floor muscles will help with my prolapse.  Thank you.  Along with excersising would a pessary help when I'm gardening?  Is it reasonable to find one I can put in and take out myself for this purpose using it only when I am doing something that I know will require a lot of  work?
    Thanks,
    Vicki

  38. Elizabeth says:

    Hi Michelle,
    I had a bladder repair done 3 years ago was successful…but  this past weeks I have had abdominal pain & prolapse again .
    I've just read on your site  cilinder you call it… does that mean a support girdle ? and  could this cause prolapse ?
     Thanking you 
    Eizabeth

    • Recurrent prolapse and core muscles

      Hi Elizabeth

      It is well established that having prolapse surgery increases the risk of future prolapse, so even though your surgery was successful any one of a number of factors may have come into play with the recurrence including: pelvic floor muscle dysfunction, bowel straining, weight gain, chronic cough, heavy lifting, inappropriate exercises just to name a few.

      Regarding the cylinder of support or core muscles… Yes the cylinder consists of muscles surrounding the trunk that act together to control the pressure within the abdomen. These are the core muscles which are not just the abdominal muscles which is a common misunderstanding. Abdominal pressure is directly transferred to the pelvic floor. All the muscles in this cylinder of support (including the abdominal muscles and the pelvic floor muscles) should work together in a coordinated manner. When they don’t, then pelvic floor problems can result for example when the abdominal muscles work too strongly and the pelvic floor muscles lack the strength to counteract the pressure associated. If the pelvic floor muscles lack strength and support then yes, this can contribute to recurrent prolapse.

      I hope this helps your understanding Elizabeth.
      Regards
      Michelle

      • Hi Michelle,
        Thank you so much for your help it has made me understand more about pelvic floor exercises i also tell my family & friends and other women i talk to about your site  .
        Thank you  also for the wonderful service you provide to women that is not explained when we have the prolapse or operation hopefully this will save a lot more women having operations .
        regards
        Elizabeth

  39. Hi michele what a fabulous service you provide! Like many of the previous comments i have vaginal prolapse and am desperate to exercise padticularly as i seem to have developed insulin resistence. The best and most effective exercise i have ever done is trampolining on mini rebounder, if i kept this low impact with one leg on trampoline would it be safe? If not, would it be safe if i first had a pessary fitted? I am desperate to loose weigh and the low impact exercises just arent helping! Thanks in advance x

    • Management for prolapse, weight loss and insulin resistance

      Hi Nicola

      Thank you for your input, you raise a number of important issues regarding prolapse, insulin resistance, weight management and use of pessary for exercise.

      A variety of exercises has been shown to be as effective as a single form of exercise in managing Type ll diabetes including walking, intermittent cycling along with resistance training. Incorporating variety into an exercise program can have the added benefits of enhancing motivation to exercise and reducing the risk of musculoskeletal injury (including pelvic floor injury) so it is important to consider a variety of options.

      With respect to the rebounder if kept low impact this should not create adverse pressure on the pelvic floor however it would be beneficial to vary the types of exercise performed and incorporate this as part6 of the program. Resistance training can be pelvic floor safe as you will see from Inside Out along with many of the videos and articles on this site. Incidental exercise is also most beneficial for weight management and Diabetes Type II management ; considercycling rather than driving and parking the car a little further away from your destination so there are many possibilities to explore that are pelvic floor safe.

      Pessaries when well fitted are a terrific option to assist women to exercise with reduced symptoms and better support, and it would be great if they were used more often. There is also a theory that pessaries may also improve the ability of the pelvic floor muscles to strengthen by lifting the weight of the prolapse on them, this is yet to be shown in studies as I write.

      I hope this gives you some of the information you require Nicola and good luck!
      Michelle

  40. Hi michele i have just bought your ebook BTW!

  41. Dear Michelle,
    Just like Elizabeth, I am also experiencing recurrent prolaspe. I had surgery 12 years ago but that did not help the situation. I been experiencing it back and forth on a mild level…it comes out and goes back in but recently it has been severe. Please help me with some advice that can help me.
    Thanks
    T

  42. Hi Michelle,
    Thank you for your wonderful information and videos.
     I am 65 (amazing how hard it is to say that age as I felt until surgery about 30)   2 1/2 weeks ago, I had a laproscopic assisted vaginal hysterectomy, removal of both fallopian tubes, suturing of the bladder to abdominal wall. with repairs for both an extensive cystocele and rectocele.  I believe this damage was the result of birth injuries after my 3rd pregnancy and several cases of pneumonia complicated by my previously uncontrolled asthma. (I must of coughed for 3 years after exposure to chlorine gas but that is another story).
    I am looking at resuming my exercise programs.  Previously, I went to aquafit, "hot" yoga, cycled and played tennis. I love cycling and tennis and do the others in order to improve my fitness for tennis.  
    My gyne, says I can resume tennis 8 weeks after my surgery ( not likely as the net won't go up here until mid -end of April-I'm Canadian).
    What do you advise?  My bicycle handlebars and seat are adapted so I sit upright, I can talk to the instructor at aquafit so that I can follow your instructions regarding water exercises.  What exercises do you think I should avoid at yoga?
    I will see my gyne in another 4 weeks.  I am going to recommend that he take a look at your website – Your information is wonderful.  Until January of this year when I turned 65,  I was a Registered Nurse and really appreciate the amount of work it takes to provide such usful information.
    thank you for your advice
    Roberta

  43. Hi
    Just wondering, holding on to your bladder rather than going to the toilet straight away would make things worse? I know you mentioned straining, but holding on too?
    Ta – Amanda

    • Bladder empty and prolapse

      Hi Amanda
      Good bladder habits involve the practice of avoiding going as soon as you get the urge to empty the bladder. Many women develop urinary urgency as a direct result of emptying their bladder too frequently. It is normal to empty the bladder 6-7 times daily for most women, and once at night. It is very important to avoid emptying the bladder ‘just in case’. For most women the bladder should emptied between around 300 – 500 mls. You can readily measure your volumes by voiding into a measuring jug to monitor the amount of urine you void. It is not advisable to hold on to very large volumes over and above 500 mls either.

      Holding onto your bladder contents will not make things worse in terms of prolapse. It is unlike straining which places tremendous downward force on the bladder. It may well be that holding on for a short while actually uses your pelvic floor muscles to help control the urge.

      The best way to know if you are empting your bladder at the appropriate time is to measure how much you empty.
      Michelle

  44. Hi Michelle,
    I am 64, a black belt in Taekwondo which I have done for decades and love, and a grade 2/3 prolapse.
    I did not want to be a drama queen, so I ignored doctor advice and now he is strongly advising surgery, no heavy lifting and no Taekwondo.  I also have IBS which is a most annoying problem and contributes to pelvic floor strain.
    The prolapse gives me no problems apart from being aware of it, so I am reluctant about surgery, but he tells me such horror stories.
    I will control heavy lifting, (no more moving apartments for kids).
    But I am mortified about stopping Taekwondo.  It is great exercise, which I need (high cholesterol), and it has been part of my life forever.  The bulk of Taekwondo is lower body, kicks etc, even punches are practiced in squat position, crunches, stretching, etc., etc., 
    Should I get a second opinion about surgery?
    Will a physiotherapist be able to give me advice about continuing Taekwondo?
    Will your book help me do the correct pelvic floor exercises and is it possible to reverse or at least not worsen a prolapse at my age?
    Thanks Michelle, I  appreciate it.
    Gwen, USA
     
     

  45. Hi MichelleI think your site is most informative.I manage quite well with my uterine prolapse but do not knowwhat to do when it suddenly falls down causing pain and stops me in my tracks.I would appreciate advice thank you Paula

    • Prolapse and walking

      Hi Paula

      Do you mean that your prolapse falls down suddenly during exercise such as walking? Are you sure that this is what is happening and have you discussed this with your doctor?
      If the prolapse is moving down and causing discomfort then steps need to be taken to improve prolapse support generally. This may include:
      – use of pessary ring (discuss this with your gynaecologist)
      – pelvic floor muscle rehabilitation
      – wearing supportive undergarments when walking
      – weight loss if warranted
      – short walks/ frequent walks rather than extended walks
      – timing walking to when you are not fatigued.

      I do suggest you seek medical review on this issue particularly if it is associated with intense pain.
      Hoping this gives you some direction Paula
      Michelle

  46. Hi Michelle
    I have a rectocele and wide-spread muscle pain, i.e. fibromyalgia, which also makes my muscles stiff.  An exercise I like to do to ease the muscle pain and stiffness is the on all fours yoga stretch called 'the cat – cow pose' to which I add a variation where, when I am in the 'cow' part of the pose, I turn my head and move my hips to one side and then the other.  Am wondering whether this is okay with a rectocele?  Also whether the chi gong 8 brocades are prolapse safe?
    Is squatting okay, e.g. would opting for a semi squatting position to go to the toilet  be of benefit for prolapse, i.e. by raising the legs on a stool by a few inches?  It certainly seems to help ease the constipation caused by my rectocele, but I am wondering whether squatting generally applies too much abdominal pressure and could cause further prolapse, for example, a cystocele.
    I am going to order your book.
    Many thanks,
    Joan

    • Yoga, bowel management and rectcoele

      Hi Joan

      The cat-cow yoga pose shouldn’t place excessive pressure on a rectocoele and the side tilt modification you describe here won’t increase pressure unduly on the pelvic floor. A word of caution from a physiotherapy perspective would be not to take cow into the full range of arched spine since with cow there is the potential risk of jamming up the small facet joints either side or the spine with this movement especially with a sideways tilt however modified should not be an issue.

      Yes elimination can be so difficult with a rectocoele. Raising the knees higher than the hips can be really useful to assist with emptying (a toilet roll still in its wrapping placed under each foot can assist and can be stored in the restroom/toilet without drawing attention). Some women choose to use a low footstool however it can be difficult to get stool that is not too high that still allows you to take the hips and legs apart and lean forwards, if the stool is too high it can cause the loss of the inward curve in the spine which is not helpful when trying to empty the bowels. This video on how to empty the bowels without straining may also assist you Joan. Squatting on the ground will increase pressure on the pelvic floor and rectocoele.

      Regarding Tai Chi and the 8 brocades, the only exercise that I can see that can potentially increase pressure on the pelvic floor that may be aggravating for some women could be number 6 the forward touch toes and then back bend. Bending forwards to touch the toes would increase intra-abdominal pressure however in general this type of exercise routine is low impact, gentle, non-weight bearing and should place minimal pressure on the pelvic floor. As always if you notice symptoms with this or any exercise then you are best advised to cease.

      Thanks for your interesting enquiry Joan
      Michelle

  47. hi, i have fibroids and a slight uterine prolapse and was having very heavy periods  , the gp suggested i have the mirena coil fitted to help but since then ( 6 months ago ) things are worse, i bleed every 2 weeks for 10 days and get really bad cramps and now i think the prolapse is worse, im getting really bad lower back ache and lower abdominal pain, sometimes it feels differcult to walk and go to the toilet, i have a appointment at the hospital but wondered in the meanwhile what i can do to help myself other than pelvic floor exercises. i do zumba which i love but should i stop for now?
    thanks

    • Fibroids, prolapse and zumba

      Hi Jan

      The best way to minimise pressure on the pelvic floor with your current exercise regime is to minimise any high impact exercise and this includes Zumba until you have your condition medically assessed. It is best to select low impact exercise to minimise pelvic floor pressure such as stationary cycling or walking small distances on flat surfaces.

      Taking action to decrease the pressure on the pelvic floor throughout the day includes sitting rather than standing, elevating the legs and lying down when possible especially at the end of the day and wearing support briefs when up and around. This is in addition to a good routine of daily pelvic floor exercises.

      Best of luck,
      Michelle

  48. I have had recent POP surgery.  I have to keep my lower back and ab muscles strong to support DJD in lower spine.  Any suggestions on how to safely strenghten while avoiding pelvic floor pressure? Pretty much every exercise I do for my back is on the DON'T list. Thank you

    • Pelvic organ prolapse surgery and safe core abdominal muscle exercises

      Hi Andrea,

      Thanks for your comment. There are quite a number of gentle core abdominal exercises that are pelvic floor friendly and avoid placing pressure on the pelvic floor. Some of these include:

      • very basic Pilates mat exercises with head and legs on the mat;
      • Seated fit ball exercise and also engage the supportive deep abdominal muscles that support the low back. Intense core abdominal exercises can have the reverse effect of increasing pressure on lower spine conditions so these are not the type of exercises for degenerative spinal conditions.

      For further information on seated fit ball exercises you may wish to refer to this video on core exercises after hysterectomy and prolapse surgery.
      I hope this helps Andrea.
      Michelle

  49. Mary Frances says:

    I have uterine and bladder prolapse and a cystocyle.  I went through physical therapy over a year ago but the physical therapist said that I am the only patient she has had that still cannot activate my pelvic floor muscles. What are the possible causes for this? What exercises can I do to activate the pelvic floor? 

    • Pelvic exercises after bladder and uterine prolapse surgery

      Hi Mary,

      Firstly, don’t feel you are on your own. It is actually the case that women are unable to activate their pelvic floor muscles. There are a number of possible causes for this. These causes include:

      1. Having sustained nerve damage during pregnancy or child birth;
      2. Having something called levator avulsion which means that the pelvic floor muscles are torn from their attachments and therefore they don’t work;
      3. Pelvic pain is another reason. Pelvic pain can also cause pelvic floor muscle spasm making the muscles unable to be activated; and
      4. Pelvic floor muscle weakness can also be a cause of unable to activate pelvic floor muscles especially if you are unable to feel your pelvic floor muscles working.

      When women are unable to activate their pelvic floor muscles, pelvic floor muscle stimulation therapy is often used clinically. Pelvic floor muscle stimulation therapy activates the pelvic floor muscles and the women practice their pelvic floor exercises with the pelvic floor muscle stimulator. This is often done under the supervision of a pelvic floor physiotherapist and it is very important to learn how to activate the pelvic floor muscles correctly because if they are done incorrectly especially after uterine and bladder surgery then the risk is straining and making the condition worse.

      Thank you for your comment.

      Michelle

  50. Hi I was wondering whether surgery is a good option if I still want to engage in quite intensive exercise with a prolapse? I love extreme sports and to be honest to read that I should be careful at a Zumba class…. Well let’s just say I tried it once but it was a bit sedate for me – I don’t mean any disrespect by that – I just mean I am in the minority of women who live for extreme sports, and my training mimics this. I also wanted to carry on sprinting. As someone else said my life would be over without this. But as an ski instructor to disabled people (who I have to lift) I see people who have broken their spines learn to sit ski – I am sure I can cope with a prolapse. However, my question is… Would surgery be a good option for a moderate prolapse or is it better to muddle on … adapting some exercises and have surgery in the future when….if it gets worse?

    • Hi Katie
      Yours is a great question. First and foremost the decision relating to your suitability for prolapse surgery obviously rests with your gynaecologist. I am guessing that you are reasonably young from your comments. My suggestion is to be mindful of the fact that prolapse surgery doesn’t mean that you can then resume some intense high impact and resistance forms of exercise. Rather the opposite- the first prolapse repair is your best repair, and having a prolapse repair increases the risk of recurrent prolapse too. Regardless of whether you go ahead with surgery in the future or not modification of your exercise program will allow you to keep exercising.

      Pelvic floor safe exercise doesn’t necessarily equate to sedate unchallenging exercises. There are many strength training exercises and cardiovascular fitness exercises that remain challenging and pelvic floor safe at the same time. Skiing is a wonderful form of exercise as you well know, cross country skiing will give you a great low impact workout, probably wise to avoid jumps with your prolapse. Heavy lifting is the issue at hand for you and you will need to ensure your pelvic floor strength is up to the task of the great work you do helping others, so that you can keep helping them.

      In short having a prolapse doesn’t mean your exercising days are over-it does mean modifying the high impact exercise and avoiding intense core exercise. Hope this helps you to keep exercising and enjoying life
      Cheers
      Michelle

  51. Hi! Great info-thank you! Just found out I have a herniated disc in my spine and need to start physical therapy to strengthen my core to help with this pain….wondering what advice you may have as I also have prolapse!!

    Thank you!

    • Michelle Kenway says:

      Hi Laurie
      Great that you are getting Physical Therapy to help your herniated disc recovery. As your Physical Therapist has probably explained, your core muscles wrap around your trunk and include your abdominal, some spinal, and pelvic floor muscles along with your diaphragm. The reason for training these core muscles is to improve the control of pressure within your trunk and support for your spine (and discs). With a herniated disc, your core exercises will be very gentle, and I imagine they should not be so intense as to place pressure on your prolapse. The key focus for spinal rehabilitation with a pelvic prolapse is on gentle core control exercise, with some gentle core strengthening progressing to using your core muscles functionally during your everyday activities. Your Physical Therapist will know to avoid those intense core exercises with the potential to impact on prolapse such as double leg raises, as they are not appropriate for a herniated disc either.

      In summary gentle core control exercises are the order of the day – it’s a case of slow and steady to regain your core control for both your spine and your pelvic floor.

      Best of luck
      Michelle

  52. hi, i am a women’s health physiotherapist,happy to see this website which throw much lights on area that goes unnoticed,or many are unaware of,my heartfelt wishes for your growth

  53. I have been doing hard crunches, sit-ups, deadman squats, leg lunges, scissors kicks, and running since I was 16. I am now 26 and find out two years ago that I have a prolasped uterus. I want to continue to do exercise without harming myself more. Are
    reverse crunches safe to do?

    Step 1
    Starting Position: Lie on your back on a mat with your knees bent, feet flat on the floor and arms spread out to your sides with your palms facing down. Gently exhale. Engage your abdominal/core muscles to support the spine. Slowly lift your feet off the floor, raising your knees directly above your hips. Bend the knees to 90 degrees. Hold this position and breathe normally. Use your arms as a base of support.

    Step 2
    Upward Phase: Exhale, and slowly raise your hips off the mat, rolling your spine up as if trying to bring your knees towards your head. Avoid any change in the angle of your knees during the roll-up. Use your arms and hands to assist with maintaining your balance and continue to curl-up until your spine cannot roll any further. Hold this position briefly.

    Step 3
    Downward Phase: Gently inhale. With control, lower your spine and hips back to the start position.
    Proper form is important when performing this exercise to prevent excessive stress on your low back. When returning to your starting position during the repetitions, control your leg movement. Do not allow your knees to move past your hips, but instead return to a position directly above your hips. Since the abdominals connect the rib cage to the pelvis, the emphasis of the movement should be on pulling your pelvis upwards towards your rib cage.

    Also are wall squats okay to do. I like to keep my thights tone as well. Thank you in advance.

    • Michelle Kenway says:

      Hi
      Thanks for your question on reverse crunches and your prolapsed uterus. As you are probably aware reverse crunches are usually performed to focus upon lower abdominal muscle strength however they also involve other abdominal muscle groups being activated including upper abdominals and external obliques. What you are capable of doing ultimately depends on the functioning of your pelvic floor to withstand your chosen abdominal exercise, in this case reverse crunches.

      Unfortunately having a prolapsed uterus indicates a degree of pelvic floor dysfunction exists and this means that your pelvic floor would be likely to be at increased risk of injury compared with someone without pelvic floor dysfunction. Reverse crunches are an intense core abdominal exercise, and not one to be recommended to women with uterine prolapse owing to the potential for increased pressure within the abdomen that is transeferred to the pelvic floor.

      In simple terms when you contract your abs strongly, it’s like squeezing the sides of a toothpaste tube. If there is an area of weakness or a give point, then the pressure will mostly impact upon this area. In many women, especialy women with uterine prolapse, the give point is the pelvic floor.

      As far as squats go, they can be readily modified to be a pelvic floor safe exercise. This ‘How to Squat‘ video will help you know the modifications to make to keep your squats pelvic floor safe and how to avoid compromising your pelvic floor with unsafe squats – hope this helps you keep exercising.

      Let me know if you need any further clarification here
      Best wishes
      Michelle

  54. Hi,

    ive been doing high intensity interval exercises (together with heavy weights) for the past 2 years.

    i believe i may have a weak pelvic floor as a result. I do not wish to aggravate the situation but yet i still wish to continue my exercise regime. I would like your advice on whether the following are pelvic floor safe exercises.

    1) mountain climbers

    2) heavy weight training on the gym machine (while seated)

    3) brisk walking on the treadmill on incline

    Thanks!

    • Michelle Kenway says:

      Hi Rai
      Thanks for your questions…
      1. Mountain climbers or steppers are low impact which is good – it is important to keep the steps small and resistance low rather than high
      2. Heavy weight training seated will depend on the exercises involved. Which exercises are you doing seated Rai?
      3. Brisk walking is probably better done on the flat surface or a very slight incline only however I am not certain on this one. Why? I don’t have any studies to support this, it is just a sense that leaning forward may somehow increase pressure, do you notice any symptoms with incline versus flat? This is a good question. Obviously walking downhill will increase impact…
      Cheers
      Michelle

      • Hi Michelle

        Thanks for the reply.

        Regarding the heavy weight training while seated, there are several:-

        1) one of them, i’m not sure what its called but its something like the cable row (but with a lifted cushion against my chest to keep my back straight) – i do 4 sets of 20 (20kg)

        2) another machine somewhat like the Front lat pulldown (4 sets of 20 (20kg))

        3) leg extension (3 sets of 20 (15kg))

        4) adductor (inner thigh) – 4 sets of 30 (30kg)

        5) abductor (outer thigh) – 4 sets of 30 (30kg)

        are these exercises pelvic safe?

        (heres a link of the type of exercises i do -http://www.straightforwardfitness.com/gym-equipment.html#BICEPSCURLMACHINE)

        meanwhile, regarding the brisk walking/running on incline, now that i think about it, yes i do notice a difference on flat and incline.

        i find that flat and slight incline (maybe 1-4) are fine but anything above 5 i do find it tougher on the lower body as though there were a gravitional pull (does this equate to more pressure? i’m not sure..)

        ive ordered your book and dvd and cant wait to receive it to resume my exercise again.

        Thanks alot Michelle :)

        3)

        • Michelle Kenway says:

          Hi Rai
          Some key points for pelvic floor strength training using machines – the load shouldn’t make you strain, breathe out with the effort, sit where possible and choose apropriate exercises that are pelvic floor safe…Take a look at this article for more specific guidlelines http://www.pelvicexercises.com.au/strength-training-protection/

          1. seated row should have inward curve in back, exhale with pull back, keep weight manageable and feet on ground where possible
          2. take care lat pull downs as they can make you use your upper abs and increase pelvic floor pressure – need to keep inward curve in low back, exhale with pull down, keep weight manageable don’t strain
          3. leg extension seated should have ineard curve in back, exhale with extension and keep weight manageable, this exercise can increase pressure on the pelvic floor in some women
          4. adductor abductor in reclining position are usually pelvic floor safe.

          Rai remember that all women are different as our pelvic floor capacities all differ so this is general information only, and what you can do in terms of your pelvic floor will depend on the strength and fitness of your pelvic floor.

          As far as the walking machine goes, I would suggest that women keep the surface flat. Maybe you can do this – and notice your symptoms and how they change when you change the gradient. This is your best guide – listen to what your body tells you and if you sense an exercise is placing pressure on your pelvic floor either avoid or modify it and notice what happens. It sounds as though you are becoming well aware of the potential for some exercises to impact and cause you problems so steer clear or modify these ones.

          Good luck, hope this helps and thanks for your great questions!
          Michelle

          • Hi Michelle

            Thanks so much for the reply and depth of information provided.

            Will take note of it. Many thanks once again.

            Rai

  55. Hi Michelle.
    I am in my early 30’s and had my first baby last year. After the birth I was diagnosed with a mild bladder and uterine prolapse. I have since been to a womens health physio and have purchased “Inside Out” to make sure my workouts are pelvic floor safe. I also have a pessary to use when I exercise that was fitted by my physio.
    I was very fit and active previously and I can’t say I don’t miss my old workouts but I am trying really hard not to dwell (she says with tears welling up) and make do with swimming, walking and cycling. But I do feel very isolated doing them.
    I was also wondering if boxing is something I could consider. I was just going to do it at home with my husband using gloves and pads. Thanks in advance.

    • Michelle Kenway says:

      Hi Steph
      Good thing is that your prolapse is mild, and that you have a pessary fitted too. Great that you have seen a Pelvic Floor Physio, you are doing all the right things. Your boxing question is tricky to answer conclusively- there is just so much we don’t know about pelvic floor safe exercises with very little research into this area and the problem that women are all different with respect to their pelvic floor capacity.

      I suspect that boxing is not the safest exercise for pelvic floor prolapse – I would definitely leave skipping and kicking, light punching is a possibility. What types of exercise did you do before your baby that you enjoyed the most Steph?

      Look forward to hearing back
      Michelle

      • Thanks Michelle for your fast relpy. Before baby I did a lot of running, step aerobics, pump and attack classes. I also walked my dogs daily, which I still do. I was really looking forward to getting back to it and never knew this could happen after delivery.

        I was just thinking punching to try and slim down my arms a bit. I also have an underactive thyroid triggered from the birth so I am finding it a bit more difficult to lose the last couple of kilos even with a very healthy diet.

        Appreciate your feedback.

        • Michelle Kenway says:

          Hi Steph
          OK first of all arm exercises won’t slim down your arms. Unfortunately the myth of being able to ‘spot-reduce’ our fat still pervades. To slim down your arms, or any other part of your body requires whole body fat burning exercise plus diet. This is why no amount of sit ups will flatten your stomach etc.

          It sounds as though you really enjoy group exercise so why don’t you consider getting back into that? There are pelvic floor safe options of Zumba classes, or modify the exercises in a pump class. You can readily modify pump squats or avoid altogether and do lunges instead, take care with dead lifts use a lighter bar weight, do bridging when the ab training section comes on – you can readily modify or avoid some specific pump exercises to minimise the pressure on your pelvic floor and you know how to do this (see the strength training guidelines in your Inside out book) and use weights that don’t make you strain at all. It is a good idea to inform your instructor before the class that you would like to avoid some specific exercises – it’s up to you how much information you choose to reveal. If your instructor is informed about pelvic floor safe exercise this shouldn’t be an issue, if not state for your own ‘health reasons’ there are exercises that don’t suit your body that you would like to avoid. When I do pump I often stand to the back of the class so I can modify without drawing attention to myself.

          My other thought is to consider spinning if you enjoy group exercise – it is possible to keep resistance low and avoid standing tracks. The sprint work will be fantastic to help you manage your weight and also help you feel that great feeling you get from intense workouts.

          Finally you might consider some light resistance training – aside from the many health benefits this is a great way of toning, helps you feel great and may also help with weight management.

          Does this give you some ideas? Let me know how you go.
          Michelle

          • Thanks Michelle I will definitely go back to pump and make some modifications. I am just afraid I will do something and walk out with my cervix around my knees ( I’m a little dramatic). I gave spin ago this week and can see how it will work for me.

            I was also wondering if women’s pushups (on knees weight slightly forward, a bit harder than the ones you do when pregnant) are ok to do?

            You are a fantastic resource and I will let you know how I go. Thanks for the advice.

          • Michelle Kenway says:

            Hi Steph
            Sounds like a good plan! Women’s push ups can be made pelvic floor friendly with knees directly under hips, hands directly under shoulders and take your nose slightly forwards as if making a triangle with your nose as the tip and your two hands as the base of your triangle. The further forward you take your nose, the more challenging the exercise. Try it and let me know how you go…and have a great time at your classes :)
            Michelle

  56. Hi Michelle
    Firstly, I have found your website and videos to be a highly informative resource for exercise post prolapse surgery – thank you! After having 4 babies in 6.5 years, I had both a rectocele and cystocele (advanced stage 2). I found the intense dragging to be too symptomatic and elected to have wall repair surgery 4 months ago in October last year. I have only just recommenced exercise in the form of swimming. I’m concerned, however, that we have a 9 day ski holiday scheduled in 7 weeks and it may impact my healing! Do you think it is too soon for skiing? And, if it’s OK, what exercise(s) I can safety undertake to best prepare for skiing? I would really appreciate your view…

    • Michelle Kenway says:

      Hi Renee

      Thanks for your comment and feedback.

      Have you seen a Pelvic Floor Physio for post op rehab? I think this would be a great place to start, to get an idea of your pelvic floor function at the moment and to make sure that your risks of repeat prolapse are kept to a minimum. This would also give you an idea of your pelvic floor capacity to cope with physical activities like skiing. Skiing at beginner/intermediate level is usually a good low impact exercise – advanced skiing and jumps would obviously increase the impact on the pelvic floor. If all has gone smoothly with recovery, healing from prolapse surgery is usually complete by 3 months post op. If in doubt I suggest you speak with your surgeon to get the OK.

      Exercises for skiing considering recent pelvic floor surgery would focus on leg strengthening particulalry thigh strengthening exercises – sustained squats are particularly beneficial. Modified pelvic floor safe wall squats are ideal with maintained holds. Pelvic floor safe lunges also assists leg strength exercise. Upper body strengthening with seated pelvic floor safe upper arm and upper mid back strength exercises are also beneficial for using stocks in snow.

      Hope this gives you a useful starting point, and that you have a great holiday.
      Cheers
      Michelle

  57. Had a hysterectomy for uterine prolapse, various pelvic pain and bladder issues in Sept 2012. Following operation, as still had pelvic pain, problems emptying bladder, groin pain, pelvic floor pain, and my gp and urogyne seemed to be unable to offer any further help, I consulted an osteopath as also had buttock pain and sciatica following hysterectomy. Osteopath diagnosed me with SI joint problem and pelvic torsion. He felt this was causing my problems. Had several weeks treatment with him and back pain has improved and he says my pelvis is now in a neutral position. Still experiencing sometimes acute pelvic pain groin pain and sometimes problems emptying bladder and he thinks I need to improve my core strength and back muscle strength. He has given me exercises to do using a gym ball. I have your book and dvd Inside Out and have been doing these pelvic floor safe exercises as I have a slight rectocele. I am a bit concerned that some of the exercises he has recommended are not pelvic floor safe, exercises such as Full Abdominal Curls, Dynamic full sit-up and would appreciate your advice Michelle.

    • Michelle Kenway says:

      Hi Rosemary
      Thanks so much for your comment/question.

      First and foremost have you consulted your surgeon regarding your pelvic pain? Did you have a sacrospnous fixation for your prolapse? I am not sure what country you are in but is it possible for you to see a Pelvic Floor Physio? There are a number of things that can cause post op pelvic surgery groin and pelvic pain. Sacrospinous fixation often causes buttock pain (initially) as the upper part of the vagina is stiched internally to a strong ligament on the inside of the pelvis (on the region of the SIJ but inside the pelvis). This pain usually settles down but in some cases doesn’t – first an foremost speak with your surgeon. He or she may also have a a Pelvic Floor Physio to recommend to you.

      As far as core strengthening goes, with previous uterine prolapse surgery caution is necessary with the core exercises performed since an intense core exercise program will increase downward pressure on the pelvic floor and this exactly what needs to be avoided if the uppermost part of the vagina is newly suspended. Dynamic sit ups/ full abdominal curls are those abdominal exercises known to place downwards pressure on the pelvic floor – these are also not the deep core abdominal stabilising exercises or what we refer to as core control exercises usually prescribed for an unstable pelvis and accompanying SIJ problems, they are core strength exercises for the outer abdominal muscles (rectus abdominis) in particular. Rosemary you can read more about the effect of this strengthening on p7 of Inside Out. Core rehab needs to be very specific and targetted at where muscle control is lacking and then gradual strength of specific muscles (usually deep abdominal muscles and pelvic muscles) for SIJ dysfunction. Sit up exercises are highly unlikely to stabilise a pelvis or improve core control.

      I hope this gives you some direction and assistance Rosemary. First stop – your specialist!
      Best wishes
      Michelle

      • Thanks so much for your reply Michelle. I am based in the UK and being treated under our NHS. I am 55 years old. Don’t think I had the fixation thing done. Asked consultant about this before hysterectomy and he didn’t seem to think necessary and wasn’t told this was done after op. I had the pelvic pain, groin pain and bladder issues before the hysterectomy . These started after a previous gyne op in May 2011 when I had a very large prolapsed fibroid removed vaginally by a general gynecologist. This is where all my troubles and pain and bladder problems began. Was told by this gyne I had a slight, less than first degree prolapse, and there was nothing much wrong with me. Saw a women’s physio in Nov 2011 and she did the Kegels with me and told me to do pilates to strengthen core but was given no guidance on exercises to avoid. I asked for a second opinion at this stage with a urogynecologist as first gyne wanted to do hysterectomy even though he said there was “nothing much wrong”. Urogyne did exploratory lap and said I had first to second degree uterine prolapse and vulvadynia. So after seven month wait and alot of pain had the hysterectomy. Thought this would be end of problems and although some improvement with bladder issues and pain, some of the same pain in groin and pubic bone area at times acute. As far as my consultant is concerned the op went well everything is healed and that is it. He did say that if I have a pelvic torsion this could be twisting my pelvic floor muscles also. I do feel now that most of my problems and pain have always been to do with the SI joint and pelvic torsion rather than the uterine prolapse but unfortunately this was not spotted by any one until I went privately to see the osteopath. I have been referred on the NHS (10 week wait) for ordinary physio for the SI joint so think I will carry on with your dvd exercises and the ones on your web site in the meantime as I feel happier and safer doing these. Think the acute pain in groin is maybe from my pelvic floor. Sorry to go on so much but it has been a tough couple of years.

        • Michelle Kenway says:

          Hi Rosemary
          Don’t apologise, pelvic pain can be very debilitating and is very poorly diagnosed and treated despite the fact that it is so common.

          Your original question to me related to the suitability of specific abdominal core exercise having had a prolapse repair, and I will reiterate that dynamic abdominals (sit ups) are not pelvic floor safe exercises.

          If your symptoms have improved with SIJ treatment, the SIJ has obviously been involved.

          I think the fact that you say you have been diagnosed in the past with Vulvodynia is important – Vulvodynia is a complex condition and usually requires appropriate multidisciplinary treatment you may find this link useful to read more.

          From a Pelvic Floor Physiotherapist point of view, pelvic pain is often accompanied by pelvic floor muscles spasm or overactive pelvic floor muscles. Treatment involves pelvic floor muscle retraining, it can take quite some time to teach pelvic floor muscles to relax (a little bit like really tight neck muscles). Pelvic floor muscles can react to pain with spasm in the same manner. You may also find that this article on pelvic muscle tension provides you with some further insights too.

          Finally I was really interested to listen to this excellent ABC radio interview recently on pelvic pain, I hope you can access it in the UK – you may find it interesting too Rosemary. There is a free ebooklet on Pelvic Pain by Dr Evans as well who speaks during the interview.

          You are most welcome to reply further Rosemary, I do hope this helps a little.
          Kindest regards
          Michelle

  58. Hello Michelle, I’m a 24 year old who just had a rectopexy surgery for a prolapsed rectum just 6 weeks ago. I’m feeling great but still some soreness in my abdomen area, which is normal. I had it done through my lower abdomen right below my underwear line. I was quite active before surgery and enjoyed doing strength training with weights and machines, group classes that focus on weights, resistance training and toning. I also did plenty of core strengthening (planks, abs, bicycle kicks, burpees, weighted crunches etc), yoga- specifically a yoga class that focuses on strengthening the abdominals and lower back. And for cardio, some stair master here and there, little sets of heart rate pumping sets such as high knees, burpees etc. I also ran here and there and would eventually like to get back into it. With that said, it seems like everything I enjoyed doing is on the “unsafe list” which makes me quite sad. When I start exercising again, I know I’ll have to start slow. I still have little abdominal tears from the surgery that will take months to fully heal which is normal. What is a good way to get back into exercising keeping in mind that i do enjoy strength training, yoga, core exercises, and running/stair/master/carido here and there? Is is also unrealistic for me to want to run a half marathon way down the road in like a year? Will my exercising intensity basically have to be less intense for the rest of my life to avoid pressure on my pelvic floor? Sorry this was so long and looking forward to hearing from you.

    • Michelle Kenway says:

      Hi Dee
      I will preface this reply by saying first and foremost be guided by your surgeon’s recommendations about your future exercises. I do however think that is very possible to exercise after prolapse surgery, including prolapse surgery for many women being mindful of pelvic floor safe exercise principles and this doesn’t have to be low intensity either.

      Pelvic floor safe strength exercises would be preferable and these can include appropriate weighted machines, positions and techniques. I also believe that Yoga can be performed in a pelvic floor safe manner avoiding potentially compromising exercises such as wide deep leg squats and intense core exercises in some Yoga classes. Have you considered cycle/ seated spinning/elliptical low impact forms of cardio where it is still possible to exercise at increased intensity?

      First and foremost is safe return to exercise usually with walking, progressing to gentle cardio exercises as approved by your surgeon. Have you seen the pelvic floor strength exercises I have free online and those in my pelvic floor safe strength training DVD? These are usually the types of pelvic floor safe strength exercises that can still give you a great workout but minimise pressure on your pelvic floor.

      When it comes to running what we know from science is that this is a high impact exercise, which when repeated over time places repeated pressure on the pelvic floor. I think this is something your worth speaking to your surgeon about, and always being mindful of the potential for high impact exercise to repeatedly stretch and weaken the pelvic floor.

      Last but not least is pelvic floor rehab. Essentially the better functioning your pelvic floor is, the better it is able to cope with exercise that you enjoy so much life –long. I would think that seeing a Pelvic Floor Physiotherapist would be an valuable investment in your future ability to exercise and stay active too, and to ensure that your bowel management is really good too.

      I hope this gives some idea about pelvic floor safe exercise after rectal prolapse repair Anny and please feel welcome to send through any further thoughts you may have.

      Best wishes
      Michelle

  59. Hi Michelle

    I have vaginal and bowel prolapses, and am currently working with a personal trainer to get fit again. We both had questions about plank. To date I’ve been doing modified plank on knees. She would like me to just do it on hands and feet, no knees, but with a slight bend (i.e. with hips/bum up a little, so I’m not straight). I did raise questions about whether this would be safe. She thought it would, given that I have built up to 3 x 45 secs on modified knee plank.

    She said if I did 20 secs max, and paid particular attention to what was happening with pelvic floor, stopping if I felt anything untowards, then I might be able to build up strength. I am reluctant, and thought I should ask you!

    • Michelle Kenway says:

      Hi Sarah

      Thanks for your question- yes the issue of Plank is confusing isn’t it!

      The first point to make is that women with prolapse can assume they have had pelvic floor muscle dysfunction/weakness for the prolapse to have occurred in the first place. So that many women with prolapse will be at increased risk of further overloading their pelvic floor (and prolapse) if their core abdominal exercises are too intense for their existing pelvic floor support to withstand unless they have had pelvic floor rehabilitation.

      The only way of you knowing for sure whether your pelvic floor has the capacity to withstand long full plank holds is by real time ultrasound during this exercise to actually look and see what happens to your pelvic floor during the exercise. Does it hold? Does it descend? Does it contract sufficiently in time? Does it hold throughout? Anything else is pure guess work. Just because you can support your body with modified Plank in no way means your pelvic floor is any stronger, I hope this makes sense.

      In all honesty I just don’t see the need or justification for full Plank exercises in women with or at increased risk of prolapse. If it comes down to a benefit versus risk issue, well yes great to have strong abdominal core muscles, but I don’t know that the added risk of overloading the pelvic floor is worth this for many women. I am not suggesting that your PT is not on the right track, she probably has your best fitness interests at heart. I will be interested in hearing your thoughts on this Sarah.

      Hope this helps you out
      Michelle

  60. Hi Michelle,
    i have moderate, i guess, (was seen by my GP when i bore down) bladder/rectum prolapse. i have no symptoms except multiple re-occuring yest infections/cystitis for 11 years. i started on kegels and it feels like i need to urinate during this – is it normal or i do it wrong? another question i have concerns exercises – i have been exercising all my life and have strong abs/core and most likely pelvic muscles as well; so i thought it should be safe for me to do wide stand forward folds, wide stands squats, full planks ( i am yoga practitioner and teacher as well for 5 years). What do u think? thank you

    • Michelle Kenway says:

      Hi again Yelena
      Once again my previous comment stands. I am inclined to suspect there may be a risk of increased pelvic floor muscle tension especially if you are a teacher and doing alot of intense core and pelvic floor work. If this is the case it actually weakens the pelvic floor and increases the risk of inappropriate exercises by making the pelvic floor more vulnerable to injury. Have a read of this article on pelvic floor muscle tension, see your GP and then a pelvic floor physio (especially one experienced in pelvic pain/pelvic floor muscle tension) may be a good way to proceed.

      I will be interested to hear how you go Yelena
      Michelle

  61. Michelle,
    last night i had to get up and go pee many times, hardly got enough sleep; i didn’t drink anything 4 hrs prior going to bed, so seems like that’s how kegels affect me. What do you think about that? thank you

    • Michelle Kenway says:

      Hi Yelena
      I think that first and foremost see your medical practioner to rule out possible urinary tract infection or other. Then it is possible that you are not relaxing your pelvic floor muscles completely in between each attempt. My approach would be after getting medical clearance that there is no pathology, recommence very gentle pelvic floor exercises and do just a couple, making sure you relax completely between each effort. See how this goes and progress the number of reps and then the intensity of your reps as you are able to. If this continues to happen, it may be worth seeing a pelvic floor physio to check your technique is correct.
      Cheers
      Michelle

      • hi Michelle,
        thanks for your response. i am clear of UTI. may be it was just body’s response to a new move. i am confused however when you say that for those of us who are physically fit/active, pelvic floor is most likely tense, then wouldn’t kegels make the tension even stronger? secondly, if pelvic ligaments are overstretched (which i am sure is the case for me) and there is no incontinence, what benefit kegels could have? thanks

  62. Hello, I have prolapse due to my first pregnancy/labor. I just had my second baby a few months ago and really want to start working out again but want to be extra cautious to not aggravate my prolapse more. For the most part, I just do a lot of intense walking, but I also love pilates. I understand that anything lying on my back is not a good idea, and am fine with skipping those, but I can’t find any information about the floor exercises performed while lying on your side, like leg lifts, that target the hips and thighs. Do you have any insight on these kinds of exercises? I did some today from a winsor pilates DVD, but didn’t engage my abdominals as intensely as they say to and it felt okay but I’m worried about making things worse. Thank you.

    • Michelle Kenway says:

      Hi Ingrid

      Yes side lying leg lifts are no problem with a prolapse. There are actually many pelvic floor safe Pilates style exercises lying on your back that can be performed – bridge (lifting the butt) and exercise combinations, single leg raise/ single leg movements (heel slides, bent knee fallouts) plus arm combinations and single leg table top with arm combinations. The Pilates exercises for caution with prolapse issues are those involving double leg raises, and combined leg and upper body raises ie ‘The Hundred’. Yes I see no issue with sidelying hip strength exercises such as clam and side leg raises for prolapse issues. You may like to read this article on Pilates exercises to avoid

      Hope this helps you exercise Ingrid

  63. Hi,
    I have just found your site and it is such a blessing. Its not easy to find good information and you have obviously put alot of work into it.
    I had a baby 18 months ago and suffered with a small prolapse. I have a pretty weak pelvic floor. I have been seeing a pelvic floor physio but have just been told to do pelvic floor exercises, improve my posture and stick to stationary bike, walking or swimming. I am 30 years old and I am small framed.
    I am extremely desperate to get back to ‘proper’ exercise. I have never been so weak or unfit and I am finding it all disheartening and depressing. There doesn’t seem to be a form of exercise that I can do which is safe for a weak pelvic floor. Its not possibe for me to go swimming regularly and I find that working hard on the stationary bike also makes my symptoms worse. Is there any other form of exercise you can reccomend? Something that will get me strong and fit again. Also, will I ever be able to do things like running/ aerobic style exercises or weights ever again?

    • Michelle Kenway says:

      Hi Chloe
      Yes I understand it can feel very disheartening and depressing to think that you can’t exercise however I would actually think there is a wide range of exercise should be able to do with a minor prolapse, including both aerobic fitness and weights. This whole site is dedicated to helping women to exercise so it is very difficult to summarise in a few lines. What do you like doing and what are you hoping to do and then I can refer you to the appropriate information. Also wondering about your cycling – how you have been doing this to date and if you have tried recumbent cycle? Let me know
      Cheers
      Michelle

  64. liz muldawer says:

    I’m working with someone who has “pelvic floor dysfunction”. We have pretty much cut out all the traditional abdominal crunches, ball crunches etc., but have started doing a side-lying straight-leg exercise where the bottom leg comes up to meet the top leg as an inner thigh work-out. It takes strength in the abdomen to do this and now I’m wondering if this is appropriate for her to do.

  65. Jennifer says:

    Hi Michelle,
    My physical therapist just told me today I could do planks and modified planks, that it would strengthen the pelvic floor (uterine prolapse in my case) at the same time strengthening abs. I told her I was under the impression I couldn’t do planks. She says I shouldn’t do sit-ups/crunches, but planks doesn’t place pressure in the same way and it would be safe, and that any exercises that works my core/abs/stomach would strength my pelvic floor. Now I’m confused. What’s your opinion on her suggestions? Why would she tell me this? I really want to believe her, but want to reconcile the difference in opinions on this topic first.

    • Michelle Kenway says:

      Hi Jennifer

      This is confusing I agree. First and foremost be guided by your Physio she knows your pelvic floor capacity and would advise accordingly.

      Yes sit ups are the exercise we know can force the weak or poorly functioning pelvic floor downwards, basically because of the effect of the rectus or 6 pack muscles contracting strongly along with the crunch forward action increasing pressure within the abdomen that is then transferred to the pelvic floor. To be honest I can’t say that Planks are safe for everyone, rectus is still involved contracting during the exercise, the key is that the core exercise chosen doesn’t overwhelm or overload the pelvic floor. Different women will be able to withstand different levels of core exercise because of differing pelvic floor muscle strength and function. We can’t assume that Plank will strengthen the pelvic floor – in women with good pelvic floor capacity maybe yes, in women with poor pelvic floor capacity maybe no – studies are yet to investigate this exercise. What is important is that the core exercises undertaken are appropriate to the capacity of the pelvic floor. A great way to know is using real time ultrasound during the exercise to watch on screen whether the pelvic floor moves down or stays elevated during the exercise. Does this help?

      Michelle

      • Jennifer says:

        Yes, thank you, Michelle. That does help clarify. Maybe I can get my OB to run the ultrasound on me during a plank. :)

        • Michelle Kenway says:

          Yes, I wonder what he/she would say!
          In all seriousness many Pelvic Floor Physios are now using ultrasound for this exact purpose and it makes sense. I think it’s also worth mentioning that you may be able to sense what is happening during or after modified Plank if you don’t have access to real time ultrasound. Try to notice the sensation and what the muscles are doing in your pelvic floor with Plank. Avoid actively drawing your abs in during the exercise and don’t hold your breath, plus modify by kneeling. One thing is certain though, if your pelvic floor is weak, the Plank exercise won’t strengthen it.
          Best of luck

  66. Hi Michelle,

    I am 21 years old and after reading this article and all of its comments, I got kind of worried!

    Ever since about 18, I have been doing some sit ups and crunches, but recently in the past 2 months I started going to the gym for yoga classes and also classes that aims to strengthen the abs. After class, I would use the resistance machines to further work out my core too. At home i’ll do planks, squats, starjumps, bicycle crunches, reverse crunches, both leg lifts etc. It really comes as a shock that doing such exercises would create a high risk of prolapse!

    After reading about symptoms, I am getting very worried as occasionally i can feel that my abdominal are bloated and weird. When I am not wearing tight underwear or pants, its like i can feel all the bloated contents are moving inside, therefore i usually wear tight pants it makes me feel more intact and secure. since young, i usually have constipation too, having the urge to clear my bowels only about 3 times per week which results in having to push. My parents also always taught me to push hard, oh man now i am getting really scared. When i push sometimes it feels like im pushing from my vagina too, and there normally there will be discharge even if i didnt push hard, do i have to be worried about this? Now i realise i should take more fiber instead of pushing hard. Everything i am doing seems bad. I also usually buy lots of groceries at one go and walk a long distance home, i thought it would serve as good exercise, how wrong am i..

    I always had bad posture, with slouching and I think it should be my posture that creates this no butt and protruded stomach look. This should be really bad for my pelvic floor and after reading all these I am starting to keep reminding myself to create the curve in the bottom of my spine. Will having good posture help me get back to normal? Also, all the while my labia doesnt cover anything, all is visible even when i stand normally. I have no idea does this means i have a bulge. The vagina will normally get direct contact with my pants and the rubbing from walking sometimes makes it sore.

    What should i do!I am stopping my gym classes for now. Its so awkward to go to the GP and tell her I am worried i may have prolapse! Im only 21 without child, and gosh i am so gonna freak out if i go to the GP wants to look or insert anything into my vagina :( Maybe just purchase your book first and do the exercises you recommend and see if my symptoms get better? sorry this is way too long, im so overwhelmed and worried..

    • Michelle Kenway says:

      Hi Mandy
      This article really applies to women with pelvic floor dysfunction including prolapse so you can relax. There is no reason to believe that intense core exercises will make a young woman have a prolapse, and exercise is great for women of all ages so please don’t feel alarmed, this is not the intention of this informaation.

      The problem with core exercise seems to be related to women with weak pelvic floor muscles – particulalry women who have had vaginal delivery. There is even some suggestion that young women who have not been through childbirth may actually strengthen their pelvic floor muscles with abdominal exercises.

      To clear up a few things for you:
      – Abdominal bloating is not usually a sign of prolapse – it can be related to many things including too much fibre, constipation, food intolerances, this is something to discuss with your doctor.
      – All women look different when naked, for some women the Labia Majora (on the outside) do cover the vaginal tissues, for others they don’t – either is usually completely normal.
      – With a prolapse the inside of the vagina comes out and bulges from within the vagina.
      – Always avoid pushing hard when emptying your bowels, this video shows the correct bowel movement position and technique.
      – Use good posture, it helps your core abdominal and pelvic floor muscles work as they should.

      Good idea to see your doctor about your constipation, start using good bowel habits, and yes enjoy your exercises and include regular pelvic floor exercises in your daily routine to keep your pelvic floor strong and supportive, life long.

      Let me know how you go if you feel you’d like to.
      Cheers
      Michelle

  67. HI I have grade 2 bladder prolapsed. I am 7 months PP and I wanted to start exercise what do you recommend? also is Bike riding and running going to make things worst? Please reply. This is my 4th baby I am having a huge self steam issue.

    Thanks

    • Michelle Kenway says:

      Hi Kalz
      For most women with mild-moderate prolapse bike riding is great. better to steer clear of running to avoid worsening the prolapse espcially after recent childbirth. This article on prolapse exercise will give you a good understanding of how to start, let me know if you need any further information at this stage.
      Cheers
      Michelle

  68. Hello Michelle,
    I recently saw a UroGynecologist about some pelvic pressure, bloating and urge/frequency I have been having for several months. Next week, I will have a cystoscopy to rule out any bladder related issues. I did show some mild bladder prolapse, but the doctor seemed to think this should not be causing some of my problems. I had a hysterectomy about 18 months ago, and have been in great shape ever since. I run marathons, and race pretty aggressively (i.e. hard, fast running). I have been told by both my Gyno and this new doctor, that I absolutely shouldn’t give up running. I am still, however, very apprehensive to continue, given that my pelvic pressure exists primarily while running. I am having a hard time finding any sort of research on runners and pelvic related issues. Ultimately, I don’t want to give up running marathons, but I want to know what type of damage might ensue if I continue. Are they telling me to keep running b/c I will eventually prolapse anyway? The medical community is so confusing sometimes…

    • Michelle Kenway says:

      Hi Niki
      Yes I agree there are so many differing opinions and in all fairness this stems in part from the fact that different women will be able to cope with different exercises owing to individual differences in pelvic floor support. Here is a quote for you from an evidence based Physical Therapy text “Evidence-Based Physical Therapy for the Pelvic Floor”

      Increased stress placed upon the musculature of the pelvic floor will exacerbate pelvic floor defects and weakness, therefor increasing the risk of pelvic floor prolapse. Consquently heavy lifting and exercise as well as sports such as weight lifting, high -impact aerobics and long distance running increase the risk of urogential prolapse

      (Bo et al 2007, p236)

      I think this quote says it all apart from the fact that individual differences will undoubtedly play a role. Have you discussed the use of a pessary with your doctors as a means to support for your running?
      Michelle

  69. Dear Michelle,
    I suffered a bladder prolapse after the birth of my son 4 years ago. I use your DVD together with swimming and the elliptical trainer on alternative days.

    I suffered a late miscarriage at 4 months of pregnancy last week. I am not bleeding anymore. When can I start exercising again?

    Thanx
    Sharon

    • Michelle Kenway says:

      Hi Sharon
      I am sorry to read this news. Best to check with your doctor or gynaecologist who will know your circumstances, and your treatment to date. Sorry I can’t advise on this one.
      Kindest regards
      Michelle

  70. Sarah Marchant says:

    HI michelle, I am two weeks post op for rectocele and cystocele repair. I have no pain and dont feel tired at all. I am walking for around fifteen twenty minutes each day, and am back cooking, dusting, tidying up etc.but not hoovering or ironing. Prior, to the op I was walking around three miles a day, and doing pilates and yoga once a week. In your view am I rushing things , I am also spending time sitting and resting each day.

    • Michelle Kenway says:

      Hi Sarah
      It would be worth dividing your walks into a couple of sessions in the first weeks and resting in between. If you think that time uproght means downward pressure on your pelvic floor and that you want this repair to heal well and avoid strain, then try to take things slowly no matter how tempted you are to push through. Sitting will place less pressure than standing and time spent laying down (pillow under knees) resting daily is also very beneficial in terms of healing.
      Best of luck
      Michelle

  71. Hi michelle

    Great website!

    I have a question…..I am currently waiting for your dvd to arrive but also own the Habit dvd. I have also just purchased a more advanced workout program from the habit website which is where my question comes from. There is a lot of full plank work and other exercises that I would say are quite intense….I am nervous to try them after reading your blog. Can you give me some advice? I can’t understand why the exercises would be shown and recommended for women with prolapse if they are unsafe?

    Thanks
    X

    • Michelle Kenway says:

      Hi Maria

      Good question!

      What you can do for your core really comes down to the strength and control in your pelvic floor. We know that intense core exercises in women with pelvic floor weakness cause the pelvic floor to descend (this may not be true for women with strong and well functioning pelvic floor muscles). Full Plank exercise is an intense core abdominal exercise and it assumes that the woman’s pelvic floor can withstand considerable downward pressure and we know that women with prolapse usually have pelvic floor weakness, so this is not an exercise I give any woman I suspect may be at risk of or have prolapse. This article on “How to modify The Plank” will explain more for you, I hope this helps and thank you for asking this question.

      Cheers
      Michelle

  72. I had a hysterectomy as I had a cystocele prolapse, then 8 years later, it happened again. I had a repair which resulted in pudendal nerve damage 5 years ago, now I have a rectocele prolapse, do you think exercise could help me please?

    • Michelle Kenway says:

      Hi Pauline
      Thanks for your comment – this is a good question. The pudendal nerve is involved in pelvic floor muscle activation so with pudendal nerve damage, pelvic floor muscle support can be decreased. In individual situations such as yours, the extent of the damage determines how effective pelvic floor exercises will be – in women with extensive pudendal nerve damage, capacity for pelvic floor strengthening will usually be very limited while some women have partial nerve damage in which case the intact pelvic floor muscle and nerve fibres may be strengthened. Consultation with a pelvic floor physio can provide you with an assessment of your existing pelvic floor muscle function and help you understand your individual situation. There is specialised EMG equipment used by some physiotherapists that can assess how much nerve input the muscles are receiving.

      Feel welcome to let me know if you require any further information Pauline
      Michelle

  73. Hysterectomy girdle says:

    I came to know about your blog. All the information are tremendous thanks for sharing such a great post.

  74. Loriana says:

    Hi Michelle,
    I had a full Hysterectomy (ovaries intact) / Bladder prolapse repair about 3 1/2 weeks ago. I’m not totally sure what I’m allowed to do exercise wise. By the sounds of it I won’t be able to return to my Jillian Michaels workouts :( I mountain bike, not sure if this will be allowed to do anymore, I hike, ski and snowshoe. Will I be able to do any of these this summer. Not the ski or snowshoe but the rest. I live in a place where there is nothing but hills and I am a speed walker. I love getting out first thing in the morning and going for my 1 hour walk up any hill I can find. Will I be able to start my walking routine in 6 weeks or is that unrealistic? My husband also booked some mountain biking trips this summer, not sure if I should do this. I love mountain biking and just got in to it 3 years ago. Would I be better off just road biking instead. I also am a hairstylist and will be returning to work in 3 weeks. I’m on my feet 8 hours a day. Should I go back for full or half days the 1st week back? I don’t usually get a break, I’m generally pretty busy and have a lot of regular clients. I also have been getting a bit dizzy when standing for too long. Just found out last week I need to take Iron Pills again since my hemoglobin was very low.
    Thanks Michelle

    • Michelle Kenway says:

      Hi Loriana

      You are a busy active woman – I see your challenge. First and foremost bear in mind that I don’t know your age, pelvic floor muscle condition, body weight …many of the factors that need to be taken into account for returning to exercise. I do know that you are now oestrogen depleted, not sure if you’d already gone through menopause pre op.

      These factors aside it will take 3 mths for full internal healing of your repair even tough you might look and feel great on the outside. During this time take things easy – regular work breaks, sit rather than stand when you can with your hairdressing work, take the time to elevate your legs when you can to take the load off your pelvic floor. Yes great idea to go back on a graduated return to work by all means if you can.

      Hilly terrain mountain biking is definitely not your best holiday option in the months following a prolapse repair in order to prevent recurrent prolapse. Flat terrain cycling is much more pelvic floor friendly. Again steep hiking is not advisable especially carrying back packs – low level cross country skiing is a better option to hilly terrain. Skiing will depend on individual proficiency for example a beginner will load her pelvic floor muscle more than an more advanced skier (provided she is not doing jumps).

      Loriana give your body time to recover, listen to your body, build your iron stores and give yourself time for your wound to heal – I believe this will pay dividends long term

      All the best and thank you for your questions!
      Cheers
      Michelle

      • Hi Michelle,
        Thanks for replying so quickly. I know you’re a busy person. I forgot to mention that I am 53 years old. I weigh about 149 now after my surgery. I put on 10lbs. & I’m 5’2″. No, I haven’t hit menopause yet. I was having my period every 2 weeks for the last 3 years. I had a few large fibroids and an enlarged uterus not to mention, this is my 2nd bladder lift. My first bladder lift was 10 years ago. 1 year ago I lost 54lbs due to health reasons. My mom was in her early 60’s when she went thru menopause. So more than likely I take after her. My mom never experienced any hot flashes either, I haven’t had any hot flashes. I’m always cold due to my thyroid. I’m on medication for that. So does this mean my recovery will take a bit longer than I thought to get back to the so called normal routines? so I guess this means no walking up any steep hills for this year….
        Thanks again, Loriana

  75. Hi im really confused since i was diagnosed with uterine prolapse but i have neve hr had a child before. It is truly nerve rocking for me. Can i still hsve childrrn. I

    • Michelle Kenway says:

      Hi Shev
      It is possible to have a prolapse without previous pregnancy or chuldbirth but more common for women who have had vaginal delivery. Women can in most cases proceed to have pregnancies and childbirth with mild to moderate uterine prolapse. Some women wear a support peassary during pregnancy and the best method of delivering the baby needs to be worked out with the obstetrician.

      All the best
      Michelle

  76. ann doshi says:

    Hi! Michelle,
    Thanks so much for your informative website.
    I am 55 years old and post menopausal I have a bladder prolapse which I have been managing quite well with pelvic floor exercise. Just recently I have started going to the gym and am using weight machines to exercise my arms and my legs, (no abdominal work) but I am starting to feel that the prolapse is worsening again.
    Should I just stick to walking and stretching and avoid these machines altogether?
    Would appreciate your advice.
    Thank you very much

    • Michelle Kenway says:

      Hi Ann

      Not necessarily – it may be just one or two of the machines or even the way you are using them that’s causing you the problem. I think the potential benefits for women from strength training are numerous and simply knowing which machines to choose and what to avoid can often allow women to continue to reap the benefits and protect their prolapse. It would help me to know which machines you are using if you would like to reply further, I am happy to let you know which ones are pelvic floor safe and those to avoid. These are also outlined in my books if you care to read further too but feel welcome to reply further.

      Kindest regards
      Michelle

  77. Hi
    Many thanks for all the info on your site.
    Recently diagnosed with rectocele (had hysterectomy approx 12 yrs ago). Am being referred to specialist physio but would like to ask you if Powerhooping exercise is a good or bad thing. I believe it helps strengthen abs but from reading your articles I am not sure if the hoop and movements involved exert any pressure on pelvic floor muscles?
    It has been a revelation to read what exercises can be more harmful than good as very little info was given to me after my hysterectomy and I now realise that many of my gym and body tone exercises may not have been useful.
    Thanks again
    Regards
    PT

    • Michelle Kenway says:

      Hi PT
      I haven’t seen Powerhooping – do you have a link or information you might be aable to send me so that I can take a look? The safety of the exercise for the pelvic floor will depend upon which abdominal muscles are working and how intensely.
      Cheers
      Michelle

      • Pauline Taylor says:

        Hi
        Thanks for reply. I think most of the info you may need can be found at powerhoop.co.uk
        Thanks again

        • Michelle Kenway says:

          Hi Pauline

          Yes I was interested to try out a weighted hoop recently. I found it used my upper abdominals strongly and to be honest I felt this contributed to some pelvic floor pressure. There is no evidence to support this I can only report what I experienced along with another Physiotherapist when we tried out the weighted hoop.

          I think it’s worth remebering that as much as we’d like exercises and equipment like hoops for the waist, rollers for the abs etc to trim these areas, they won’t. Unfortunately we can’t ‘spot’ reduce belly fat. Yes we can tone muscles however it doesn’t matter how many sit ups we do – unless we are very lean there will be no visible difference. I know you didn’t ask me this however I feel many women get taken in by promises of weight reduction using various types of equipment when really what is most effective is cardiovascular exercise such as walking or cycling along with appropriate diet.

          I hope this helps Pauline.
          Kindest regards
          Michelle

          • Pauline says:

            Hi Michelle
            Thank you so much for your reply. I did appreciate all the info, especially the piece about spot reducing belly fat. I do enjoy the Powerhooping classes but it’s the frequent bending down to pick up the hoop that doesn’t help! I think that I am the only one in the class who cannot keep the hoop up longer than 5mins! I don’t think that this helps the prolapse situation. The good news is that my GP has referred me to a specialist gynocology physio, like yourself, so hopefully I will be a be able to ask her more questions. You are doing a great job as there is very little advice out there on this subject so thank you again and I’m so glad I found your website.
            Kind regards
            Pauline

  78. Hi Michelle,
    Just wondering what you think about rowing machines. Do they put undue pressure on the pelvic floor?
    Also do you have any contacts with your expertise in London, UK?
    Many thanks

    • Michelle Kenway says:

      Hi Amelia
      I think that rowing machines have potential to place undue pressure on the pelvic floor if high resistance is used, fast stroke rate and lean forward on the return (with bending knees). This previous comment on rowing machine elaborates a little more on modifications to keep rowing safer.

      I am sending out some requests for UK contacts, I will let you know if I can come up with some names – it seems that accessing pelvic floor rehabilitation services in the UK can be challenging for women as I understand it, I may be incorrect but I receive many emails to the contrary.

      All the best
      Michelle

  79. Kristina says:

    Hi Michelle – thank you so much for keeping up with the comments on this post for 4 years!

    I’m post-op about 4 years now for multiple -celes :) … I found your site because I started doing hardcore abdominal workouts and had all my awful symptoms return. The doctor says everything is still in its place surgery-wise, so now it’s up to me to do a safe return to exercise to get things as strong as possible.

    For starters, I’m going to trade in my upright elliptical trainer for either a recumbent stationary bike or a recumbent elliptical trainer (which I didn’t even know was a thing until today). Do you have any concerns about the latter?

    Thanks for your help.

    • Michelle Kenway says:

      Hi Kristina

      Thanks for returning to visit again! I am not sure which recumbent elliptical you are looking at using and how much these vary one machine to the next. I am inclined to think that the recumbent elliptical might place more pressure on the pelvic floor than the recumbent cycle; the seat is more upright and I think the arm levers encourage leaning forwards in the elliptical. If you have a choice then the cycle would be preferable and use it keeping your head and body reclined (avoid lifting your head forwards which will be more likely activate your upper abs.

      Hope this helps!
      Michelle

  80. Michelle, I am so glad I found your site!!! I can’t believe no one has ever told us gals in the USA how to protect our pelvic floor. I had a hysterectomy and big bladder repair in 2/2014. My core is very weak and I have started to get back to the gym. I have been also been going to Physical Therapy for a fall that resulted in a bruised sacrum. The PT has me doing a core exercise that I am not sure is safe. While lying on my back, knees up, I place the red fit ball in my lap and stretch my arms up straight up on the ball. Then raise both feet off the mat and push with my knees against the ball while pushing against the ball with my arms. This really targets the core muscles but is this too intense??? I need your help!

    • Michelle Kenway says:

      Hi Lina
      Let me clarify this exercise – are you squeezing the ball using your knees from one side and counteracting this with your arms on the other side, and doing this laying on your back? If this is so, this will create intense downward force onto your pelvic floor. I think it would be worth speaking with your PT about the rationale behind this exercise. We know that intense core abdominal exercises are not appropriate for women at increased risk of pelvic floor prolapse and after previous prolapse surgery the risk is definitely increased.

      Let me know if you have a moment
      Cheers
      Michelle

      • Thanks for your reply. Do you have a suggestion on how to alter this exercise? The PT is trying to strengthen my core. I have ordered Inside Out. Looking forward to it’s arrival.

        • Michelle Kenway says:

          Hi Lina
          I think the first step is to respect the PT who has prescribed this for you – their intentions will be to help you, try to assess his/her understanding of prescribing appropriate exercises for women with previous prolapse surgery. Whoever you work with needs to have a good grasp on this so you can work with them confidently long-term otherwise this issues may continue to arise.

          There are many safe core exercises you can do I am about to post a seated core abdominal fitball routine online in the next week or so (you will be notified of this if you are on the newsletter list). This floor based core abdominal exercise video routine will also show you some gentle core abdominal exercises to start with.

          This article teaches you 5 safe core abdominal exercises you may like to read this too.

          Hope this helps you start and hope you like your material! It will help you have a much better understanding on pelvic floor safe exercises
          Michelle

Trackbacks

  1. […] check this website for numerous articles and free videos on safe exercise with a prolapse and after prolapse surgery such as The most important techniques for protecting your prolapse when strength training and 12 abdominal exercises to avoid with prolapse or after prolapse surgery […]

  2. […] Avoid unsafe abdominal (core) exercises that increase pressure on the pelvic floor. Some specific abdominal exercises such as sit-ups and […]

  3. […] abdominal core exercise. For a summary of some of these exercises refer to our popular free article 12 abdominal exercises to avoid with prolapse or after prolapse surgery. For more details on safe exercises for women with prolapse refer to Inside Out – the essential […]

  4. […] Overloading the pelvic floor with intense core abdominal exercises […]

  5. […] check this website for numerous articles and free videos on safe exercise with a prolapse and after prolapse surgery such as The most important techniques for protecting your prolapse when strength training and 12 abdominal exercises to avoid with prolapse or after prolapse surgery […]

  6. […] Potentially unsafe core exercises with a prolapse include: […]

  7. […] Unsafe abdominal exercises can increase the likelihood of to: […]

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