How to manage your uterine prolapse and uterine prolapse repair surgery

Uterine prolapse exercises and exercises after prolapse surgery

By Michelle Kenway Pelvic Floor Physiotherapist

Read on now to learn:

1. What is a uterine prolapse?

A uterine prolapse is one type of pelvic or vaginal prolapse and is fairly common among women, with the risk increasing in mature women. It really means a “fallen down” uterus or womb  slipped out of position. It happens when your uterus (or womb) loses its strong supports that hold it up inside your pelvis.

Your uterus is held up and in position inside the pelvis by a combination of strong ligaments (imagine ropes holding it up from above), and your pelvic floor muscles (supporting your uterus from below). When these supports fail inside the uterus moves down within the pelvis as shown in the diagram below, and the cervix, or strong muscle around the neck of the uterus moves down inside the vagina. You can see how important it is to keep strong healthy pelvic floor muscles if your have been diagnosed with a uterine prolapse or after prolapse repair surgery.

2. What are the symptoms of a uterine prolapse?

A prolapsed uterus may present with a number of different symptoms. When the prolapse is very mild you may have no symptoms. Symptoms of uterine prolapse tend to become more apparent as the prolapse becomes worse including any of the following:

• a bulging, heavy/dragging feeling in your vagina
• a lump coming down inside the vagina
• a heavy feeling in your abdomen or pelvis
• difficulty inserting tampons
• difficulty emptying your bladder
• low back discomfort.

3. What causes a prolapsed uterus?

There are many different factors that can cause a uterine prolapse. Some common causes include the following:

• factors associated with pregnancy and childbirth that cause damage to the pelvic floor during birth such as prolonged pushing, multiple births and large babies. Note that injury to your pelvic floor during childbirth may not become apparent until many years later!
• factors associated with the postnatal period before the pelvic floor has recovered including constipation and inappropriate exercise.
• chronic constipation and straining to use your bowels
• chronic coughing or sneezing
• wasting of the supportive structures in your pelvic floor during and after menopause
• obesity
• heavy lifting
• the wrong kind of exercise including high impact exercise, heavy weight training and intense abdominal or core exercise. For full details on inappropriate exercise and appropriate fitness routines if you have a uterine prolapse and after prolapse repair refer to Inside Out – the essential women’s guide to pelvic support by Michelle Kenway Physiotherapist and Dr Judith Goh Urogynaecologist.

4. How to protect your uterine prolapse/prolapse repair surgery?

There are a number of important steps you can take to manage your prolapse and protect your prolapse repair if you have taken the step of having prolapse repair surgery.

Avoid:

• straining/constipation (see our free training video now on how to overcome bowel movement problems to learn how to empty and avoid straining )
• heavy lifting, pushing/pulling, bending
• smoking (to reduce coughing)
• high impact sports (e.g. jogging, sit-ups, horse-riding, high impact aerobics)
• heavy resistance training
• intense core or abdominal exercises
• becoming overweight

Do:

• pelvic floor muscle exercises regularly – start after surgery when you have your specialist’s approval to commence. If you are not sure seek further information on how to exercise your pelvic floor muscles (see our free training video on how to find and feel your pelvic floor muscles to the right of your screen, read Inside Out or check with your women’s health physiotherapist).
• wear quality support briefs (underwear) or postoperatively for added support or try wearing a pelvic support brace
  
• speak with your specialist about a pessary. A pessary is a ring that sits high inside the vagina. Many women find that using a pessary ring helps them exercise their pelvic floor muscles and supports their prolapse, reducing their symptoms.
• practice good bowel habits (e.g. never strain and you may find that you can support your prolapse when passing a bowel motion by holding a pad of toilet paper over the vaginal opening using upward pressure).
• alternate activities (e.g. sitting/standing) and avoid prolonged standing especially when you are recovering from pelvic floor repair surgery.
• do tasks early in the day.
• split tasks (e.g. do vacuuming over a few days rather than all in one day).
• manage your weight and lose weight if you are overweight.
• have a rest in afternoon and elevate your legs if possible.
• see your doctor if you have a chronic cough, chronic hay fever and sneezing and manage these conditions well.
• choose low impact exercise and be guided by the expert recommendations in Inside Out – the essential women’s guide to pelvic support if you plan to perform strength training exercises or attend gym/circuit/Pilates classes.

Other helpful hints for protecting uterine prolapse and after prolapse repair surgery:

• wear large supportive underwear especially when you are performing exercise or if you are going to be standing for extended periods of time
• try to maintain good general fitness
• always try to maintain good upright sitting and standing  posture.

5. How to exercise safely with a uterine prolapse/after prolapse surgery

You need to be very careful about the types of exercise you perform to avoid worsening your uterine prolapse and after surgical repair for a prolapsed uterus (when you have your specialist’s approval to exercise). Many everyday exercises can increase pressure on your pelvic floor and worsen your prolapse or even contribute to repeat prolapse after already having had prolapse surgery. Unfortunately many fitness instructors are unaware of the potential for this kind of injury with exercise so that you need to make sure that you are fully informed about the exercises that are appropriate for you if you are living with a prolapse.

1. Safe fitness exercise

Fitness exercise should be be low impact to protect your pelvic floor - this means keeping at least one foot on the ground as you exercise. Ideal low impact fitness exercises include:  

• cycling
• walking
• dancing
• bush walking
• swimming

2. Strength training and abdominal exercises

Your need to be very careful about the types of strength training exercises you perform and the techniques you use.

• avoid abdominal strength exercises and abdominal exercise machines to minimise downward pressure on your pelvic floor
• avoid exercises such as leg press and wide leg squats that increase pressure on your prolapse
• avoid heavy lifting and straining when lifting weights
• choose seated positions for all your strength wherever possible to support your pelvic floor
• avoid holding your breath when lifting weights and breathe out with all effort whether it be a lift/lower/push or pull
• 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

For expert exercise guidelines and safe strength and fitness workouts for women with prolapse conditions; refer to Inside Out – the essential women’s guide to pelvic support by Physiotherapist Michelle Kenway and Professor Judith Goh Urogynaecologist

 

Please read our disclaimer regarding this information

This information is provided for general information only and should in no way be considered as a substitute for medical advice and information  about your particular condition.
While every effort has been made to ensure that the information is accurate, the author accepts no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation.

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