Yoga prolapse guidelines are designed to help women with pelvic prolapse or having had previous prolapse surgery to exercise safely and minimise the risk of pelvic floor injury.
This article teaches you the Yoga exercises and techniques that improve prolapse support, and Yoga poses with potential to worsen prolapse and pelvic floor problems.
Read on now to learn:
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Can yoga fix a prolapse?
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Yoga prolapse poses to alleviate and strengthen prolapse;
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How can yoga worsen a prolapse; and
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Yoga poses to modify or avoid with pelvic prolapse.
Can Yoga fix a Prolapse?
No, the only way to completely repair a pelvic prolapse is via surgery. Appropriate exercise can however alleviate and in some cases eliminate prolapse symptoms in women with mild to moderate prolapse.
Prolapse occurs when the supportive tissues within the pelvic floor and around the pelvic organs (bladder, uterus and bowel) stretch beyond their limit and lose their elasticity. When the supportive tissues lose their elasticity they become thin, floppy and weak. While pelvic floor muscles can often be rehabilitated with exercise, the pelvic floor connective tissues having once failed and stretched beyond their normal limits, cannot recover with exercise.
Yoga Prolapse Exercises to Promote Support
These Yoga exercises and poses may assist women with prolapse by improving pelvic floor support and alleviating prolapse symptoms:
- Mula bandha (“the root” or pelvic and deep abdominal core muscle exercise) If performed correctly this exercise in should promote improved support for the pelvic organs. Mula bandha can be practiced on its own or incorporated into other poses such as Mountain Pose for improved prolapse support. Avoid strong abdominal muscle in draw particularly if the pelvic floor is at risk. The abdominal activation in this exercise must be gentle, if forceful it may have the capacity to force the pelvic floor and prolapse downwards, particularly with pelvic floor muscle weakness.
- Pranayama (breath exercise) can be valuable for women with prolapse. Breathing is closely integrated with the function of the pelvic floor, in fact the pelvic floor moves up and down in coordination with the breath. Some women with pelvic floor dysfunction need to attend to the breath before they can contract and relax their pelvic floor muscles.
- Tadasana (Mountain pose) may be a beneficial posture exercise for women with prolapse and pelvic floor dysfunction. Posture affects the pelvic floor with slumped posture increasing pressure on the pelvic floor. The pelvic floor and deep core abdominal muscles that support the pelvic organs (and prolapse) work most effectively when using the postural muscles effectively and maintaining a natural slight inward curve in the low back. Mula bandha in Tadasana (Mountain Pose) is an ideal combination of exercises to promote pelvic support.
- Inversions (Upside down/incline positions) may help to alleviate prolapse symptoms such as bulging and dragging however not all inversions are appropriate. Wall Flower Stretch will take pressure of the pelvic floor by elevating the legs. Wall Flower Stretch has potential to aggravate low back conditions in some individuals and should be either modified using cushion support to elevate the pelvis off the ground or avoided by those with or at risk of low back pain. Sarvangasana (Shoulder stand) may also provide prolapse relief by simply revering the effect of gravity on the prolapsed tissues. Shoulder stand has the potential to place force upon the neck and should be undertaken with caution and avoided by individuals with or at risk of neck pain and neck dysfunction.
Can Yoga Worsen Prolapse?
Some Yoga poses may have the potential to increase pressure on the pelvic floor and prolapse. Women can often be guided by their prolapse symptoms; increased prolapse symptoms during and/or following Yoga may suggest that the exercises performed increased pressure on the prolapsed tissues. When repeated over time, symptom producing exercises may worsen a prolapse.
Yoga Prolapse Poses to Modify
If your pelvic floor is at increased risk of injury, there are some Yoga exercises to be mindful of that may need to be modified or avoided depending upon how well your pelvic floor is working. Speak with your instructor about those intense core Yoga exercises, and poses that increase pelvic floor pressure if you feel concerned about your exercises and require modified exercise or alternative exercises. The following Yoga exercises and poses may increase pelvic floor pressure:
Yoga intense core abdominal poses and exercises
Intense core abdominal Yoga exercises should be avoided or modified with a prolapse. Strong activation of the upper abdominal muscles increases downward pressure on the pelvic floor (and prolapse). If the pelvic floor cannot withstand the associated pressure it is forced downwards. If repeated with intense force or repeated often this can result in weakening of the pelvic floor muscles and connective tissues. This is why prolapse symptoms can feel worse after performing intense core abdominal Yoga poses.
Yoga prolapse poses to avoid and modify include:
- Double Leg Lift (modify by raising one leg only);
- Boat Poses (modify raising one leg only);
- Plank (shown above- modify by weight bearing through knees rather than through feet); and
- Uddiyana bandha (“belly lock”) - this bandha should be avoided by women seeking to avoid increasing pressure on their prolapse. The action of drawing the abdomen in strongly and simulating an in breath increases pressure within the abdomen which is transferred directly down onto the pelvic floor.
Deep squat poses
Avoid poses involving deep squats to reduce pressure on the pelvic floor including:
- Garland Pose; and
- Noose Pose.
Forward bends with wide legs
Avoid or modify wide leg forward bends which increase downward pressure in a vulnerable wide leg position such as Forward Bend with V-Legs.
Upper body weight bearing
Weight bearing through the upper limbs increases downward pressure on the pelvic floor with poses such as Crane Pose.
This Yoga prolapse information is designed to help you continue your Yoga practice with confidence even if you do have pelvic floor problems. The strength and function of your pelvic floor muscles is ultimately the major determining factor of which Yoga exercises your body can withstand. If you remain unsure about Yoga prolapse exercises having read this article, seek the assistance of a Pelvic Floor Physiotherapist for assessment of your pelvic floor strength and for appropriate exercise prescription.
‘Yoga Prolapse Poses’ is by Michelle Kenway, Pelvic Floor Physiotherapist. Michelle is the author of the internationally acclaimed guide to pelvic floor safe exercises for women Inside Out – the essential women’s guide to pelvic support
We welcome your comments about Yoga prolapse poses below
Please read our disclaimer regarding this information
This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition. While every effort has been made to ensure that this information is accurate, the author and publisher accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. Pelvic exercises accept no liability to any person for the information or advice provided, or for loss or damages incurred as a result of reliance upon the material contained herein.
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Would you consider putting together a yoga routine on DVD for strengthening the pelvic floor?
Yes Victoria, a Yoga DVD for pelvic floor is great idea!
Many thanks for this input.
Michelle
I have a mobile bladder neck which has caused stress incontinence. How can I strengthen and flatten my stomach without making things worse. I am due to have a tension free tape fitted.
Hi Sue
Great question regarding flattening the stomach after a TVT. You are undoubtedly aware of the potential for intense core exercises to place downwards pressure on your TVT so best to avoid these types of exercises. Also too, you can further relax in the knowledge that intense core exercise will never flatten the stomach, this is a myth. A flatter looking is achieved with weightloss which usually occurs all over (unless surgically assisted!), we can’t spot reduce with exercise. We can however gently tone the core abdominal muscles with exercises such as those shown in this safe core exercises video, hope they help you along with a safe recovery post-op and long-term.
Best of luck
Michelle
I’m a 60 year old Yoga instructor and I’ve begun to notice some symptoms of “inner slackening” in my own pelvic muscles. Have recently discovered your site. THANK YOU for this information in particular!! Bandha is, of course, commonly taught to instructors, but the idea of avoiding the “downward thrust” of some of these other poses is news to me!! (oh, dang, and just when I (thought) I was getting really strong in Navasana!)
Hi Nanna
So glad this information has helped you a little towards safe Yoga (and hopefully your female Yoga class participants too).
Best wishes
Michelle
thank you for this information. I love doing warrior pose, triangle, downward dog…and have often wondered if they’re ok. recently bought a yoga tape and started some new exercises which aggravated my prolapse (uterine). But the above warrior pose, etc. don’t seem to bother me. I, too, would love to have a dvd especially with prolapse in mind!
Hi Margaret
Thanks for your comment! Yes these are nice exercises- which Yoga exercises do you think have recently been aggravating for your prolapse? Always interested to hear. And yes, I need to get busy with a DVD lased along these lines.
Best wishes
Michelle
I have had surgery to correct prolapse of bladder and rectum…I really like yoga and am getting my core stronger. But, I am concerned what yoga poses pose a risk for future prolapse. I am in favor of a DVD that ya’ll put together for us lovers of yoga!!
I have had prolapse surgery and rectum also but specialist didnt tell me not to do yoga, pilates of gym. I was thinking of going to crossfit but after reading thses comments I am wondering what you think. I have probably already undone the good of the surgery.
Hi Moira
The pelvic floor risk can be with intense core abdominal exercises in Pilates and Yoga along with some Yoga positions combined with specific exercises such as wide leg bend forwards.
Cross fit suitability will depend on your instructor and the exercises incorporated. Cross fit can involve intense workouts, and some inappropriate exercises for women after prolapse surgery. You will know even when you start about the class suitability by whether or not the instructor enquires about any history of pelvic floor surgery. If there is no screening it will be highly unlikely to be a pelvic floor friendly class.
I hope this helps you a little with your future exercise program, best of luck
Michelle
Hi Michelle
You are right about confusing advice on exercises and yoga after prolapse surgery. I have just had my third stint of prolapse surgery so definitely have to look after this last attempt. I have avoided yoga since last surgery 3 months ago but would really like to resume. A DVD would be great; meanwhile I’ll send your advice above on what poses to do and what to avoid to my yoga instructor.
I’m having trouble with a “jelly belly” since last surgery. I’d really like to restore some strength to my abdominal region without doing weights. Sadly, surgeon says I shouldn’t lift anything much for the rest of my days (including grandchildren). Do you have any recommendations for safe exercises?
Many thanks for all your help to we prolapsed ladies.
Maree
Hi Maree
Lovely to hear from you. Are you interested in a pelvic floor safe yoga DVD or a pelvic floor safe tummy toning DVD? What would help you most?
I really think that after three attempts, you need to be so very careful with your exercises now. Do you have access to a pelvic floor physiotherapist to help you Maree? This is my first thought.
I really like gentle seated ball core exercises, I have some shown in this core exercise video I made for post hysterectomy but they also apply to women after prolapse surgery. There are many seated variations you can use but the nice thing is that they involve sitting and supporting your pelvic floor. Let me know if you’d like to see some more and I’ll set about making another online video of these types of pelvic floor safe core exercises.
Swimming is also a great gentle tummy toner. Swimming freestyle will not overload the pelvic floor, but involves the core abdominal muscles working gently.
This article on pelvic floor safe core abdominal exercises may also assist you too.
Does this help a little? Let me know is you need more information Maree
Kindest regards
Michelle
I had bladder prolaspe surgery 3 mos. ago. Read your book “Inside Out”. Still some questions. What about the following postures: Plough, cobra, headstand. I’m guessing the headstand is not good because you use adominals to raise yourself up. How about sitting cross-legged? I would love a prolapse appropriate yoga dvd. I purchased a pelvic floor rehab dvd, but it includes wide leg squat positions which I am not doing.
PS—thank you so much for “Inside Out”. It contains the best infomation I have been able to find on post surgery appropriate excercises.
Hi Marlene
Thanks you for your questions, I am not advocating these following exercises as pelvic floor safe but I will try to appraise them in terms of potential impact upon the pelvic floor. As always different exercises will impact differently upon women’s bodies, however with previous prolapse surgery I think it is particularly prudent to avoid potential risks with inappropriate exercises.
The Plough is a little difficult to assess – it does involve double leg raise to get into position (this could be modified by raising one leg at a time to get into position). There is no research to my knowledge that assesses the pelvic floor pressure associated with these types of yoga exercises. I also wonder if by compressing the abdominal area when in the Plough position with legs backwards over the body, whether the pressure within the abdomen and transferred to the pelvic floor is enough to impact upon the pelvic floor? Again this will be a very individual thing and vary from woman to woman depending upon her pelvic floor capacity. Did you do this exercise prior to your prolapse surgery? Did you notice any symptoms with this exercise?
I don’t see Cobra as an issue for the pelvic floor although I would not do full Cobra during recovery from pelvic floor surgery. I always avoid full Cobra to avoid compressing the joints of the low back, and I avoid extending the neck backwards (many necks are not happy in the hyper-extended position). I find when exercising with classes of mature women this helps to avoid discomfort or injury to those participants in class with more vulnerable low backs and necks.
As for Headstand, once you are in the position I imagine there is actually very minimal pressure on the pelvic floor as there is no gravity, and no weight of abdominal contents on the pelvic floor either. It would be a matter of raising into headstand one leg at a time, which will use the back of your legs and butt. Abdominals are active in this position but not in a manner that would impact upon the pelvic floor.
Sitting cross legged? Once again no research, I don’t see a major issue with it sitting upright, however I would avoid cross legged or legs apart lean foward exercises.
Hope this helps a little!
Cheers
Michelle
Hello Michelle, What a wonderful informative article you have written. My input is on Udiyana Bandha. I believe the only safe way is to teach it in stages slowly so they completely understand the workings of the three diaphragms, and many find cat breathe is successful for them.
On the exhalation Jalandha bandha is executed, then uddiyana by gently drawing navel in and UP to lift central diaphragm and widen rib cage (as back is then bought down keeping natural curve in spine) then drawing up as in Mula Bandha and anal area of Aswini Bandha and we have three successful locks then gently releasing … a resting breathe …and repeat if we ..and they have felt the three locks especially pelvic floor. As Inderstand and I feel vwithin my self the chin locks starts off the vacuum with the mid diaphgram then as the pelvic floor in joining in the vacuum increase the drawing up. It often takes a lot of classes to teach this correctly and many teachers find it too hard to teach but I feeel it is so worthwhile that I persevere until the student and I am happy with the result. I can tell without asking the student if they felt it alletc however Iet them give me THEIR feedback. We teach very gentle style classes yet with awareness.
I appreciate and welcome your input please?
We don’t teach the strong abdominal work but gentle with awareness of the lift.
I do teach sitting correctly as taught by Judith Lasseter and have found it quite successful as well.
Look forward to hearing from you.
Hi Lesleigh
Yes we do know that the pelvic floor is constantly moving with the breath. On the out breath the pelvic floor rises owing to the decrease in intra abdominal pressure, and then descends with the in breath, in doing so mirrors the action of the diaphragm.
I would agree with you that breathing and abdominal muscle activation should be gentle not forceful and that breathing awareness is vital for women when it comes to pelvic floor contraction and relaxation. I think that problems come into play when the action is strong and forceful. WE know from research that while some women think they are activating their pelvic floor muscles correctly, in fact they are bracing and pushing down which can have the potential to worsen pelvic floor problems. So that if a woman is strongly activating her abdominals, we can’t be sure that she is also elevating her pelvic floor without a pelvic floor examination.
In my experience, women who have practiced Yoga breathing often have a very good understanding of diaphragmatic breathing to aid in post operative ventilation and also to help pelvic floor muscle rehab and relaxation.
Cheers
Michelle
Hi Michelle
I’m really grateful for all the advice you’ve given on pelvic floor safe exercises, and am now working with a personal trainer to put some of this into practice.
Is downward dog a suitable pose?
And I really have enjoyed sun salutation before prolapse (vaginal and bowel) – would this be suitable now? I haven’t had surgery, but am having physio to strengthen my muscles
Thanks
Sarah
Hi Sarah
I don’t see a major problem for the pelvic floor for most women with Downward Dog, the pelvic floor is usually not under pressure in this position. Downward Dog is definitely not for everyone, especially women with low back disc problems but that’s another story.
Yes the Sun Salutation is a lovely Yoga sequence isn’t it. Is the Sun Salutation pelvic floor safe? I suspect not for everyone – the full Plank position lowering to Push Up position is quite an intense core exercise. For some women this will be too much for their pelvic floor to withstand espceially if repeated, for other women it will be fine, so it ultimately depends on the individual capacity of the pelvic floor. Sun Salutation can be modified by kneeling rather than full Plank on the toes to make it a less-intense core exercise. This doesn’t answer whether it is ok for you, as this unfortunately Ican’t answer but your Physio should be able to give you some feedback on your pelvic floor strength and capacity to resist the associated pressure with this sequence of exercises.
Hope this helps you enjoy your yoga Sarah
Michelle
What is wallflower stretch?
Hi Maria
Wallflower stretch involves laying on the ground with legs up against a wall. The position usually involves getting the buttocks as close to the wall as possible, upper body relaxed and head down, legs up. This position places stretch on the hamstring muscles at the back of the thighs and the lower back. It is not a position I would recommend for anyone who is prone to lower back problems. It can sometimnes be modified by placing a firm cushion under the lower back to lift the buttocks off the ground. This is an energy restoration position in Yoga.
Michelle