Heart Disease in Women and Prolapse – When Prolapse Becomes More Than a Pelvic Floor Problem

prolapse and heart diseaseHeart disease in women is currently a major women’s health issue in the Western world.

Quick Quiz: What is the leading cause of death among women?

A. Breast cancer
B. Bowel cancer
C. Heart disease
D. Diabetes

If you guessed C. you are correct. Not only is heart disease the biggest killer of women, but it’s way above and beyond all the other causes, in fact 4 times the rate of death among women from breast cancer!

Read on now to learn:

  • The link between prolapse and heart disease in women
  • How fitness exercise reduces your risk of heart disease
  • The symptoms of heart attack in women
  • How to exercise with a prolapse to reduce your risk of heart disease

The Link Between Prolapse and Heart Disease in Women

Physical inactivity increases the risk in heart disease in women however keeping up your fitness can be a real problem if you have a prolapse or after prolapse surgery:

  • Some women with prolapse stop exercising altogether
  • Others are put off physical activity because their prolapse symptoms become worse with exercise
  • Returning to fitness exercise after prolapse surgery can cause anxiety and confusion about what exercise is safe and what to avoid.

We need to be very clear on this, prolapse itself doesn’t cause heart disease in women – the consequences of having a pelvic prolapse and feeling unable to exercise can affect your overall health including your heart health. Let’s face it – mature women are already at increased risk of heart disease owing to the effects of menopause on our bodies.

How Does Fitness Exercise Reduce Heart Disease in Women?

Regular cardiovascular fitness exercise can improve your heart health in a number of ways by: heart disease in women

  • Lowering the bad cholesterol (LDL) that causes fatty deposits to line your arteries
  • Decreasing your blood pressure which decreases strain on your heart
  • Improving circulation which helps prevent clots in the heart
  • Managing your body weight to reduce the work load on your heart.

Professor Noel Bairey Merz is Director Women’s Health Centre Cedar-Sinai Institute and Director of Research at the Barbra Streisand Women’s Heart Centre. Professor Merz says part of the problem is that women the symptoms of heart attack in women may be atypical and often go undetected. This contrasts with the symptoms of heart attack in men. This is part of the reason why more women now die of heart disease than men

What are the Symptoms of Heart Attack or Heart Disease in Women?

Dr Merz groups the symptoms of heart disease into 2 categories – typical and atypical symptoms. She says that the symptoms of heart disease in women may differ from those in men and this is part of the reason why heart disease in women goes undetected at times.

Typical symptoms of heart disease

  • Chest pain or pressure*

*Only half of women present with this typical symptom compared with most men.

Atypical symptoms of heart disease

  • Indigestion
  • Sense of fullness in the stomach
  • Shortness of breath
  • Jaw, arm or shoulder pain
  • A feeling of overwhelming fatigue.

More women experience these atypical symptoms than men, however approximately 1/3 of men may experience these atypical symptoms too.

Dr Merz talks about heart disease in women and says that raising awareness of both typical and atypical symptoms of heart disease will save the lives of more women and men.

How to Exercise with Prolapse to Reduce Your Risk of Heart Disease

Women with prolapse or after prolapse surgery may need help and encouragement towards safe prolapse exercises for their heart health despite their prolapse problems. It is indeed very feasible for many women with mild to moderate prolapse to perform effective exercise that reduces their risk of heart disease. Here’s how…

1. Choose Low Impact Fitness Exercises

Pelvic floor safe low impact exercises for prolapse are those exercises that involve at least one foot in contact with the ground throughout. Cardiovascular fitness exercises should ideally be regular and continuous so the less impact during exercise the better for your pelvic floor.

Types of low impact cardiovascular fitness exercise: heart disease in women

  • Walking
  • Cycling
  • Hiking
  • Bushwalking
  • Water-base exercise (swimming, water walking, aqua exercises)
  • Dancing (low impact)
  • Exercise equipment (treadmill, elliptical low resistance, stationary cycle)
  • Kayaking

2. Guidelines for Aerobic Fitness Exercise in Healthy Women

Following are the current ACSM guidelines1 for exercising to develop and maintain cardio respiratory fitness in healthy adults. In other words how much exercise you need to do and how often you need to do it to keep your heart healthy.

  • Perform at least 30 minutes of moderate intensity aerobic exercise on 5 days or more (total at least 150 minutes or 2.5 hrs/week)

Or alternatively if you are pressed for time

  • Perform at least 20 minutes of high intensity aerobic exercise on 3 days or more (total at least 75 minutes or 1.25hrs/week).

1. Exercise sessions can be made up of short sessions at least 10 minutes in duration, or one continuous longer session.
2. Even if you are unable to meet these minimum requirements you will still benefit from some physical aerobic activity.
3. Regularly progress the quantity of aerobic fitness exercise you perform as your fitness improves over time.

3. Pelvic Floor Exercises to Maximise Pelvic Floor Support

What do pelvic floor exercises have to do with heart health if anything?

One of the keys to staying active with a prolapse is to ensure your pelvic floor support. If your pelvic floor is in good shape, then so too will be your ability to exercise for your heart health with regular aerobic fitness exercise. This is how regular daily pelvic floor exercises can help you exercise effectively and in so doing, indirectly help you to minimise your risk of heart disease.

In summary

If you are living with a pelvic prolapse or if you’ve had previous prolapse surgery, regular cardiovascular exercise that incorporates appropriate pelvic floor safe low impact exercises for your body can help you reduce your risk of heart disease. You can help yourself and other women in your life by recognising and being alert to the atypical symptoms of heart disease in women that currently go unrecognised.

1ACSM Position Stand  Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise Garber, Carol Ewing Ph.D., FACSM, (Chair); Blissmer, Bryan Ph.D.; Deschenes, Michael R. PhD, FACSM; Franklin, Barry A. Ph.D., FACSM; Lamonte, Michael J. Ph.D., FACSM; Lee, I-Min M.D., Sc.D., FACSM; Nieman, David C. Ph.D., FACSM; Swain, David P. Ph.D., FACSM Medicine & Science in Sports & Exercise: July 2011 – Volume 43 – Issue 7 – pp 1334-1359

prolapse exercisesABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Prolapse Exercises Inside Out. Prolapse Exercises is a complete exercise guide for women with prolapse and after prolapse surgery seeking to exercise safely and protect their pelvic floor.

We Welcome Your Comments



  1. Thankyou Michelle I’m started to understand it all alot better now and realising its not the end of my gyming ,thanks again

  2. I’ve just been diagnosed with rectocele , heartbroken to say the least , my life before getting pregnant was gym , circuit training , running 5 miles everyday with my spaniels and spinning and couldn’t wait for my 6 week check to get going again and I got the all clear and started my exercise and then felt something that shouldn’t have been there as I was out jogging , now as I’m reading up on rectocele I’m finding it so hard to get my head around what I can and can’t do because different sites say different thing like its ok to build yourself up to more physically challenging fitness and then some say no to high impact exercise , I have a baby belly now and was looking forward to doing some major stomach exercises and now I don’t know what to do, I know now I need to basically change my exercise lifestyle to a more softer way to exercise , have you please got any suggestions for more physically challenging activities because I really do think I will go mad if I can’t get that feeling I used to get after a real intense workout , thank you for any help and advice

    • Michelle Kenway says

      Hi Mandy
      I think the best course of action in your position is to see a Pelvic Floor Physio for an accurate assessement of your pelvic floor capacity as this is what actually determines what you can/can’t do with respect to exercise. It may well be that your pelvic floor is functioning quite well or has the capacity to increase strength and fitness in which case you will be able to do more physically. So ultimately it comes down to your own pelvic floor so getting yur pelvic floor into shape is a priority, and perhaps consider pessary support options too.

      I think there is a great misconception about how to flatten the post natal belly – the biggest one being the need for abdominal exercises to reduce abdominal size. Abdominal exercises won’t flatten your belly or reduce belly size, apropriate fat burning cardiovascular exercise and whole body pelvic floor safe strength training will help you to lose your belly. The research suggests that high intensity exercise helps women lose abdominal body fat, especially high/low as outlines in this article on fat loss exercise. Get back to the gym if that’s what you love, modify those exercises you need to, ge back to your spinning and if you have any questions re specific exercises you will find a search button on the RHS facing of our home page, or comment further and I am happy to assist.
      Best wishes

  3. Thank you so much for your kind response! I’ve been open with my friends about my condition because I think it’s so important that women spread the word that it’s common and we’re not alone! Several of my friends opened up to me that they have it to.
    I wouldn’t trade my two natural births, even though I have this condition now, but I would like to have another baby, someday, and I’m not sure what the best plan would be in that case. I would love to ask you more questions about a fitness plan and how to break out of this mental barrier. I appreciate your willingness to help!

  4. Michelle,
    Thank you so much for your website and blog. I’m so thankful to have found it. I’m a 31 yr old mom of 2 active toddlers and was diagnosed with Prolapse 3 weeks after my 2 child’s birth. I now have a stage 2 cystocele and rectocele. I did physical therapy for 6 months and then began training with a coach on the pilates reformer. I got into great shape externally but experienced continued issues with my prolapse and back pain. Other than strolling with my kids, I stopped exercising and got very depressed, not knowing how to work out without hurting myself. Before prolapse, I was a runner, dancer, and very active at the gym. It’s so hard to give up that lifestyle and live in a confused state of what to do! Your site confirmed my fears that my Pilates training was hurting me more than helping, because of some frequent moves my trainer had me do. I want to get back into great shape and be active, but it’s frustrating to be limited to a low-impact routine. This article reminded me that I need to suck it up and keep exercising despite my pity party. I’m finding comfort in your site and will try your e-book and DVD.

    • Michelle Kenway says

      Hi Liz
      I think you say exactly what many women feel, so thank you for putting it out there. And to be honest I think you have every right to feel the way you do – no one tells you about prolapse before babies, ok we hear the odd story about poor bladder control, but no one sits you down and says listen up, there is a chance you may sustain a major pelvic floor injury called a prolapse with a vaginal delivery that could make exercising the way you love to very difficult in the future which in reality is how it is. If I had a daughter I would be telling her without a doubt – and then there’s always the “It won’t hapen to me” problem too.

      Liz what I can say is that it is very possible to exercise, even at high level so that you stay in shape and feel well physically and mentally. Make your exercise about your health. Become educated on what you can do and what is best to avoid, maximise your pelvic floor strength and support, get back to the gym and get yourself going. Exercise is what makes you feel good about you and life and makes you a happy mum and partner. Let me know if you have specific questions and how you go I am only too happy to help.
      Best wishes to you

  5. barbara keddy says

    I cannot believe my good fortune in reading this blog today. In January I suffered a heart attack and left the hospital 5 days later with a stent. I had been so successful with my regime to help my prolapse until then. After 6 weeks without following any kind of exercise for my prolapse, being concentrated on heart exercises I was in trouble again. This past week I was back at the physio who is the expert on pelvic floor disorders and found out I had not regressed back to square one! I began taking the esteriol again and following the regime which had been so successful. I am still having some spasms but I can feel the exercises beginning to work. A year of beng faithful to my pelvic floor paid off! But I am still not up to what I was before the heart attack. Slowly, slowly, slowly…

    • Michelle Kenway says

      Hi Barbara

      Thanks so much for posting this feedback! You have been through alot with your heart and your prolapse issues, it is a tricky combination of health issues to deal with and I don’t think it is well recognised that women with prolapse have additional health issues that can be influenced by their prolapse. I am really glad to hear that you are receiving pelvic floor physio to help you exercise. I sincerely hope that with time and gradual return to exercise you can return to your regular lifestyle and activities. I do believe that appropriate exercise for you is a key component of your rehab.

      Best of luck over the coming months Barbara

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