Pilates Pelvic Floor Dysfunction – 7 Exercises Women Need to Know

Pilates pelvic floor safe exercises can minimise the risk of pelvic floor injury.

Some intense core abdominal Pilates exercises have potential to cause or worsen existing pelvic floor problems. Unfortunately some women commence Pilates exercises to strengthen their core muscles only to find that they develop or aggravate existing pelvic floor problems.

Not all Pilates exercises are unsafe for the pelvic floor and many can be performed with confidence despite pre-existing pelvic floor problems. This Pelvic Floor Physiotherapist information discusses Pilates pelvic floor safe exercises to help women continue Pilates exercises, not to alarm. Pilates pelvic floor dysfunction

Read on now to learn:

  • Who is at risk with some Pilates exercises;
  • How intense core exercises can cause pelvic floor problems;
  • 7 Pilates exercises to avoid or modify with pelvic floor dysfunction; and
  • How to modify routines for Pilates pelvic floor safe exercises.

1. Who is at Risk?

Some women are more at risk of pelvic floor problems than others with some intense core Pilates exercises including women:

  • With pelvic prolapse and after prolapse surgery;
  • After a hysterectomy;
  • After bladder surgery;
  • With increased pelvic floor muscle tension or pelvic floor muscle spasm;
  • During and after menopause; and
  • During and after pregnancy.

2. Pilates Pelvic Floor Problems and Pilates

There are two ways that intense core Pilates exercises can contribute to pelvic floor problems:

A. Pelvic floor overload caused by strong contraction of the abdominal muscles (particularly the upper abdominal muscles which can generate a large amount of downward pressure onto the pelvic floor). If the pelvic floor is not able to withstand the associated downward pressure, then it is forced downwards. When this type of exercise is repeated over time the pelvic floor can become stretched, strained and pelvic floor problems can become worse.

B. Increased pelvic floor muscle tension or overactive pelvic floor muscles resulting from intense activation of the core muscles including the pelvic floor muscles without learning to relax these muscles. In this way intense Pilates core exercises, particularly those that involve sustained core and pelvic floor contractions have the potential to cause overactive pelvic floor muscles that are unable to relax.

7 Intense Core Abdominal Pilates Exercises

The following Pilates exercises are those that involve intense abdominal exercise. Women with pelvic floor problems may need to modify or avoid these types of Pilates exercises, particularly women with prolapse or after prolapse surgery. If unsure speak with your Pilates instructor about how to modify your Pilates exercises  to avoid strain on your pelvic floor.

1. The Hundred

Pilates pelvic floor dysfunction

The Hundred exercise (pictured right) is a core strength and stability exercise involving both legs being raised and held in ‘tabletop’ position or the hips and knees raised together above the body at right angles.

The intensity of The Hundred is increased by raising the head and shoulders of the ground while maintaining tabletop position (including ‘Oblique Lifts’) and by extending one or both legs straight at 45 degrees from the ground (known respectively as the Single or Double Leg Stretch). This exercise and its’ variations with both legs raised have potential to contribute to pelvic floor overload and increased pelvic floor muscle tension.

2. Scissors

Scissors is also a core stability and strength exercise. From tabletop position the legs are lowered to the floor alternately without changing the angle of the knee. The Scissors also has potential to contribute to pelvic floor overload and overactive pelvic floor muscles.

3. Dead Bugs

Dead bugs are another core stability and core strength using tabletop position. Dead bugs involve lying in tabletop position this time with the arms raised to the ceiling at right angles to the body. From this position the arms are raised above the head to the ground and one leg straightens while the other is held aloft. Dead Bugs activate those muscles having potential for pelvic floor overload and may also promote overactive pelvic floor muscles with insufficient muscle relaxation. 

4. Chest Lift Holding (Sit-Up)

Maintained chest lift is a Pilates exercise – it is a sit-up or abdominal curl exercise that involves the head and shoulders being held lifted off the ground and maintained for a series of breaths. This exercise has the potential to force the pelvic floor down and overload it especially when repeated over time.

5. Roll Ups /Rolling Back

This exercise is designed to enhance spinal mobility. Roll ups involve rolling the body back into lying from a seated position on the ground. The legs are extended in front of the body. The body is then raised back up into sitting from the lying down position. The action of rolling down and returning to upright can both increase pelvic floor pressure and pelvic floor tension. Rolling Back involves similar abdominal muscles to the Roll Up but is performed with the knees bent Rolling back involves the strong upper core abdominal muscles contracting strongly when reclining and rolling back and also when returning upright. Both exercises have potential to contribute to overload the pelvic floor and/or inappropriately increase pelvic floor muscle tension. muscle activity.

Pilates Pelvic Floor Dysfunction

6. Plank

The Plank Pilates exercise (shown right) is designed as a core and upper limb strength and stability exercise. Plank is performed prone and body weight taken through the forearms or hands and the balls of the feet as the body is raised and held off the ground for a series of breaths. The Plank involves intense sustained contraction of the core muscles.

7. Push Up

Push Up is primarily a strength exercise for the core and a strength/stability exercise for the upper limbs. The Push Up involves the body in prone and weight bearing through the hands and the balls of the feet. From this position the body is lowered to and raised from the floor. This exercise involves intense repeated upper abdominal core muscle activation.

Are Pilates Exercises all Inappropriate for all Women?

No. Your ability to perform Pilates pelvic floor safe exercises is determined by how well your pelvic floor functions. If your pelvic floor is in good condition and you are not at increased risk of pelvic floor problems owing to your life stage or life events, then you may be someone who can perform these exercises unmodified. Unfortunately some women commence core exercise programs such as Pilates with a normally functioning pelvic floor only to find that they develop pelvic floor problems such as incontinence, prolapse or pelvic pain and increased pelvic floor muscle tension result.

4. How to Modify Pilates Floor Exercises

Most of the exercises listed above (aside from the Chest Lift and Rolling exercises) can be modified to reduce the pressure on the pelvic floor. Pilates exercises can be modified by reducing the intensity of upper abdominal muscles involvement, avoiding breath holding and straining with any Pilates exercise. Women also need to be encouraged to relax their pelvic floor and core abdominal muscles having once contracted them. These modifications will be discussed in an upcoming  Pilates pelvic floor safe exercises article.

Pilates pelvic floor safe exercises require an understanding of the potential effects of intense core abdominal Pilates exercises upon the pelvic floor. Women with weak pelvic floor muscles and those at increased risk of pelvic floor dysfunction are well advised to avoid intense abdominal core exercises and modify their Pilates exercises.

INSIDE OUT – PELVIC FLOOR SAFE EXERCISES

Inside Out Book & DVD

with Pelvic Floor Physiotherapist
Michelle Kenway

Learn how to exercise and avoid exercises that overload the pelvic floor causing pelvic floor problems.

Inside Out book and DVD is a complete exercise solution for women seeking to exercise safely and protect their pelvic floor.

READ MORE NOW

 

Comments

  1. Hello. I’m so glad I found your site before beginning an exercise program. Thank you for providing free information & videos. Many of us can’t afford to buy the information we need so your help is appreciated immensely. I just recently learned about Callanetics exercises and wondered if there are any concerns for pelvic floor injury with any of the Callanetics exercises?

    • Re Callanetics and Pelvic Floor Safe Exercises
      Hi Joanne
      Thanks for this great question. From what I can see online, Callanetics is low impact which is great. I can see that there are a range of exercises in the Callanetics program that look quite suited to pelvic floor safe exercise. I have contacted Callanetics.com for some more information regarding their exercise program. I have not been able to view their abdominal exercises yet so I am unable to comment on these. I can see some really nice exercises in their online snippets. Are you watching a specific exercise DVD? Do you have any specific exercises that you wish to ask about in relation to Callanetics? I can answer this question when I have seen more details of the exercise program but let me know about specific exercises. Are there a lot of wide leg/forward bends standing exercises? Look forward to hearing from you further on this exercise program Michelle

  2. Michelle, thank you for the quick response. I have the Beginning Callanetics DVD but haven’t done it yet so don’t have any specific questions. A clip can be seen here http://www.youtube.com/watch?v=fydaIpqPzZo

    I was planning to start tomorrow so I’ll watch the whole DVD & be back with questions then!

    • Hi Joanne
      I am glad you sent this link. See the exercises that comence at 8 seconds with the head lifting off the ground? This exercise involves the strong upper abdominal muscles which when activated increase pressure on the pelvic floor. Exercises that recruit these strong upper abdominal muscles lifting head and shoulders off the ground are not pelvic floor friendly if the pelvic floor is at risk, especially in women who have had previous vaginal deliveries. However this is not to say that this is not an appropriate exercise program. Like many exercise programs many exercises can be modified to be pelvic floor safe, a single leg raise without lifting the head and shoulders but rather with a gentle lower abdominal core contraction would have much less pressure on the pelvic floor. Send through your questions on this, it is an interesting exercise program. Cheers Micelle

      • Hi Michelle,
        I’ve just ordered your book and dvd….did you ever get a chance to review any other callanetics exercises, especially the newer callanetics evolution ones which require you to ‘engage the pelvic floor’ before each exercise? I have practiced these on and off for years but now worry I’ve done more harm than good. My first birth was a long and traumatic one with instrumental delivery of a big baby.(I am petite) During my second pregnancy I suffered symphsis pubis dysfunction and an even bigger baby got ‘stuck’ and was an emergency c-section. I was treated for diastasis recti post birth and when the spd still hadn’t gone away two years later, I went for physio/pilates rehabilitation after being diagnosed with hypermobility by my rhuematologist. I still have pelvic pain if I do any lifting/stepping/climbing – or at certain times of the month, when my pelvic floor is also at its weakest. I wonder if my pelvic floor will ever recover and I’m so fearful of a prolapse in the future. I really hope that your dvd/book will help but I also love the ‘stretched out’ feeling I get from callanetics. Thanks for your help

        • Michelle Kenway says:

          Hi Cath
          I think that Callanetics exercise routines are very much like most other forms of group exercise in that there are exercises that suit the mainstream but may not necessarily all be appropriate with pelvic floor dysfunction. As far as I understand, the origins of Callanetics stem from an injured ballet dancer who designed exercises to rehabilitate her back.

          The low impact nature of Callanetics makes it more suitable than high impact exercises for women who are at increased risk of pelvic floor problems. From what I can see in the online videos, the stretches look gentle, again some of the sustained forward bending stretches will suit some bodies and not others. One area for caution may be the isometric abdominal muscle contractions I see repeated in the Callanetics workouts. I think it is very difficult for many women with pelvic floor dysfunction to activate pelvic floor muscles, let alone try to do this during abdominal exercises which we know increase downward pressure on the pelvic floor. So it is great to cue women to do this before an exercise but how many women know that they are in fact contracting and maintaining the contraction throughout. Some women with well functioning pelvic floor muscles may well be able to withstand sustained abdominal core exercises however others will not, and this will come down to the individual woman’s capacity.

          Having read some of the information I have sent you, I hope you will be able to identify some of those exercises and techniques for caution, and others that are fine for your body. Hyeprmobility is one of those risk factors for pelvic floor issues and pelvic instability as you have unfortunately experienced with your pregnancies, and yes as you continue to experience with hormonal fluctuations in your cycle. The focus of rehab. with pelvic instability is usually stability exercise so that the muscles around the pelvic joints, and the trunk stabilise and support the pelvis – it sounds as though you have undertaken this. I think this becomes a fine balance of exercising for core stability but not overdoing the core abdominal component at the expense of your pelvic floor, so that the
          muscles surrounding your trunk all work together in a balanced and coordinated manner.

          I hope this makes some sense and helps you out, feel welcome to reply further with any questions you have.
          Michelle

  3. I have often done the pilates abdominal strengthening exercises, situps, crunches and other similar exercises because I was told they would strengthen my back as I have some lower back problems – can you suggest how can I still strengthen my back muscles while avoiding those exercises that can negatively impact my prolapse? The two seem to be at odds with each other. Thanks so much!!

    • Re Back pain, core abdominal sit-up exercises and pelvic prolapse exercises
      Hi Krystyna
      Thanks for your comments. Unfortunately sit-ups and crunches won’t help with back pain. In fact they can often make low back pain worse depending on the problem, both through the sit-up action of repetitively bending forward and the over strengthening of the global abdominal muscles ( outer abdominal trunk moving muscles) as opposed to the local abdominal muscles (the inner trunk and spine core stabilisers). Furthermore sit-ups can overload the pelvic floor muscles (part of the core muscle make up) and place pressure on a prolapse.

      There is considerable confusion regarding the issue of low back pain and appropriate core strengthening and I am glad you have raised this issue.
      Regarding safe core exercises for the spine…the focus should be initially on the deep innermost core/trunk stabilising muscles. This involves a variety of methods from appropriate Pilates exercises with gentle deep abdominal muscle core control exercises (without both legs raised in the air!), appropriate fitball seated exercises including using weights while seated, you will see many of these types of exercises on our online hysterectomy recovery exercise videos such as this one http://www.pelvicexercises.com.au/safe-core-exercises/ for floor based exercises. Abdominal exercises for your spine are essentially about gaining control of the innermost local trunk muscles first. You don’t need to “feel the burn” for them to be effective for spinal control.

      I hope this gives you some ideas on appropriate exercises for your low back pain and your pelvic floor.
      Cheers Michelle

      • Thank you so much – that makes sense, I shall research how to strengthen those inner most core muscles more and watch your video etc – having been a dancer (modern dance) in my younger years I do have an innate understanding of the distinction you are making, just need to develop a good exercise regimen that is suitable. But your comments have been a good “aha” for me – so thanks for being there and willing to share your expertise and knowledge, I truly appreciate it.

        • Great to hear Krystyna, I am so glad you understand this, hope it helps with your long term health and spinal management, Michelle

  4. Hi, thanks for sharing this
    Info. Michelle how about yoga? Can that develop or worsen PFD?

    Thanks!

    • Re Yoga Exercises and pelvic floor dysfunction
      Hi Roweda
      Yes some Yoga exercises can also increase pressure on the pelvic floor. Yoga exercises with potential to increase pelvic floor pressure include intense core exercises such as Plank holds and sustained positions such as deep wide squat holds amongst others. I do not in any way wish to detract from the fact that Yoga is a great form of exercise with a multitude of potential benefits for physical and emotional well being. Just like many forms of organised exercise it’s a matter of modifying or simply avoiding those exercises that may compromise the pelvic floor. Hope this helps Cheers Michelle

  5. Thanks heaps Michelle!

  6. Thank you for clarifying the problems related to Pilates and prolapse. I underwent surgery recently for a prolapse and hysterectomy Prior to this a physio experienced in women’s issues advised against Pilates. However not one of the physiotherapists where I did Pilates knew why! I will certainly continue my exercises further before returning to these classes. Thank you for preventing me from perhaps making problems return.

  7. Hi thankyou for your email. I had posterior prolapse surgery a year ago & this week am having:
    1)sacropcolpopexy
    2) rectopexy
    3)AP Repair
    I am really worried about returining to a gym. In the past I did aerobics, jogging & weights & circuit training. My first prolapse problem occured when I started weight training & I never lifted very eavy weights. What about exercise with the ball. Could I sit on the ball & do arm weight . I won’t ever jog againor do high impact aerobics. What about the , stepmaster elliptical machine, sideways & elliptical machine forward & back Cycling & spinning?
    Thank you would love to know your views

    • Re Exercise after Prolapse Repair

      Hi Pam

      Thank you for your questions regarding prolapse repair. Just briefly for the understanding of other women reading this comment I will provide a couple of definitions here:
      1. Sacrocolpopexy – surgery to suspend the vagina in some cases of vaginal vault prolapse (to part of the vagina)
      2. Rectopexy – surgery to reposition the rectum in some cases of prolapse of the rectum
      3. AP repair – surgical repair of the front and back walls of the vagina in some cases of anterior or bladder prolapse (cystocoele) and posterior vaginal wall prolapse (rectocoele).

      Pam you can see that the surgery is a number of surgical procedures and this surgery involves lifting your pelvic organs back into position in your pelvis. In terms of exercise after this type of surgery this means that long-term it is advisable to avoid exercises that place downward pressure on the pelvic floor in addition to ensuring that the pelvic floor muscle support is as good as it can be.

      Strength training needs to be supported and appropriate without a doubt to ensure minimal pressure is placed on the pelvic floor. This is indeed quite possible however you need to become educated about what is safe and what to avoid. You will see many free articles and videos on pelvic exercises designed for this purpose at Exercise after Prolapse Repair . Inside Out is entirely dedicated to teaching women such as yourself and I suggest that you would benefit greatly from reading this information, especially since this is your second prolapse operation and this seems to be far more extensive than the first.

      In terms of specific exercises and how much pressure they place upon the pelvic floor: cycling and spinning whilst using low gears and sitting in the saddle is appropriate for women to minimise pelvic floor pressure, the elliptical machine is similar in that it is low impact, but it is important to use little force through the upper body. Stairmaster may have the potential to increase pressure on the pelvic floor compared with the previous two forms of exercise.

      I hope this helps you with your long-term recovery and return to fitness following your prolapse repair Carol.
      Best wishes
      Michele

  8. 4 weeks ago, I had a repair of my Stage III cystocele (prolapse of bladder). The surgery I was fortunate to have by a uro-gyn surgeon: sacrocolpopexy. I am extremely pleased with the results, especially when walking and no longer feeling that heavy bulging with each step.

    I downloaded your exercise book, and have been using it during my rehab. Your careful explanations and your video clips give me the confidence to exercise! Thank you for your expertise and evidence-based recommendations!

    Is the yoga ‘downward dog’ position ok to perform after I’m 3 months post-op (i.e. surgeon says to be careful until then).

    • Re Downward Dog Yoga Exercise and Prolapse repair

      Hi Lela

      Thank you for your comments.

      There is little research available to my knowledge on this type of yoga exercise and the pelvic floor, epecially after prolapse repair. We do know that bending forwards increases pressure within the abdomen but if your think about the position of your pelvis in downward dog (i.e. pelvic floor elevated) one would think that it should not place major pressure on the pelvic floor. I always ask women to try to recall those exercises that they noticed placed pressure on their pelvic floor and prolapse prior to surgery. This can often give many clues to what to avoid post op too. Downward dog can always be modified too by leaning onto a bench or a stabilised fitball against a wall. This would be a good way of easing into this exercise post op when you have approval to recommence yoga exercises.

      Best wishes for a good recovery Lela
      Michelle

  9. Hi Michelle,
    Thank you very much for your help!
    You mentioned some time ago about a dvd with yoga exercises that are pelvic floor friendly.
    Did you change your mind or still working on it?

  10. I wish I had found this before I started at the gym 6 years ago! They gave me exercises to strengthen my pelvic floor. They are the very ones which you have pointed out as being the wrong ones. I now have a slight bladder prolapse which I didn’t have before! I am 64, had four vaginal birthings, one instrument assisted in which I felt pulling of the tendons supported the bladder. You have a brilliant website here and I am emailing the link to my daughters. Thanks heaps.

    • Pilates and bladder prolapse

      Hi Sue

      Yes this is such a shame to hear. Pilates is such a great from of exercise for most women. It is so frustrating to hear about well intentioned women such as yourself encountering this issue with exercise prescription. I will say that knowledge in this area is only recently becoming more available with studies from about 2005 revealing some of the risks associated with core abdominal exercises.

      Sue you have had multiple births, instrumental delivery and pelvic floor injury during childbirth and this says in flashing lights that your pelvic floor is and probably has been vulnerable to injury for quite some time. Added to this your post menopausal status and the risk of pelvic floor injury with inappropriate exercises increases. Wouldn’t it be great if women were screened before starting their exercise program as to their risks for pelvic floor dysfunction. Then their exercise program could be tailored more specifically to them and avoiding intense inappropriate core exercises such as those in this article where appropriate.

      I think it is great that you are making your daughters aware of this issue. The more women that exercise safely according to the status of their pelvic floor, the better.

      Thank you for taking the time to comment Sue
      Best wishes
      Michelle

  11. Hi Michelle,

    Thanks so much for your informative information.

    Although I had never heard of these potential risks to pelvic floor I have always suspected that some exercises I have been doing for years were having a negative effect in certain areas.

    What a wonderful thing your knowledge is their to be shared for us women just at the click of a mouse .

    I am very grateful to have learned such helpful information from spot on articles you have supplied

    Thankyou

    suzie.

  12. I am so glad I found you! I am floundering when it comes to what exercises are ok. What about brisk walking? I am desparate to find the right things to do. I have not had to exercise for weight control, but now that I’m 56 yrs young, I am losing my strength and flexibility. Help!

    • Re Strength exercises post menopause

      Hi GentleWind

      Brisk walking is an ideal exercise for weight control and pelvic floor protection but it won’t address your overall strength. Women really need to perform strength training exercises to maintain lean muscle and strength post menopause. Just make sure you select the correct strength exercises and techniques too. Remember that with menopause a woman loses lean muscle mass. This causes loss in strength, more difficulty with weight management, along with other physical issues. The American College of Sports Medicine recommend that healthy active adults aged 18-65 years perform at least 5 days of aerobic fitness activities per week, and resistance training exercises on at least 2 alternate days per week, exercising the major muscle groups. Sounds a lot doesn’t it? I think it can be readily achieved with a good walking program or varied with cycling, and a basic strength training program such as the one outlined in inside Out. I really believe strength training for women is vital for strength, tone, bone density not to mention mood and personally I find weight management too.

      Hope this snippet of information helps you. You are indeed not alone Gentle Wind!

      Kindest regards
      Michelle

  13. I have had an hysterectomy , bowel and bladder prolaspe repair.Should l avoid doing double table top in my pilates class and stick to single leg.Or is it ok to build up to double table top as long as my head is flat. Cheers

    • Pilates after hysterectomy and prolapse surgery

      Hi Christine

      Thank you for your question, it is a good one. I am unable to answer you specifically with respect to your condition. What I can say is that table top with both legs will increase pressure on your pelvic floor and this will be reduced with a single leg tabletop exercise. Keeping your head flat will also reduce downwards pressure you are absolutely correct. What I cannot answer is whether or not your pelvic floor and your prolapse repair is strong enough to withstand the associated pressure of full tabletop progression. The only way to answer this would be with a thorough physio assessment perhaps using ultrasound on your abdomen to view your pelvic floor and test what happens to your pelvic floor with one and then repeated table top exercises. This would tell you whether your pelvic floor is being pushed down with your tabletop exercises or whether it is able to withstand the associated pressure. Some Australian physiotherapists are using real time ultrasound are able to assess movement of the pelvic floor during regular exercises.

      I also suggest strongly that if you remain in doubt, then leave it out, especially with the increased risk of repeat prolapse following your prolapse surgery already.

      Cheers Christine
      Michelle

      • Hi Michelle thank you for your quick reply. I love your website and have showed it to my pilates teacher. I have your book and hope that one day you make a dvd on all your safe exercises to do after and before prolapse surgery. Take care kind regards Christine.

  14. Hi Michelle, You mention a screening survey for women to measure risks before beginning exercises. What is the screen’s name? That’s a great idea to screen women before they begin an exercise program. Thanks, Lela

    • Hi Lela

      Sorry I can’t give you a name for name for the survey, I just think there should be a universal screening tool/questionaire that can be used prior to any form of exercise participation with discreet questions that help to determine a woman’s susceptibility to pelvic floor problems before she commences her exercise program. In this way women who are at risk such as post menopausal, previous traumatic deliveries, forceps, previous gynaecological surgery etc could be picked up and their exercise program tailored accordingly. I know that Pelvic Floor First, an intitative of the Continence Foundation of Australia has commenced working with fitness professionals to teach them to screen and then prescribe exercises accordingly. I will let you know if they have devised a screning tool.

      Cheers
      Michelle

  15. Hi Michelle, I must say I’m disappointed to learn that pilates is not recommended for post menopausal women. I am 62 and have just started pilates classes which I love. I would not want these exercises to effect my pelvic floor as I do have a problem if I cough or sneeze and was hoping that pilates woulp strenghten these muscles. Glad I saw your article, thanks for the info. Regards Carol

    • Pilates and pelvic floor dysfunction

      Hi Carol

      Please do not think that because you are post menopausal that Pilates is not suitable for you. You are correct in that Pilates won’t cure your stress incontinence, to address this appropriately through exercise rehabilitation requires dedicated pelvic floor exercises. However if you do have some incontinence symptoms it may be an indication that you have some pelvic floor muscle weakness. This along with being post menopausal could potentially increase your risk of worsening pelvic floor problems with the wrong king of intense core Pilates exercises. It would be wise to speak with your instructor about modifying the intense core abdominal component of your exercise program to avoid or modify the exercises such as those in this article. Your instructor may have some alternative exercises for you to help you improve your core control and at the same time protect your pelvic floor. Pilates can have wonderful benefits for a post menopausal woman’s body – the exercises just need to be appropriate to your level of pelvic floor function and avoid overloading if your pelvic floor is vulnerable.

      Hope this helps Carol and enjoy your Pilates
      Michelle

      • need help. Have begun Pilates doing at least 4 of the 7 that hurt the pelvic floor. I have a bulge of my bladder protruding and it is irritated also. Will this improve if I stop the exercises? I am 64 and had a hysterectomy 20 years ago.

        • Pilates and bladder prolapse

          Hi Lynda

          Thank you for your question regarding Pilates and bladder prolapse. With this kind of a concern I would advise that you seek the assessment of your medical practitioner to ensure that you do indeed have a bladder prolapse and the severity.

          Pilates does have many excellent core exercises. Unfortunately for some women when they are given intense core abdominal exercises such as those in some Pilates sessions, then their pelvic floor dysfunction including prolapse can be worsened. This is because the pressure on the pelvic floor created from these exercises may be greater than the ability of the pelvic floor to withstand the pressure. This forces the pelvic floor downwards and can have the effect of worsening a bladder prolapse. In mature women, the pelvic floor can lack the strength to withstand the pressure of intense Pilates core exercises.

          Some women find that when they cease the aggravating abdominal exercises, their pelvic floor condition improves. This will often depend upon the size of the prolapse. If the bladder prolapse is large then ceasing intense core abdominal Pilates exercises is definitely an important part of overall management however alone this may not necessarily resolve the prolapse symptoms. In the case of mild bladder prolapse it may be that ceasing intense abdominal exercises combined with pelvic floor muscle rehabilitation may help to reduce and even eliminate prolapse symptoms. Every woman is different so it is difficult to generalise.

          Hope this provides the information your require Lynda
          Michelle

  16. Hi Michelle,
    Four years ago I had a complete vaginal hysterectomy.  Six months later my bladder and rectum began to prolapse.  I was so distraught to find out that I had suffered a pelvic prolapse (I am currently 54 years old).  I would like to start some type of yoga and was wondering if there is any dvd that you can recommend that is addressed for women with prolapse issues.  Also, which exercise is safer to do, stationary cycling or eliptical training?  Thank you in advance for your response.  I am so glad to have found this site!
    Hope

    • Yoga and prolapse

      Hi Hope
      To my knowledge there is no specifically designed pelvic floor safe yoga DVD at this stage, I may stand corrected on this. You are wise to be cautious with some yoga exercises and prolapse. My feeling is that many yoga exercises are pelvic floor safe and that in many cases the ones that aren’t can be modified or substituted with others. It is a matter of understanding safe core exercises and positions for exercise.

      Regarding elliptical versus stationary cycling they are both low impact cardiovascular fitness exercises and therefore both suited to pelvic floor safe exercise programmes. To be reduce impact on the pelvic floor avoid intense work of the arms on the elliptical. Also, keep gears low and avoid standing in the saddle when cycling. If you think about positioning and support, perhaps cycling would place the least pressure on the pelvic floor however I am not aware of studies comparing the two.
      Hoping this information assists you
      Michelle

  17. I am a trained pilates instructor and would like to raise the topic of pelvic floor activation prior to the commencement of any Pilates exercise. When I start my new clients, I start with location and activation of pelvic floor and then bring transversus abdominus into the sequence before any other muscle activation for an exercise. I do not progress my clients until I can see that they are doing these activations well. I have had a number of clients who have visited your website and are questioning the program. Are you referring to general Pilates classes where participants are doing what everyone else is doing and DVDs which cannot give the participant the feedback they need?
    Pam.

    • Hi Pam
      Thanks so much for your comment, pelvic floor safe exercise is such an important issue for discussion, I am really glad to receive your comment. I am also really glad to hear that women are becoming informed about this issue as it has the potential to impact greatly on their pelvic floor. Before commenting further I want to mention the importance of well functioning core muscles, and how appropriate Pilates can help women achieve this, and that we want women to exercise and enjoy exercise and get the best possible benefit from the exercises they perform.

      As you are probably aware there are two main risks associated with intense core exercises (including some Pilates exercises) for women with or at risk of pelvic floor issues:
      1. Overbracing or the core muscles and inadequate relaxation causing pelvic floor muscle tension and associated conditions of pelvic pain and pain during intercourse
      2. Overloading the pelvic floor with intense core exercises, particularly in women who are at increased risk of pelvic floor dysfunction (women with prolapse, previous hysterectomy, incontinence, traumatic vaginal deliveries, overweight, chronic constipation…)

      In the class setting there are numerous challenges for the instructor:
      – Are our participants at risk of pelvic floor problems with intense core exercise? Have they been screened regarding their pelvic floor function prior to joining the class? Are participants going to volunteer that they have a pelvic floor issue prior to the class? Do they even know that their pelvic floor is at risk with some exercises? I am in a similar situation to you in that I conduct classes too and I understand this challenge, it is really very difficult and unless women are screened prior to participating we can have no real idea whether they are at risk with the exercises we provide for them and the rate at which we progress them. Pelvic floor first has a good exercise screening tool that is designed for instructors to use to screen their participants prior to participation in classes and personal training
      – Are they in fact activating their pelvic floor muscles with the appropriate strength, timing, coordination necessary to support a the load of core exercises and then relaxing it fully? We have no real idea – it’s only guess work unless we are using real time ultrasound at the same time to view their pelvic floor -we have no idea looking from the outside. Unless they have had a visit to a pelvic floor physio before attending class it is really only guesswork, and let’s face it it’s just not practical or appropriate for all our participants to be running off seeing a pelvic floor physio before exercise.
      – Does the class setting make participants overload their pelvic floor as they try to keep up with others in the class? Etc etc

      So really at the end of the day, the best we can do for our participants is know our clients pelvic floor risks, just as we would want to know their other musculoskeletal risks prior to class. Then at least we can have some idea about appropriate pelvic floor safe core exercise delivery. And for those women who are at risk, then we can modify their exercises accordingly and ensure that they don’t risk overloading their pelvic floor or over bracing – and we can do this with modified exercise and working with a pelvic floor physio to understand our client individual needs, risks and really help to improve their fitness and health outcomes which is what we as instructors are all about at the end of the day.

      Pam It sounds as though you are already well on track in understanding the potential risk for some of your participants with your current approach and graduating their exercises as you see fit. And yes as you say Pilates DVD’s cannot give that kind of feedback and as you mention some classes lack any kind of exercise modification for any participants. There is no one exercise fits all exercise instructors on the whole are making an effort to tailor exercises to their clients’ needs. It’s also great to see that participants are more informed and creating this drive towards more individualised instruction.

      So I hope this answers your qn Pam
      Best wishes
      Michelle

  18. Hi Michelle,
    I would appreciate your opinion about some exercises that I’ve been advised to do twice a day by a physiotherapist to help me with my weak pelvic floor muscles after having a total abdominal hysterectomy about nine weeks ago (I had a uterus and a vaginal prolapse last October, with four fibroids and one of them was a solid mass that was equivalent to an eighteen week old fetus so my uterus was very large and I had to wait seven months for surgery, I’m now 51 years old).
    My Exercises are Dead Bugs & Femur Arcs – lift one leg off the floor at a time X10 twice a day. Top Tops – feet both in the air and tap one toe down at a time X10 twice a day.
    Oblique Holds (sitting or lying) press opposite hand against inside of knee and hold for 5 seconds and swap sides. The other exercises are Bent knee fall outs and Pelvic tilts X10 twice a day that seems to be OK.
    Thank you for sharing your knowledge, I find the information here very useful and it’s a pity that my gynaecologist and the hospital gave so little information.

    Best Wishes,
    Jane.

    • Michelle Kenway says:

      Hi Jane
      Thank you for your comment & qn.about your post op exercises. You are still in the healing stages – full healing takes up to 3 mths and during this time it is very important to avoid strain on your pelvic floor, so this is the time for very gentle core control exercises, particulalry if your pelvic floor has been under considerable strain pre op. I am unable to comment on the exercises prescibed for you by your Physiotherapist who is undoubtedly prescibing for you based on his/her assessment of you and knowledge and understanding of your pelvic floor capacity to support and counteract downward strain.

      I am familiar with the exercises you describe – yes pelvic tilts and bent knee fall outs are gentle core control exercises and most women don’t find these problematic. If you feel that the other two exercises are a little too intense for you (and yes they are potentially challenging moderate intensity core abdominal exercises) then perhaps discuss this with your physio and ask for some less intense modifications.

      I hope this helps a little. Keen to hear how you go.
      Cheers
      Michelle

  19. Hi Michelle,
    Thank you for your opinion on some core exercises that I asked you about. I feel that since I’ve been seeing a physiotherapist these past few weeks that I’m slowly noticing a slight improvement with some problems I’ve been having after surgery (I found your article how to empty your bowels without straining beneficial). I seem to be coping well with all the exercises the physiotherapist advised me to do and I actually do a few more reps every morning and afternoon because I feel that by doing this that my pelvic muscles should improve. For years it seems that I’ve been doing all these exercises that are harsh on my pelvic floor and not realising this, (so it wasn’t surprising later on when I learnt about this waiting for my surgery) whilst I was doing jumping jacks that I felt something falling down which turned out to be my uterus. With so much valuable information here, I’ve decided that I need to get your Inside out Book and DVD because it will be beneficial to me.

    Thank you!
    Jane

  20. Hi. Please can you advise whether or not inner thigh press using a cushion/small ball and outer thigh exercise using a band are suitable to do with a prolapse? I thought I had read this already on one of your blogs/posts but can’t seem to find it again. We were asked to do the inner thigh press at Pilates this week at the same time as pelvic tilts and I am a little apprehensive?!tia

    • Michelle Kenway says:

      Hi Janet
      Thigh press with a prolapse shouldn’t be an issue with prolapse. It uses the inner thigh muscles and is usually performed lying down. Outer thigh band exercises will not be an issue for the pelvic floor when performed lying down either.
      Cheers
      Michelle

  21. Michelle says:

    After two years of having no issues I find myself having the displaced pelvic crud again. I just did a search on proper exercises and came across this site. Thank You :) before I had insurance and could do PT. Now I’m on my own and it is incredible how tough the pain is, effects knees, ankles, feet, lower back and even upper back. About to turn 47, work 50hrs a week on my feet and decided I need to focus on my body, then the pelvis turned on me forcing me to put some action behind my decision. You have no idea how awesome it is to come across this site. :) You Rock :) (like my pelvis,,,,lolol)

    • Michelle Kenway says:

      Hi Michelle

      I am really glad to be able to help you out.

      The long hours on your feet won’t be helping that pelvic floor. I’m not sure if you have a prolapse, just wondering if you’ve throught about a support pessary to insert when you are working big days if your pelvic floor muscles aren’t doing what they should be and you do have a prolapse? It’s just a thought and I am off track with your condition but maybe an option down the track to consider if you come to grief. I am just trying to think about how to help you keep up your workload as many women don’t have any option but long hours.

      Best wishes to you and thanks so much for taking the time to comment and share your experience with other ladies
      Michelle

  22. Hi Michelle – a great web-site. V informative. You refer to a forthcoming article pelvic floor safe exercises. Has this been published yet? If so, can you point me in the right direction? Many thanks. Linda

    • Michelle Kenway says:

      Hi Linda
      Thanks for your question – I have published quite a few articles now on pelvic floor safe exercises, are you after fitness, strength or weight loss exercises? Just let me know and I’ll send you the links.

  23. Hi Michelle, I just found your site. I have Interstital Cystitis and hypertone pelvic floor. I have been looking for exercises to loosen my pelvic muscles. I am currently taking a yoga class and a fitness ball class. Are there poses/exercises I can safely do to keep my pelvic floor muscles from going into spasms? I have been suffering with this for seven years and need relief. Thank you for your help.

    • Michelle Kenway says:

      Hi Sandee

      7 years is a long time to suffer from this issue! I hope this info helps you.

      Usually the first line of treatment for pelvic floor spasm is to relax the pelvic floor rather than exercise the pelvic floor muscles. You can read more about specific relaxation for the pelvic floor tension here

      Unfortunately some of the regular exercises in Yoga and fit ball classes are intense abdominal core exercises and these will be most likely to increase pelvic floor spasm. It might be good to start by letting your instructors know that you need to leave out intense abdominal exercises (for the moment) and you might even ask if they can provide alternative exercises. Interestingly all the information I have on this site for women with prolapse and exercise will also apply to you as the principles are the same – avoiding the intense abdominal exercises, avoiding heavy lifting and loading of the pelvic floor and avoiding high impact exercises.

      Start with walking and learning to relax the pelvic floor. Avoid core abdominal exercises for the moment especially Plank, abdominal curls, roll ups, an weight bearing through your upper body.

      You can also read much more here in this pelvic floor safe Yoga exercises information.

      I hope this gives you a start, let me know about specific exercises you may be unsure about Sandee and all the best to you
      Michelle

      • Thank you Michelle for the speedy reply. I am walking most days. Sometimes the spasms are so bad that I cannot walk. Thank you also for the safe yoga poses. The only one I have difficulty with is cobra because of my IC it is painful to put pressure on my bladder. I will talk with the instructor for the ball class and see if she can recommend alternatives for the abdominal workout.

        • Michelle Kenway says:

          Hi Sandee

          Best to keep the walks very short at first with pelvic floor spasm. Usually best when well rested and on flat surfaces.

          Are you doing daily pelvic floor muscle relaxation training?

          Michelle