Prolapse and Coughing – How to Cough and Avoid Prolapse Worsening

Author: Michelle Kenway Pelvic Floor Physiotherapist

Prolapse and coughing is a risk factor for prolapse worsening.

Coughing forces the pelvic floor to move downwards.

Repeated and/or forceful coughing can:

Stretch pelvic floor tissues
Weaken the pelvic floor
Worsen prolapse symptoms
Increase prolapse severity

If you have a prolapse and a cough, it’s important to know how to clear your chest and cough up phlegm.

‘How to Cough’ video (below) helps you manage prolapse and coughing.

How to Cough with a Prolapse

1. With a Sudden Coughing Fit

Sit rather than stand
Use a strong pelvic floor contraction before and during your cough (known as The Knack technique). Research shows that using the Knack reduces downwards bladder movement during coughing¹
Try to cough softly to reduce the force of your cough
Contract your pelvic floor muscles by lifting and squeezing them once you’ve coughed.

2. When you Can’t Stop Coughing

Sit rather than standing upright or lying down when coughing
Manually support the perineum using a hand placed firmly against the outside of the vagina to provide additional prolapse support when coughing
Use the active cycle of breathing lung clearance technique demonstrated in this video below to help you clear your lungs

Prolapse Exercises Book

This complete guide is especially for women with prolapse and after prolapse surgery seeking to exercise safely, reduce the risk of prolapse worsening and improve prolapse support.

Prolapse Exercises teaches you how to:

Exercise safely after prolapse surgery
Reduce your risk or repeat prolapse
Avoid unsafe exercises
Choose pelvic floor safe exercises
Reduce your risk of prolapse worsening
Improve prolapse support
Increase your strength and fitness
Strengthen your core
Lose weight

The Huff technique (demonstrated above) makes coughing more effective by drawing phlegm towards the central airways ².

Use the huff chest clearance technique to reduce the need for repeated and/or forceful coughing. This technique can benefit women with prolapse who are seeking to clear the chest and avoid or reduce coughing.

Contract your pelvic floor muscles strongly immediately before and during the cough using the Knack technique
Perform pelvic floor exercises regularly throughout the day, especially during an exacerbation of coughing
Some women may benefit from using a cough suppressant immediately after prolapse surgery to avoid injuring the prolapse repair. Consider using medication to reduce coughing if this is appropriate for your condition*

* Speak with your doctor or pharmacist about appropriate medication for your cough. Coughing is the method by which you normally clear secretions out of your lungs. It’s therefore an important process for clearing your lungs especially with a productive cough.

Repeated coughing can have a variety of causes which is why it’s important to speak with your doctor for advice on appropriate medication for the condition causing your cough.

References

1. Miller, J. et al (2001) Pelvic floor muscle contraction during a cough and decreased vesical neck mobility. Obstetrics & Gynecology, Volume 97 (2): Pages 255-260. https://doi.org/10.1016/S0029-7844(00)01132-7

2. van der Schans CP (1997) Forced expiratory manoeuvres to increase transport of bronchial mucus: a mechanistic approach. Monaldi Arch Chest Dis.52(4): Pages 367-70.