Prolapse and Exercise – General Exercise Guidelines

prolapse exerciseProlapse and exercise-related worsening of prolapse can be avoided. How do you choose safe exercises, manage your weight and maintain your fitness if you’ve been diagnosed with a prolapse?

These Pelvic Floor Physiotherapist guidelines teach you how to exercise with confidence and protect your prolapse.

Read on now to learn about:

  • Prolapse and pelvic floor weakness
  • How some exercises can make a prolapse worse
  • How to choose safe exercise for prolapse
  • Prolapse and exercise for fitness
  • Prolapse and exercise for strength
  • Prolapse and core abdominal exercise
  • Prolapse and exercise classes.

Download this Prolapse and exercise information as a user friendly PDF (below).

Prolapse and exercise is by Pelvic Floor Physiotherapist Michelle Kenway to help women with prolapse stay active and exercise safely. Michelle is the author of Inside Out the internationally acclaimed guide to pelvic floor safe exercise for women.

Prolapse and Pelvic Floor Weakness

A pelvic prolapse can occur with any of the pelvic organs including the bladder, urethra (urine tube) uterus and rectum. A prolapse occurs when the pelvic floor supports weaken and stretch allowing the pelvic organs to bulge into the walls of the vagina (vaginal prolapse) or from the rectum (rectal prolapse). The pelvic floor supports include the pelvic floor muscles and the strong pelvic floor tissues that hold the pelvic organs in place.

A prolapse usually occurs in women (and men) who have weakened pelvic floor support. The pelvic floor is commonly weakened and prolapse caused by:

  • Inappropriate exercise;
  • Pregnancy and childbirth;
  • Obesity and overweight;
  • Chronic straining with constipation;
  • Chronic coughing;
  • Menopause and ageing; and
  • Previous pelvic surgery.

How can exercise make prolapse worse?Prolapse and exercise

Some forms of exercise can weaken the pelvic floor and worsen a prolapse.

If you have a prolapse you are likely to have weakness in your pelvic floor muscles and supportive tissues. This makes your pelvic floor more prone to injury since it is less resistant to pressure and strain. Exercise places downward pressure on the pelvic floor (shown right) If the pressure is too great for the pelvic floor to withstand, the pelvic floor muscles becomes stretched, weak and floppy and less able to support your already prolapsed organs. This is how prolapse can become mere severe with inappropriate exercise that is not matched to the existing strength of the pelvic floor.

Prolapse and weak pelvic floor supports ⇒ inappropriate exercise causes pelvic floor strain ⇒ progressive stretch and damage to pelvic floor tissues ⇒ progressive weakness of pelvic floor ⇒ decreased prolapse support ⇒ prolapse worsens in severity

How to Choose Safe Prolapse Exercises?

The key questions to ask when choosing exercise with a prolapse are:

  1. How much downward pressure and/or strain does your chosen exercise place upon your pelvic floor?
  2. How strong and well functioning is your pelvic floor? How well can your pelvic floor provide support to counteract the associated downward pressure?

These following safe exercise selection principles apply to all forms of pelvic prolapse including;

  • Uterine prolapse;
  • Bladder prolapse;
  • Vaginal wall prolapse (cystocoele/rectocoele); and
  • Rectal prolapse.

Prolapse and Exercise for Fitness

High impact fitness exercise involves exercises with both feet off the ground at the same time. The impact of landing forcefully increases the downward pressure on the pelvic floor and prolapse. The pressure of body weight is transferred to the pelvic floor and lower body. This is why prolapse symptoms often feel worse inappropriate fitness exercises such as running and jumping. When repeated over extended duration, high impact exercise can progressively stretch and strain the pelvic floor supports.

High impact exercises that may compromise the pelvic floor: Unsafe exercise for prolapse

  • Running;
  • Jumping;
  • Skipping; and
  • Some dance exercises.

Fitness and weight loss/management exercise can be readily modified to protect the pelvic floor and remain highly effective. Low impact exercise is the key to reducing impact on the pelvic floor. Low impact exercise is exercise with at least one foot in contact with the ground at all times.

Low impact exercises that are pelvic floor safe include:

  • Walking;
  • Cross trainer;
  • Road cycle;
  • Spinning or indoor cycle classes(stay seated and chose low gears);
  • Water based exercise;
  • Low impact fitball classes; and
  • Low impact fitness classes.

Prolapse and Exercise for Strength and Bone Health

Safe strength training with a prolapse is very feasible, however traditional strength training programs are designed for men and often fail to apply pelvic floor safe strength training principles

Pelvic floor and prolapse worsening is more likely with:

  • Heavy lifting and straining;
  • Specific strength training exercises; and
  • Unsupported positions when lifting (i.e. standing).

Strength exercises that increase pressure on prolapse:

  • Wide leg deep squats;
  • Smith machine squats;
  • Leg press (seated and incline); and
  • Weighted abdominal core strength exercises.

Women seeking pelvic floor safe strength exercises can access a complete physical workout in Inside Out Strength DVD workout for women with prolapse, designed and presented by Pelvic Floor Physiotherapist Michelle Kenway.

Core Abdominal Exercise and ProlapseUnsafe core exercises for prolapse

Scientific research shows that traditional intense core abdominal exercises increase the downward pressure on the pelvic floor and cause descent of the pelvic floor in women with pelvic floor dysfunction. The risk of injury seems to be increased with these exercises in women with previous vaginal delivery.

Some unsafe core exercises with a prolapse include:

  • Sit ups / abdominal crunches (shown right);
  • Fit ball sit ups and medicine ball sit ups;
  • The Hundred (Pilates);
  • The Plank;
  • Fit ball or Swiss ball sit ups; and
  • Abdominal exercise machines.

Prolapse and Exercise Classes

Some general exercise classes include exercises that may increase the risk of prolapse worsening with increased pelvic floor pressure. General exercise classes are designed for mainstream, not for women with pelvic floor prolapse. This means that exercises general exercise classes may be unsuitable for prolapse and require modification. The temptation in general exercise classes is often to perform intense and unsuitable exercises with the potential to worsen a prolapse.

Tips for exercise classes and prolapse:

  • High impact exercise classes – many of these exercises can be modified to be low impact.
  • Strength training/resistance classes can include inappropriate strength exercises and techniques. These can often be modified or alternative pelvic floor safe strength exercises performed.
  • Core training classes-intense core exercises will increase the likelihood of pelvic floor and prolapse strain. Core exercises can also be modified using techniques to reduce the intensity of the exercises on the upper abdominal muscles in particular.

If unsure about any exercise either leave it out or speak with your instructor for alternative exercises. Be mindful of the difficulty of catering to a large number of individuals with wide ranging abilities and expectations with pelvic floor safe exercises in group exercise.

PDF Download this Prolapse and exercise professional article as a user friendly PDF

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.

Comments

  1. Hi,
    I'm 62 years old, have had two children naturally when I was 32 and 36, teach yoga and for the past few years have been working hard at contracting my abs (core work, yoga poses using mula bandha (root lock) and uddiyana bandha (belly lock).  Just the other day, I felt a bulge when wiping after urination and realized my uterus has prolapsed.  Not a good thing.  I can engage manually push it up with my finger and engage pelvic floor muscles to keep it "up" but it slips down between those.  And, worse yet, I run on hard surfaces regularly (have done 6 marathons in the past 10 years) and just recently took a boot-camp style fitness class that involved jumping rope, weight lifting and strong core plank type work.  So, now I have to figure out how to "back off" and prevent worsening and heaven forbid, surgery.  I thank you for your webpage and the information on what exercises are good and which ones are not good.  What about rebounding?  One article on the web said it helped with bladder prolapse.  Or is it contraindicated also.  I was going to purchase a Gyneflex device to use for Kegels exercises, but it looks like the Whole Woman webpage feels this is a useless device for uterine prolapse.  I look forward to hearing from you.  thanks again.

    • Hi Eileen

      Thank you for your comment/question. The risk factors for prolapse that immediately stand out from your story are:
      - High impact exercise (marathons and boot-camp jumping)
      - Intense core abdominal exercises
      - Weightlifting (I am not sure of the details from your comment however also a potential risk for prolapse)
      - Post menopause
      - Previous vaginal deliveries.

      Rebounding this will not help bladder prolapse at all, in fact the opposite is possible. The rebounder, while lower in impact than road running without doubt, will still create downward force on an existing prolapse.

      Spring loaded kegel exercise devices do not train the lift and squeeze action that is so vital for correct pelvic floor exercise technique. Rather these simply train a squeeze action which does not fully train the required pelvic floor action for prolapse support.

      If you suspect you may have a prolapse the steps to take are:
      1. Confirm the diagnosis and severity with your doctor
      2. Discuss the possibility of seeing a gynaecologist to assess your suitability for a pessary for prolapse support
      3. Commence daily kegel exercises
      4. Modify existing high impact exercises to low impact exercise, cease unsafe core exercises, modify unsuitable yoga exercises, address and modify running for prolapse.

      I hope this gives you somewhere to start and please feel welcome to comment further.
      Michelle

  2. Johanna says:

    Is it safe to use Leslie Sansome’s ‘Walk Slim’ or ‘Walk Away the Pounds’ programs when you have pelvic prolapse?  These exercises involve walking in place, side steps, kicks and knee lifts.   ‘Walk Away the Pounds’ also uses 2 lb. weights for part of the program.  Also,  can one walk for 2-3 miles using a medium pace (not too vigorous)?
     
    Thank you.
     
    Johanna
     

    • Hi Johanna

      Thanks for your great question. I haven’t seen these programs, I have just looked taken a quick look at the site but cannot see a full exercise list so I will have to keep my comments general to walking and the exercises you have described.

      • Walking is an ideal low impact exercise for women seeking to minimise pressure on the pelvic floor. The key to low impact exercise is that at least one foot stays in contact with the ground at all times so this may help you assess some of the exercises in the program for their suitability.
      • Side steps are usually ok, jus avoid wide side step squatting action which is potentially more compromising
      • Kicks with one foot on the ground are again low impact.

      There is no benefit for women walking with hand weights. This doesn’t burn any extra calories or increase bone density and in fact increases the load ultimately carried by the pelvic floor. We do know that overweight and obesity are well established risk factors for prolapse. Body weight and weight carried are transferred to the pelvic floor so really there is no added benefit from carrying weights during walking and it may in fact increase the load on the pelvic floor.
      Walking tips

      • Support briefs or supportive exercise tights can help some women with prolapse to walk and minimise prolapse symptoms
      • Walk at the start of the day when you and your pelvic floor are not fatigued
      • Walk on flat surfaces
      • Wear well cushioned footwear when walking to help reduce impact

      Enjoy your walking Johanna and best of luck
      Michelle

  3. Diana Walker says:

    I am a 58 year old who is just recovering from a rectal prolapse repair.(5 weeks ago) I have been doing a Pole fitness class for the last 2 years and have felt that this is good for the Pelvic Floor muscles. Do you think that this form of exercise is Ok and when do you think I could start again.

    • Michelle Kenway says:

      Hi Diana
      Thanks for your comment. Pole fitness is very intense core abdominal work – double leg raises against gravity, raising the trunk against gravity and sustained holds. I would think that if the pelvic floor muscles are weak or not functioning well, this would be risky for someone with pelvic floor dysfunction especially post-op. Perhaps in women with strong well functioning pelvic floor muscles this type of exercise may even strengten the pelvic floor but not in women with pelvic floor problems. Gee I wish I could say otherwise – best thing to do is check with a pelvic floor physio regarding the strength and capacity of your pelvic floor to withstand such intense pressure. Remember that having had a repair the pelvic floor is already at increased risk of prolapse. Wish I could tell you better news Diana
      Best of luck
      Michelle

  4. Hi Michelle,
    I have had three vaginal births (second baby delivered with vacuum). My prolapse (cystocele and mild rectocele) was diagnosed after my second baby with a “middle of the road” by my ob/gyn. He said that the diagnosis is variable because I am breastfeeding. I was fitted wih a ring pessary between baby two and three, and continued exercising (boot camp, running, weights). I am still wearing the pessary and love the freedom it gives me to continue to remain active. However, I want to be more realistic as to maintaining a fit lifestyle that is conducive to supporting my prolapse. I am now six months postpartum and am just starting to get back to more regular exercise. Before children I would lift heavy weights (figure competition). I would love to get back to the definition I once had in my arms, back and legs. Is it possible to build a defined physique without compromising my pelvic floor? Can I still lift heavy weights? I’m reading contradicting information about weight-bearing exercises and pelvic floor health. Thanks :) Debbie

    • Michelle Kenway says:

      Hi Debbie

      Yes I do think it’s possible to train definition without compromising the pelvic floor but it means being clever about how you train. You need to know and apply the safe strength training principles outlined in this article. As far as heavy lifting goes, upright heavy lifting will not help your prolapse so the idea is to use antigravity positions and those that place less pressure on your pelvic floor for example instead of standing triceps do them seated or better still triceps extensions lying on your back. Another big one is weighted deep wide leg squats which can overload the pelvic floor, much better to do weighted lunges or modified ball wall squats. It is difficult to outline this in a short comment as this is the topic of Inside Out book & DVD but I hope it gives you the general idea.

      Best of luck
      Michelle

  5. Aloha Michelle, thank you so much for all the information. At 29 I had all organs prolapse after a vaginal birth. After three surgeries, I ended up with a hysterectomy, bladder sling and full repair. Surgery was successful. Now at 43, I prolapsed again. Bummer. I am a surfer, is going to make it worse? I am also a interior designer so I sit at a computer alot. What is the best way to sit for long hours? And finally, I love to be intimate with my husband. I worry at times that can weaken the vaginal walls. Can it? Thank you for your advise. Mahalo, Jennifer

    • Michelle Kenway says:

      Aloha Jennifer
      Great questions – I have often wondered about the impact of surfing on the pelvic floor with many family members being surfers (I am not quite so courageous as you!). Do you notice any symptoms with surfing? I think that on the whole it is a great low impact exercise, probably take care as you pull your feet quickly through to standing as I see some surfers do this almost in on movement and jump into standing. If your upper body is already really strong I would think that there is not too much strain with paddling, would you agree?

      As far as posture goes, the best sitting posture for pelvic floor support is to sit with the inward curve of the lower back maintained and to avoid slumping. This will involve a good ergonomic set up so that you don’t slump forwards over your keyboard. Sometimes a small towel roll or D shaped lumbar support pillow can assist with maintaining the lower back curve. Studies have shown that pelvic floor activity is promoted sitting away from the back of the chair, so it could be useful to spend some time during your working hours on an exercise ball or sitting forwards interspersed with resting your spine and using back support. You can read some more posture information here.

      Finally as far as intimate activity goes, this is usually not a problem in terms of worsening prolapse – with prolapse the pelvic tissues fall down, quite the opposite to what happens during intimacy. Once again you can read some more information on sex and prolapse.

      Hope this helps you along
      Best wishes
      Michelle

  6. Hi Michelle
    i am 34 and had my first baby 10 weeks ago a vaucum delivery and i have a csytocele. i was very active before and during my pregnancy heavy weight lifting running high impact exercise etc. I am wondering whether pilates and yoga are safe to do with prolaspe? i already do sun salutation yoga routine with down ward dog . are full press ups ok as am currently doing these .As regards weight training can i still lift heavy weights should i be seated are lunges ok with weights ? So sorry for all the questions am fairly shocked about having prolapse dont know how to get rid of it

    • Michelle Kenway says:

      Hi Aisling
      Yes I think it is a shock to be diagnosed with a prolapse and most women feel this to some degree or another, especially after having a baby. It is important at this early stage of recovery from pregnancy and childbirth to give your pelvic floor time to recover and strengthen and many women find that this helps with their prolapse management and symptoms which often decrease markedly. In terms of postnatal prolapse management women need to consider: regular daily pelvic floor exercises (feeding is a great time), avoiding heavy lifting where possible, good bowel management and avoiding constipation and straining, appropriate rest (with fatigue the pelvic floor muscles become fatigues too especially towards the end of the day).

      Intense core abdominal exercises should be avoided with prolapse especially in the postnatal period. Remember these exercises are often performed in Pilates classes (eg tabletop &variations, The Hundred) and some Yoga classes (eg Plank/hover). So the focus should be upon gentle deep core muscle activation and training, definitely not intense core as this may have potential to compromise an already weakened pelvic floor. Weight training should be light, you will find many vidoes and articles for pelvic floor safe strength training on this site and many exercises and techniques in Inside Out strength training DVD. Lunges are usually ok for women postnatally who don’t have issues with their pelvic stability or SIJ dysfunction/pubic symphysis problems. I tend to start with modified squats you can watch in this how to squat video and then progress for safety. Yes sitting is far more preferable to standing upper body, especially seated on a fit ball.

      Let me know if you have any further questions Aisling
      Take care
      Michelle

  7. Hi Michelle. I am a 32 yr old mother of 5 and have been diagnosed with a stage 2-3 uterine prolapse after my last baby. Thank you for your information. It has all been very helpful and gives me hope of staying active. I wondered if a 3 lb weighted hula hoop is OK… and also are the waist trimming exercise belts safe to wear with a prolapse? I know they push in on the stomach, but can this damage pelvic floor muscles, or is it OK? Also, in your experience how often does post partum prolapse repair itself, to what extent, and how long does it take? Thank you!

    • Michelle Kenway says:

      Hi Elisa
      Thanks for your comment – I don’t see an issue with hoola hoop and prolapse. I have never seen a weighted hoola hoop that you describe so it is difficult to comment however I cannot forsee this straining the pelvic floor with the rotation of the pelvis. In my experience post partum prolapse does improve and this takes a number of months along with pelvic floor exercise and overall recovery. While you breast feed your pelvic floor strength and capacity will be reduced so take this into account with your overall recovery. Breast feed by all means of course, it’s just sometimes helpful to know that the pelvic floor can return to full strength when feeing ceases. This article on prolapse after childbirth may help you too.
      Best wishes
      Michelle

  8. Hi Michelle,
    I am a 48yr old mum of 3. I have had a uterus prolapse since last June. I haven’t been to have it diagnosed as I don’t want any surgery. I was wondering if it is ok to climb hills and mountains with a prolapse as I don’t want it getting any worse. I can push the prolapse back into place but it gradually drops down again during the day.

    Many Thanks,
    Maria

    • Michelle Kenway says:

      Hi Maria

      Thanks for your message. It would be a good idea to get this diagnosed by your GP or a Pelvic Floor Physiotherapist so that you know what you are dealing with – this doesn’t mean that you need to have surgery, there are alternatives to surgery including pelvic floor exercises and support pessary which can be a great alternative to keep the prolapse supported and stop it dropping down during the day or when you go trekking. You can read more about support pessary here.

      As for mountain climbing and prolapse, best to avoid carrying a heavy pack when climbing with a prolapse. The pelvic floor will be loaded by any extra weight carried when trekking. How much trekking that can be done and the most appropriate slope will in part be determined by the strength of your pelvic floor and the severity of the prolapse. Steeper descents will be most likely to increase pressure due to the impact with stepping down (rather than climbing). Obviously the longer the trek, the greater the pressure on th pelvic floor.

      In summary with a prolapse best to avoid carrying a heavy back pack and steep mountain climbing in favour of less steep terrain, particulalry if the prolapse if moderate and the pelvic floor is weak.

      All the best
      Michelle

  9. Hi Michelle,
    I had prolapse surgery about 17 weeks ago, I am 54years of age. I use to go to the gym and do a lot of running, but since my operation I have just started cycling and walking, this is my second op and quite afraid of it happening again. I have started cycling to work, it is slightly hilly and wonder if this will bother my second operation.

    Many thanks
    Julie

    • Michelle Kenway says:

      Hi Julie
      I would agree you do need to be really careful – we know that after one prolapse repair the risk of recurrent prolapse increases and after mare than one the risk increases further. Cycling using low gears and sitting in the seat on a slope where you don’t strain is the best option for pelvic floor protection. Heavy gears, standing riding out of the saddle and riding steep hills does increase pelvic floor pressure. If you can keep the hills to a minimum great as well as strengthen your pelvic floor and keep it in best possibloe shape long term are both important for you.

      This information on prolapse and cycling may help you too Julie

      Thanks for your question!
      All the best
      Michelle

  10. Vatsala says:

    Hey , im 22 yrs old with no medical problem im a fitness freak and never had problem with my body recently i started doing skipping and after it i noticed i had pain in uterus ,is it muscles ? Or something else and also a little back pain of that uterus side.

    • Michelle Kenway says:

      Hi Vatsala

      This abdominal discomfort could be one of a number of things – this needs to be checked out by your medical caregiver.

      All the best
      Michelle

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