Prolapse Exercise – Physiotherapy Daily Prolapse Exercise Guidelines

Pelvic Floor Physiotherapy Prolapse Exercise Guide

These prolapse exercise guidelines help you strengthen your prolapse support and alleviate prolapse symptoms.

Read on now to learn the answers to these prolapse questions:

• What is prolapse exercise?
• How can prolapse exercise help?
• Who can benefit from prolapse exercise?
• Can exercise fix a prolapse?
• What is the correct exercise technique?
• How many exercises to do per day?
• Common exercise mistakes to avoid
• How long will it take to notice prolapse improvements?

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• Exercise safely after prolapse surgery
• Reduce your risk or repeat prolapse
• Avoid unsafe exercises
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• Reduce your risk of prolapse worsening
• Improve prolapse support
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• Strengthen your core
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What is Prolapse Exercise?

Prolapse exercise is pelvic floor exercise designed to improve prolapse support and protect a prolapse from worsening. Prolapse exercises are specifically for the pelvic floor muscles and are known as pelvic floor exercises. Pelvic floor exercises can strengthen and restore the pelvic floor muscles.

Research shows that pelvic floor exercise can improve prolapse support and reduce the frequency and how bothersome prolapse symptoms are in women with mild to moderate prolapse. ¹

Prolapse occurs when the pelvic floor muscles and tissues weaken and stretch. This decreases support for the bladder, uterus and bowel (pelvic organs). When these organs lose support they can prolapse or bulge into the walls of the vagina (cystocoele, rectocoele), move down into the vagina (uterine prolapse) and/or protrude from the rectum (rectal prolapse).

How Prolapse Exercise Can Help Your Pelvic Floor

Many physiotherapists provide pelvic floor exercises for the treatment of prolapse. ²

Prolapse exercise involves training and rehabilitating the pelvic floor muscles.

Prolapse exercises aim to:

• Increase the strength and thickness of muscles for prolapse support
• Lift the pelvic floor to sit higher within the pelvis
• Increase the stiffness of the pelvic floor making it more resistant to strain.

Pelvic floor exercises can assist prolapse sufferers in a number of ways:

• Reduce prolapse symptoms ³
• Delay or avoid prolapse progression
• Improve prolapse support following prolapse repair surgery
• Improve bladder control
• Improve bowel emptying.

Who can Benefit from Prolapse Exercise?

Pelvic floor exercises can help to reduce and in some cases overcome prolapse symptoms in women with mild to moderate prolapse. It may well be that improving prolapse support can delay or avoid a  prolapse from worsening.

Women with severe prolapse are prescribed pelvic floor exercises to improve the outcomes of prolapse repair surgery by improving pelvic floor support. Women with severe prolapse may benefit from strengthening their pelvic floor prior to prolapse surgery rather than waiting until after it has taken place.

Can Exercise Fix Prolapse?

No, unfortunately it’s not possible to completely fix a prolapse with pelvic floor exercise.

A prolapse is like a hernia of the pelvic floor tissues. The only way to completely repair a prolapse is via prolapse surgery. As stated above, pelvic floor exercises can improve prolapse symptoms and restore pelvic floor strength and support in women with mild to moderate prolapse.

Women with more severe prolapse usually require vaginal pessary or surgical management to eliminate prolapse symptoms.

Correct Prolapse Exercise Technique

Pelvic floor exercises for prolapse involve squeezing and lifting inside the pelvis using the pelvic floor muscles.

This feels like squeezing and lifting inwards all 3 pelvic openings (vagina, urine tube/urethra and anus).

Exercises for prolapse involve lifting and squeezing:

• In and around the anus (back passage) as if trying to avoid passing wind
• Inside the vagina
• In and around the entrance to the urethra (urine tube) as if trying to stop or slow the flow of urine.

Physio Tips for Prolapse Exercise

• Re-position your prolapse within your vagina before your pelvic exercises if it tends to protrude
• Commence your exercises lying down and progress to sitting or standing when your pelvic floor strength increases
• Attend to good posture for pelvic floor exercises since slumped posture decreases the effectiveness of pelvic support exercises ⁴
• Practice your exercises at the start of the day when your prolapse will not be bulging as much as at the end of the day
• Use a vaginal pessary to lift the weight of the prolapsed tissues making pelvic floor exercises easier to perform with a prolapse.

How Many Pelvic Floor Exercises to do Daily?

• Pelvic floor exercises for prolapse support should be performed regularly aiming for at least 5 days of the week
• Perform up to 8 pelvic floor exercises in a row
• Try to maintain each exercise for up to 10 seconds
• Relax and rest your pelvic floor muscles for around 6 seconds between every attempt
• Repeat this up to 3 times daily for a maximum of 24 daily exercises.

When starting out

• If your pelvic floor is weak it is unlikely that you will be able to initially perform this quantity of exercise.
• Focus upon using the correct technique and maintaining your pelvic floor muscle contraction for as long as you are able to do so. For some women this will initially be for 1-2 seconds a time.
• Gradually build up the duration of your pelvic floor muscle exercises and the number you can perform in a row as your strength improves over time.

Common Mistakes to Avoid

There are a number of common mistakes to avoid when doing pelvic floor exercises. These include:

• Pushing the pelvic floor down rather than lifting it up
• Breath holding during pelvic exercises – breathe normally throughout your exercises
• Squeezing the buttocks and thighs instead of the inner pelvic floor muscles.

How Long to Notice Prolapse Improvements?

It can take up to 5-6 months of regular exercise to strengthen weak pelvic floor muscles.

Some women start to notice that their prolapse symptoms start to improve 3-4 weeks of daily pelvic floor exercises.

Pelvic floor exercises for improved prolapse support will only benefit women with intact pelvic floor muscles. Women with prolapse who do not notice any improvement in their pelvic floor strength and those who are unable to contract their pelvic floor muscles should seek pelvic floor rehabilitation treatment from a Pelvic Floor Physiotherapist.

References

¹ HoffBrækken I,Majida M, Enge E, Bø K.(2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology. 203,2, pps 170.e1-170.e7.

² Hagen S, Stark D, Cattermole D (2004) A United Kingdom-wide survey of physiotherapy practice in the treatment of pelvic organ prolapse. Physiotherapy, 90, pps. 19-26.

³ Hagen S. et al (2014) Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial The Lancet
383, 9919 (1–7, pps 796-806.

⁴ Sapsford R, Richardson C, Stanton W. (2006) Sitting posture affects pelvic floor muscle activity in parous women: An observational study. Australian Journal of Physiotherapy. Volume 52, Issue 3, Pages 219-222.