Are you worried about your prolapse getting worse?
Is prolapse worsening inevitable?
Is it possible to avoid prolapse worsening and prolapse surgery?
Read on now for 12 expert Physiotherapy tips that reduce the risk of prolapse worsening.
Is Prolapse Worsening Inevitable?
No, the natural course of prolapse worsening varies from woman to woman.
Some women find that their prolapse rapidly worsens in a short space of time. Others notice little change in their prolapse over many years.
Prolapse worsening isn’t inevitable and it varies from one woman to the next. While pelvic floor problems tend to worsen with increasing age, scientific studies tell us that prolapse progression is unpredictable1.
You can reduce some of the manageable risks of prolapse worsening or recurring after prolapse surgery by following these tips.
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International best selling prolapse exercise guide for women with prolapse and after prolapse surgery.
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
How to Reduce the Risk of your Prolapse Getting Worse
Reduce your risk of prolapse worsening with these 12 tips:
1. Regular Pelvic Floor Exercises (Kegels)
Pelvic floor exercises (Kegels) strengthen your pelvic floor muscles. These muscles work with other strong pelvic tissues to keep your pelvic organs in position and prevent them from falling into your vaginal walls (i.e. prolapse).
Research tells us that pelvic floor exercises can improve prolapse symptoms and lift the pelvic floor (and prolapse) to sit higher within the pelvis in some women (with mild to moderate prolapse)2.
2. ‘The Knack’ Exercise Technique
‘The Knack’ is a pelvic floor exercise technique that can counteract downward strain on your prolapse when you cough, sneeze or lift a heavy item.
‘The Knack’ technique involves lifting and squeezing your pelvic floor muscles using a strong brisk contraction immediately before and during downward pressure on your pelvic floor e.g. immediately before and with a sneeze3.
3. Support Pessary
A support pessary can help to lift up your prolapse and reduce prolapse symptoms. Support pessaries can help some women manage their prolapse and avoid prolapse surgery.
Some women report that their pelvic floor exercises are much easier when they are wearing a support pessary.
Support pessaries are available in a range of sizes and styles that are suited to managing different types of prolapse.
You can speak with your gynecologist or pelvic floor physiotherapist about whether a support pessary is suitable for you to use.
4. Pelvic Floor Safe Exercises
Keeping your whole body strong and active is a positive step you can take to reducing the load on your pelvic floor with your everyday activities.
If your body is strong you’ll be able to do more physical activity without overloading your pelvic floor (and your prolapse) than you would otherwise.
Choose pelvic floor safe exercises and techniques for keeping your body strong and fit.
Pelvic floor friendly exercises are exercises that reduce the load on your prolapse.
For most women pelvic floor safe exercise involves:
- Low impact fitness exercises
- Avoiding intense abdominal core strengthening exercises
- Appropriate strength exercises and techniques
5. Bowel Management to Avoid Straining
Manage your bowels well to avoid overloading your pelvic floor and straining your prolapse.
Good bowel management for prolapse protection involves:
- Using the correct bowel emptying position and technique
- Managing food intolerance/ IBS by working with a health professional
- Minimizing your risk of constipation and avoid straining
- Minimizing you risk of diarrhoea and associated straining
6. Body Weight Management
Your abdominal body fat surrounds your abdominal organs and sits directly above your pelvic floor (shown right).
Your pelvic floor supports the load of your abdomen so the greater the load of your abdominal fat, the greater the load on your pelvic floor.
Some women find that losing abdominal body fat reduces their prolapse symptoms markedly.
Reduce your risk of your abdominal fat overloading your pelvic floor by:
- Losing weight if you’re overweight
- Avoiding unnecessary weight gain4
- Understanding that if you are overweight, your pelvic floor is already under load during all of your everyday upright activities and exercises. You will benefit from a careful balance between pelvic floor safe activity, exercises and rest to reduce the load on your pelvic floor.
7. Managing Coughing
When you cough the pressure generated by your strong upper abdominal muscles is transferred downwards onto your pelvic floor. One severe bout of coughing with an acute chest infection can cause prolapse worsening.
Manage your cough by:
- Working with a health professional to manage your chronic cough e.g. asthma
- Managing acute chest infections by seeing your doctor (discuss using a cough suppressant to reduce coughing if appropriate)
- Using ‘The Knack’ every time you cough
- Not smoking
8. Allergy Treatment
Allergies such as hay fever can cause sneezing, coughing and repeatedly blowing your nose. This can have the effect of worsening prolapse severity.
Managing allergies to protect your prolapse involves:
- Avoiding known allergens that cause you to experience hay fever
- Working with your health practitioner to manage existing allergies
- Using ‘The Knack’ to counteract the pressure of sneezing and blowing your nose
9. Safe Lifting
Heavy lifting or using the wrong lifting technique can increase the risk of prolapse worsening. Safe lifting is vital for managing your prolapse well.
Safe lifting to protect your prolapse involves:
- Avoiding heavy lifting that causes you to strain
- Using the correct lifting technique
- Lifting from waist height or above where possible
- Minimizing lifting from ground height
- Avoiding repetitive lifting
10. Monitoring your Prolapse Symptoms
Do you notice your prolapse symptoms with exercise or particular activities?
Don’t ignore your prolapse symptoms because your body is providing you with important information about activities that your pelvic floor is currently unable to withstand.
Act on your prolapse symptoms by:
- Modifying activities or exercises that worsen your prolapse symptoms
- Spreading out your activities during the day
- Resting to unload your pelvic floor and reduce prolapse symptoms
11. Knowing When Prolapse Risk is Increased
There are times and events in every woman’s life when the pelvic floor works less effectively to support pelvic organs. During these events the risk of prolapse worsening may be increased.
The risk of pelvic floor problems is increased:
- With menopause and beyond
- Immediately after pregnancy and childbirth
- During the breastfeeding months
- After pelvic surgery
- With lower back and/or pelvic pain
If you’re living with a prolapse, be mindful of the times in your life when your risk of prolapse worsening is increased. During these times you’ll likely benefit from working to improve your pelvic support (i.e. pelvic floor exercises) and reduce the load on your pelvic floor.
12. Getting Sufficient Rest
Your pelvic floor will be more vulnerable to strain when you’re fatigued or unwell. Be mindful of the need to protect your prolapse particularly when you’re tired.
If your prolapse is moderate to severe or symptomatic:
- Balance your activities and exercises with good rest
- Put your feet up if the opportunity arises during the day
- Try to avoid prolonged standing or heavy/repetitive lifting
How to Reduce Prolapse Worsening
Key Principles for Prolapse Management
In summary, there are 2 key principles for prolapse management:
1. Improving prolapse support
2. Reducing prolapse loading
The tips outlined in this article will help you improve prolapse support and reduce your risk of prolapse overload.
If you can incorporate these principles into your everyday life, you’ll be doing everything you can to manage your prolapse and reduce the risk of your prolapse getting worse.
- Gilchrist, A.S., Campbell, W., Steele, H., Brazell, H., Foote, J. and Swift, S. (2013), Outcomes of observation as therapy for pelvic organ prolapse: A study in the natural history of pelvic organ prolapse. Neurourol. Urodyn., 32: 383-386. https://doi.org/10.1002/nau.22298
- Ingeborg Hoff Brækken, Memona Majida, Marie Ellström Engh, Kari Bø, (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, Volume 203, Issue 2, Pages 170.e1-170.e7, ISSN 0002-9378,
- Miller, J.M., Sampselle, C., Ashton-Miller, J. et al. Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to preempt expected stress incontinence. Int Urogynecol J 19, 773–782 (2008). https://doi.org/10.1007/s00192-007-0525-3
- Kudish BI, Iglesia CB, Sokol RJ, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009;113(1):81-88. doi:10.1097/AOG.0b013e318190a0dd