10 Ways To Avoid Repeat Prolapse After Prolapse Repair

Prolapse repair surgery
What can you do to avoid repeat prolapse repair surgery?

If you’ve had a prolapse repair your risk of repeat prolapse is increased.

Some women are discharged from care with very little long-term guidance despite the fact that approximately 1/3 of prolapse surgery is for repeat prolapse.1

This Physiotherapist information teaches you 10 ways to reduce your risk of repeat prolapse.

 

The 2 Key Points for Reducing Your Risk of Repeat Prolapse

  • MINIMISE THE PELVIC FLOOR LOAD downwards to reduce the risk of straining your prolapse repair
  • MAXIMISE YOUR PELVIC FLOOR SUPPORT from below so your repair can withstand the pelvic floor load from above (see image below)

Pelvic floor forces

10 Ways to Minimise Your Risk of Repeat Prolapse Repair

1. Pelvic Floor Exercises or Kegels

After prolapse surgery Kegels or  pelvic floor exercises should be a priority and incorporated as a regular part of your routine. Having strong supportive pelvic floor muscles helps you withstand the everyday forces that it needs to resist.

Make sure you’re aware of the correct pelvic floor exercise technique of lifting and squeezing your pelvic floor muscles.

If you’re not sure whether you’re doing your pelvic floor exercises correctly see a Pelvic Floor Physiotherapist to help you. It’s vital that you use the correct lifting technique rather than bearing down (which many women tend to do unknowingly).

2. Use ‘The Knack’ Technique

‘The Knack’ is an exercise technique that can help you counteract downward pressure on your pelvic floor.

‘The Knack’ is a strong squeeze and inwards lift of the pelvic floor muscles. The Knack should be used before and during every episode of downward pressure on the pelvic floor; coughing, sneezing or lifting.

3. Avoid Constipation and Straining

Bowel emptying video

Watch correct bowel emptying video

Straining with constipation increases the likelihood of prolapse; either with repeated straining or a single episode of intense straining.

If you’re prone to constipation ensure that you:

  • Use the correct bowel emptying position and technique
  • Adhere to a diet that promotes a soft well formed stool
  • Take measures to avoid constipation when travelling
  • Speak with your surgeon or regular doctor for prompt assistance if you’re constipated postoperatively; many ladies are prescribed osmotic laxative (e.g. Movicol, Osmolax) during their initial postoperative recovery

4. Manage Diarrhoea

Chronic diarrhoea can strain the pelvic floor with repeated bowel emptying. Some medical conditions are associated with chronic diarrhoea (e.g. ulcerative colitis). Take steps to manage your condition well with a health professional. Diet to manage chronic diarrhoea can assist some women.

A single episode of diarrhoea can impact upon your repair if it’s placed under repeated pressure with bowel emptying. Medications that manage diarrhoea can be readily obtained from your pharmacist.

If you’re travelling to a location with known risk of stomach upsets and diarrhoea pack anti-diarrhoea medication to have ready if needed.

5. Manage Coughing

When you cough the force generated by your abdominal muscles presses downwards onto your pelvic floor. If your cough is forceful and/or repeated your pelvic floor can be forced downwards contributing to repeat prolapse – especially if your Cough suppressantpelvic floor lacks the strength to withstand the force of your cough.

If you have a chronic cough manage your condition and exacerbations with a health professional, strengthen your pelvic floor muscles and use The Knack before and during every cough.

If you develop a cough with acute illness consult your doctor sooner rather than later. Appropriate medication may include a cough suppressant, especially when you’re more vulnerable to pelvic floor strain with fatigue and illness.

Don’t smoke.

6. Manage Your Bodyweight

Managing your body weight involves avoiding unnecessary weight gain and losing weight if you’re overweight.Abdominal body fat

The more abdominal body fat you carry around your abdominal organs, the greater the load on your pelvic floor, especially when you’re upright.

Manage your body weight by eating well and doing regular pelvic floor safe strength and fitness exercises.

Some forms of fitness exercise promote abdominal fat loss over others.

7. Eat Well

Eat well for your prolapse to manage your body weight and your bowels.

Manage food intolerance problems and associated gut disorders e.g. IBS that causes abdominal bloating and alternating constipation and diarrhoea.

Get to know those foods that your bowel reacts to and avoid them where possible. Specialist dietitians can assist with dietary management of food intolerance problems – especially dietitians with understanding of FODMAPS.

Minimise or avoid those foods that cause you to react with wind/gas and bloating. Bloating can increase prolapse symptoms. There is no suggestion in the research to date that bloating increases the risk of recurrent prolapse however some women do strain to pass wind and ease gas pain with bloating and this practice should be avoided.

8. Avoid Heavy Lifting Pelvic floor safe strength training

Heavy lifting is a known risk factor for pelvic organ prolapse so its important to know your safe lifting limit.

Forwards bending, deep squatting, heavy pushing or pulling can all increase the load on the pelvic floor.

Take the time to learn how to lift safely with prolapse issues.

After prolapse surgery modify your regular activities including work practices that involve heavy physical work.

For women in heavy lifting and physical work occupations modifications can be challenging. If you work in an occupation involving intense physical work it’s important to recognise the risks of heavy physical work and repeat prolapse before proceeding with prolapse surgery.

9. Exercise Safely for Your Strength and Fitness

Keeping your body strong with pelvic floor safe strength training helps you decrease the load of everyday activities on your pelvic floor.

Having good physical strength improves the ease of your everyday activities and reduces your risk of strain with activity. Maintaining a strong body will help you protect your pelvic floor long-term.

Regular strength exercises have the added benefit of increasing your lean muscle tissue. Lean muscle requires energy and helps you burn fat. Lean muscle increases your metabolism helping you better manage your bodyweight (thereby protecting your prolapse).

10. Avoid Inappropriate Exercises

Inappropriate exercises increase the load on your pelvic floor including your pelvic floor muscles and your internal prolapse repair.

Avoid inappropriate exercises including:

Choose pelvic floor safe strength and fitness exercises and avoid or modify inappropriate exercises to keep your body strong and active life-long.

Key Points For Successful Prolapse Repair

If you’ve had prolapse repair surgery there are many things you can do to improve your chances of long-term success.

Don’t just leave things to chance – recognise those risks for repeat prolapse that apply to you and minimise those risks by maximising your pelvic floor support and minimising the strain on your prolapse repair.

1Olsen A, Smith V, Bergstrom J et al 1997 Epidemiology of surgically manage pelvic organ prolapse and urinary incontinence. Obstetrics and Gynaecology 89:501-506.

PROLAPSE EXERCISES BOOK

prolapse exercises

 

with Pelvic Floor Physiotherapist Michelle Kenway

Learn how to exercise safely, strengthen your prolapse and reduce your risk of repeat prolapse.

Prolapse Exercises is a complete exercise guide for women after prolapse surgery seeking to exercise safely and protect their pelvic floor.

READ MORE NOW

 

We Welcome Your Comments

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Comments

  1. Hi Michelle, after having your first prolapse repair, what would be the average length of time you would expect this operation to last for before needing another operation? And, how do you really know if you’ve done any damage to yourself through making mistakes along the way without realising?

    • Michelle Kenway says

      Hi Inger

      The longevity of repair depends on so many factors it’s almost impossible to predict if and when another repair will be needed; ie type of repair, surgical technique, surgeon expertise, post op recovery, individual lifestyle factors, co existing health problems and more. When a woman damages her repair she may feel some symptoms of pelvic discomfort and/or pulling sensation associated with the event for example heavy lifting and straining. Recurrence of prolapse symptoms is usually the best indicator. Best advice is to move forwards with care and adhere closely to pelvic floor strengthening and check with your doctor if an examination would reassure you.

      All the best
      Michelle

      • Thank you so much Michelle and for taking the time to respond. I will do my best to restrengthen anything that may have been partly damaged, that is if you really can once the damage is done. Cheers :)

  2. Thank you Michelle.. Another fantastic article, full of practical tips – easy to implement, to keep us strong and active … and safe! Your articles are a constant source of advice and information for me.

  3. I have just had my second prolapse (Cystocoele and Rectocoele) repair in 15 years. I was given no information on recovery and pelvic floor protection and strengthening then or now. I am determined to learn and be as wise as possible after this second repair as I am now 61 years old and I have a whole lot of living ahead of me! Without your website I would not have known the importance of care for the Pelvic Floor nor known what questions to ask. The one question I have that I have been unable to glean information on is WHY not to bend the first 6-12 weeks. What is happening mechanically that needs to be protected. Thank you very much.

    • Michelle Kenway Physiotherapist says

      Hi Debbie

      Good question. When you bend forwards try to visualise what happens to your abdominal contents – notice how they compress? This action generates some pressure and the pressure needs to go in some direction – this is usually downwards towards the pelvic floor. A little akin to squeezing a tube of toothpaste in the middle if this makes sense.

      I hope this sheds some light on this for you

      Cheers
      Michelle

  4. Dear Michelle ,
    thank you for your web site and books . I ordered and read your book before going in for surgery thank goodness as I was given no advise on what to or not do after the surgery and was not seen by a physio in the hospital (QE11) so not even advised to move my legs , breathe deep . Discharged after 2 nts in hospital before bowels opened without your book to read I think the past couple of days would have been very hard to cope with alone . So thank you .

    • Michelle Kenway Physiotherapist says

      Hi Yvonne

      I am really glad to hear that you managed to prepare well in spite of things and manage – well done!

      All the best for your recovery Yvonne, take things slow and steady and give your body the time it needs to recover

      Michelle

  5. So frustrated because I think I may have prolapsed again after having a hysterectomy and repairs six months ago. I returned to using the weight machines a few months ago and now I am having constant bladder pressure. I love working out. At 49 I am not willing to stop going to the gym. It feels like I have a prolapse in the front , not a rectocele like before.

    • Michelle Kenway Physiotherapist says

      Hi Megan can I understand your frustration. What type of weights did you return to? Regular weights or pelvic floor safe weights?

  6. Hi Michelle
    Thank you for this newsletter. I have just had vag partial hyst with anterior and prosterior repair at 37yrs of age. I am terrified about undoing all this work so very cautious about what I can and can’t do. Thank you for your info

  7. Hi, I had op for prolapsed bladder in 2015, it came back in five weeks, did my exercises. Since then have used a pellum spacing pessary with no trouble until recently when I needed next size which was a No 7. It moved towards my rectum and caused severe constipation for two weeks
    Now considering surgery again

  8. Hi Michelle,
    Thank you for such a wonderful website – I direct many patients to it (as well as to a specialist women’s health physio). I am a physio trying to make my pilates and circuit classes pelvic floor friendly. I have read your book cover to cover which gave me a lot of great ideas. What I am still struggling with is – whether someone post prolapse repair can ever return to doing standard weights (eg squat, deadlift) or if these are a no-go for life ? And if so – what a good bone loading replacement exercise might be for the spine ? Any suggestions would be so much appreciated. thank you

    • Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Nerida
      Thanks so much for your question, my apologies for the delayed reply. Yes I have post prolapse surgery patients performing modified squats (mini squats) you’ll have seen in my book and we also perform modified dead lift (taking weights to knee level max with the forward bend and focusing on exhale with the return to standing). These can all be loaded using weights. I always match the weights and intensity of exercises to the physical ability of the patient as well as her pelvic floor condition and extent of surgery obviously keeping the more vulnerable women to lower loading. Bridging and clam can be confidently weighted with progress and are also both fantastic hip bone loading exercises that avoid pelvic overload while weighted push backs (ref my books) and seated tubing low row are great mid thoracic strength exercises that avoid pelvic floor loading and can therefore also weighted up. Hope this gives you some more ideas Nerida, all the best Michelle

  9. Oh wow- I wish I had seen this before my surgery 3 months ago (bowel/bladder prolapse/vag repair). My surgeon told me I could power walk, use the rowing machine and do pilates- so I’ve been doing that since the 8 week mark. Have also returned to spin class this week. Am worried now I might have undone any good done by the surgery. Am not really feeling any discomfort in the pelvic area, although sometimes if my bladder is full I `just make it’ to the bathroom. Unfortunately my surgeon is not the best with responding to any post-surgery queries. Should I be worried? Should I stop my exercise plan and start over again?

    • Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Kate
      Walking shouldn’t be a problem. Just take care with the how much resistance you use on the
      rowing machineand avoid Pilates exercises that involve intense core abdominal exercises see start reading hereHope this helps you get started safely Kate, cheers Michelle

  10. I had surgery for a prolapsed bladder. My surgery was called a repair. I was told not to lift more than 10 lbs. for the first 6 weeks and activity as tolerated. Not to get constipated. I was to be off work 3-6 weeks. After my 2 week check, it was decided I would stay off work 4 more weeks. That was the extent of my instructions. I have been very cautious to follow instructions. I am concerned that it may have slipped some. I can still feel the stitches but it is not prolapsed. It does seem lower to me. I am a bit concerned about that happening again.
    I feel like there should be a whole lot more education with this surgery than most patients receive! I put a lot of trust in my verbal and written instructions but do not feel like they are very thorough.