Prolapse Exercises – Pelvic Floor Safe Strength Exercises for Prolapse

Pelvic floor safe strength training

Strength Training Guidelines for Women with Prolapse

Safe prolapse exercises require an understanding of the exercises and techniques with the potential to cause pelvic floor injury.

These physiotherapy guidelines for safe prolapse exercises are by Michelle Kenway, Pelvic Floor Physiotherapist.

Michelle designed these 10 pelvic floor safe exercise principles that are widely adopted throughout Australia as part of the Continence Foundation of Australia’s Pelvic Floor First safe exercise campaign.

10 Pelvic Floor Safe Exercise Principles for Strengthening

From Inside Out – the essential women’s guide to pelvic support by Michelle Kenway

These 10 principles are designed to help you safely strengthen your body AND protect your pelvic prolapse as you do so:

1. Avoid exercises and/or machines that aggravate prolapse symptoms

Listen to your body – if your symptoms are worse with or following a particular exercise or machine then modify that exercise or perform another exercise. Doing an exercise in a women’s circuit or gym does not necessarily ensure safe prolapse exercises!

2. Avoid heavy lifting

Never lift a weight that makes your strain or inclined to hold your breath.

3. Lift with good posture

Maintain the inward curve in your low back whenever you perform a resistance exercise.

4. Exhale with every effort

Always breathe out with the effort and never hold your breath when performing a lift/lower/push or pull.

5. Choose supported positions

Sitting or laying down places much less pressure on your pelvic floor than lifting weights when standing.

6. Keep your feet close together

If you do must stand for an exercise, keep your knees close and narrow your pelvic floor openings. This always applies to squats -keep your knees close during pelvic floor safe squats in how to squat video.

7. Strengthen gradually

Start with light resistance and gradually increase the weight you lift as your body strengthens over time.

8. Take care when fatigued or injured

When you are tired or unwell your pelvic floor muscles will not work as effectively so take a break from training.

9. Rest between exercises or sets

Rest to give your muscles adequate time to recover.

10. Use your pelvic floor muscles

Try to brace your pelvic floor muscles when you can before and as you lift/lower/push/pull a weight. Always make sure you fully relax your pelvic floor muscles completely after exercise.

Who is Most at Risk of Pelvic Floor Injury?

There are times and events in every woman’s life where her risk of pelvic floor injury with inappropriate strength exercises may be increased. This includes;

  • With existing pelvic prolapse;
  • After previous prolapse surgery;
  • New mums;
  • During and after menopause;
  • After a hysterectomy;
  • With a weak pelvic floor;
  • With pelvic floor pain or increased pelvic floor muscle tension; and
  • When strength training for osteoporosis to improve bone density.

If you can apply any or all of the above strength training principles you will better ensure safer prolapse exercises. Pelvic floor safe strength training principles can help women to exercise safely for better strength and tone, and protect the health of their pelvic floor.

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.

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We Welcome Your Comments


  1. Thank you!

  2. Sorry Michelle I had one other question can I use the stair climber (the escalator looking one) and do two steps at a time? I usually have this set on 10. I’d like it for cardio instead of running.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Christina keep it at one step at a time – much kinder to your knees and post op in view of your surgery! All the best

  3. Dear Michelle,
    I had a hysterectomy and pelvic floor suspension operation (not for prolapse or anything but as a result of needing a hysterectomy the pelvic floor supspension was incorporated into my operation) 2 months ago and was devastated to hear from my gynaecologist no more squats etc.(well I can but he said he would be seeing me again in 2 years). I am 51 and love training hard with squats and deadlifts pull ups etc and had no idea what I was going to do to maintain my fitness regime – until I found your site!!

    I am very relieved, and, now actually feeling a little motivated. Although this is not the type of training I am used to I am going to give this a really good go!!! SO THANK YOU!! I am going to cancel my gym membership as I have light weights at home and will use your DVD and set up a home gym as I don’t need the heavy weights and equipment I was using, well anyway I actually shouldn’t use it now. My question is that I want to start a yoga journey and I am wondering if this safe enough for me to do? Thanks again for giving me hope that I can maintain my fitness and physique through a modified training regime. Kind regards Christina.

  4. Hi Michelle, I am 60 years old post menopause. I have always led an active life but started CrossFit 3 years ago which I currently do 5+ times per week. At the start of my CF journey I had a bad case of bronchitis which brought on an enterocele, however this has never caused me any problems until this week when I could feel the ‘lump’ when doing sit ups. I have seen my consultant who says my womb has dropped, putting pressure on my existing enterocele which is now protruding slightly. He sees no reason to carry out surgery at this point (which I would also like to avoid), but it has made me look at my lifting regimes more closely.
    I love my CF & would really like to continue with that style of training but in a more pelvic friendly way. Having read a lot of your material, I would like to ask your thoughts on me continuing with CF but at lower weights than normal & substituting full sit ups for crunches, full push ups for knee push ups etc. Does this sound reasonable, I know you say about lifting heavy weights but guess that is relative to existing strength? As an example if I was used to deadlifting 80kg but only did 40kg would you feel that is OK or would you still say NO deadlifts at all? Or what about deadlifts off a slightly raised platform rather than the floor. I am struggling to find someone who understands both CF & pelvic prolapse, I would really like to find a compromise that reduces the risk of making my prolapse worse but allows me to carry on doing the style of training I love.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Aly
      Yes I hear you and I completely understand your desire to continue and love of exercise – the issue is that you’re doing exercises originally designed for male military personnel if my memory serves me correctly (rather than mature woman with a prolapse and likely weakened pelvic floor). Aly I’ve looked closely at many of the CF exercises and they are just not pelvic floor friendly and difficult to modify. This is the classic type of exercise that can overload the pelvic floor (ie heavy dead lifts, intense core etc). I think your specialist is spot on and unfortunately surgery won’t fix this to allow you to continue CF; surgery will actually make you more vulnerable to repeat prolapse (the first surgery always has to be the best one). Enterocele can become a whole lot worse too don’t forget. There is an option that you may not have explored in addition to modifying the loads and techniques (outlined in detail here on site and in the Prolapse Exercises Book) and that maybe a support pessary. It could be worth seeing your gynae to discuss the possibility of using a pessary to allow you to exercise (in addition to Kegels etc). Does this sound like an option you might be able to explore? I hope I don’t sound blunt – I’d rather be honest than lead you along a misguided path.

  5. Jane Finden-Crofts says

    Hi Michelle

    I started exercising a few months ago after having not done any exercise other than walking for a couple of years and I was recently diagnosed with a stage 1 bladder prolapse. I was doing 2 or 3 personal training sessions a week but since being diagnosed I haven’t done much exercise as I have been scared of making my prolapse worse. I have your video and your book and I think they are brilliant but I really want to find a personal trainer who is also a pelvic floor safe exercise provider. I see from your website that you list pelvic floor safe exercise providers in Australia but I would be really grateful if you have any recommendations for England, specifically London? I am desperate to find a personal trainer who understands my needs and who I can feel confident in to help me keep fit without further damaging my pelvic floor.

    Thanks so much.

    • Michelle Kenway says

      Hi Jane

      Thanks so much for your comments – I am emailing my contacts in the UK now to see what I can come up with for you, stay posted.

      Yes we really need an international register, hmmm putting my thinking cap on

      Best wishes

  6. Hi Michelle. What a wonderful resource you are to all of us! I am an active 45yo woman with no issues with pelvic health. My PT says I’m a 4 out 5 with vaginal muscle strength (and I plan to get that to a 5) My only issue is that I have significant SUI when I run and do box jumps and double unders in crossfit. This is a quality of life issue for me and after researching the TVT surgery, I am nearly convinced that it is something I would like to do. My biggest concern is my ability to return to lifting heavy – i.e. deadlifting, back/front squats from 150-250 pounds. Assuming I have no other issues with any organ prolapses, and I have a strong pelvic floor, etc., Do you see any reason that I should fear that heavy lifting could rip/pull on the scar tissue formed from this surgery and do further damage once I have healed? Is this a matter of giving myself 3-6 months (vs 6-8 weeks) recovery before heavy lifting again, or would you be inclined to say that I should stay away from that kind of heavy lifting permanently after TVT? It is very hard to find any opinions on the effects of heavy weightlifting after this type of surgery. Thank you for any insight/opinion you can offer to me.

    • Michelle Kenway says

      Hi Christy

      Great question! MY first instinct is to wonder about the exact cause of your SUI – usually this is due to a hypermobile urethra which is forced downwards during increased pressure. The pelvic floor muscles play a large role in counteracting this pressure. I know this isn’t what you have asked me however it may suggest that your pelvic floor muscles might test a 4 out of 5 lying down on a bed but this doesn’t necessarily transfer to assuming that they are supporting well during heavy lifting exercises, so I think there is some call for caution with your lifting despite your score.

      The TVT procedure does reply on scar tissue to grow through the tape and keep the urthera well supported, so it is in your best interests to avoid heavy lifting as well as high impact exercises prior to 3 months post op. assuming that all goes well with your recovery. There are many ways to load safely and protect the pelvic floor – supine lifting (curls, triceps, lats), weighted bridges, lunges as opposed to squats, using the strength training exercises and techniques for strength training I have posted on this site and in my books. I believe that many women can modify features of their workouts to enable them to lift heavy loads. Squats with heavy loads lifted from ground height or dead lifts do need to be modified without doubt. Double unders and box jumps are high impact as you know – once again it would be a matter of how well your pelvic floor supports during these high impact exercises, and for how many of these exercises it continues to support.

      Christy I haven’t given you a yes no answer here but I hope I have raised some things for you to consider, and helped your ability to make informed decisions about the best exercises for you to proceed with post TVT surgery. I do think it is great that you are thinking about this before surgery – some women head into surgery with the mistaken beleief that they can return immediately to intense exercise programs post op so I applaud your proactive approach here.


  7. Hi, I’m 34 and was recently diagnosed with bladder and uterine prolapse. My questions is, does sleeping on my stomach safe? Also, can I use the Arch machine, and Lateral X machine.

    How about the stair climber. I’m in the USA and cannot find any good references to what I should or should not do for exercise. I just ordered your book and DVD and I can’t wait for them to arrive. It’s very frustrating to want to be active and lose weight with no real guidance from my doctors.

    Thank you.

    • Michelle Kenway says

      Hi Tammy
      Thanks for your email – yes agreed this information about pelvic floor safe exercise is difficult to access indeed.
      In answer to your questions:
      – Sleeping on your stomach should not be an issue for your prolapse, there is no downward pressure on your pelvic floor associated with this sleeping position
      – The machines you mention have some aspects worthy of mention -I assume the resistance through the upper and lower limbs can be varied, the resistance would need to be kept low to minimise the pressure on the pelvic floor. I would avoid the deep stepping action and keep it small range to reduce the pressure required to push down through the thighs and push the pedal down – keep steps small. The latter machine mentioned looks to have a legs wider apart option – with prolapse I would suggest the focus is on keeping the legs narrow when stepping not wide to maximise the ability of the pelvic floor muscles to be working when stepping (its more challenging in wide legs apart positions).

      Let me know if you have any further questions, I hope this helps you out

      • Thank you for your response Michelle. Can you receommend some cardio exercises that are safe?

        • Michelle Kenway says

          Hi Tammy
          There are many pelvic floor safe types of cardio exercise – for fitness I don’t think you can go past cycling/spinning (remeber that spinning needs to be low gear and seated). You can read an article about pelvic floor safe cardio exercisesfor prolpase in this article.

          Hope this helps out!

  8. Feather star says

    Hi there michell, I am recovering from rectal prolapse surgery and am feeling anxious about my sport of choice horse riding. This is after reading your site. I have three horses and ride for a couple of hours each week.. Your site seems to be indicating that I may have to give tis up .. Can you clarify please. Ps my surgeon indicated that there was weakening of uterus and bladder and that I may need surgery again in the future. However he also indicated i could return to horse riding and rinning after 4 weeks ? Is he being a bit laissez faire with jis advice? I have not returned to either as yet but am walking and just started swimming .I have since discovered your site and have begun your exercise regime.. And already noticing a difference.. I have also ordered your book and DVD.. Can you advise please

    • Michelle Kenway says

      Hi Feather Star

      Horse riding after prolapse surgery is an interesting issue. There are no studies to my knowledge on this activity post op. I am not sure of your level of ability and I do believe level of horse riding ability will impact the pressure on the pelvic floor. One potential issue will be with the amount of impact on your pelvic floor when the horse lands or strikes its hooves and how much of this impact is transferred to the pelvic floor. Novice riders will be far less able to reduce the impact of riding especially with trotting. I would think that if you are able to absorb the landing pressure through your thighs with a smooth canter the pressure on the pelvic floor would be decreased compared with novice riding however this remains to be confirmed. Can you recall the amount of pressure you detected on your prolapse prior to your surgery when riding? I think this will be an indication too i.e. did you notice your prolapse was symptomatic after riding?

      The other issue is caring for the horse – I understand there is considerable heavy lifting involved in feeding and grooming. If you are caring for your own horses this would be an important issue to address.

      Finally the strength and support of your pelvic floor muscles is an important consideration too – the better these muscles are working, the better the support for your prolapse repair.

      So unfortunately there is no yes or no however I believe the issues to consider are reducing pelvic impact as you ride where possible (avoid jumping), minimising lifting strain and maximising your pelvic floor muscle strength.

      Please fell most welcome to let me know if this goes towards answering your question and if you have any further questions that I haven’t answered.


      • Feather star says

        Hi Michelle, I actually did not notice anything different with my horse riding ever I’ve been riding for many many years. Not a novice .. Im 54 . My prol apse appeared at menpause.My prolapse tendered to worsen with motor bike trips where there was associated vibration. I also used to notice that when I was tired my symptoms increased (?).My surgery is now six weeks so I’m going to give it a go . I think I will now avoid sit trotting and will refrain from cantering for a fair bitblonger. I will let you know how I go.Thanks for your advice re lifting and i am now avoiding those x25 kgs + feed bag lifts

        • Michelle Kenway says

          Hi again
          Yes absolutely avoid lifting those 25kg feed bags – especially lifting them off the ground. The lower the height from which you lift the greater the pressure on your pelvic floor and this applies to all lifting. You may like to read this article on how to lift with prolapse issues.

          I agree avoid trotting, wait to canter, just walk for the moment and probably for the next few months (full healing internally at around 3 mths post op but the risk or repeat prolapse is increased with previous surgery). The fact that you did not have symptoms previously is quite a good sign too. Great feedback re motorcycle and vibration this makes complete sense so probably avoid long motor cycle trips wherever possible. Very keen to hear how you go, best of luck!


  9. Hi Michelle,
    I so much appreciate being able to ask questions and all the information found on your most useful site.
    I just gave birth to my 4 th child in 4 years. Vaginal/normal births for all and saw a PFPT after baby #3 because of Mild incontinence at the end of long runs or soccer games. She said she was surprise at how strong my PF was after 3 kids in 3 years and I had no signs of prolapse- I had never heard of prolapse before and didnt ask more about it at the time. So wish I had!!
    Halfway through my 4 th pregnancy I noticed something was ‘off’ and was diagnosed with a very mild uretha prolapse (I am attributing this to so many oregnanices in such a short period, likely returning to exercise to soon after each birth AND I did a lot of heavy weight lifting/squatting throughout my 4 th pregnancy. I just didn’t know about prolapse or I need would have done such exercises). I had a good labour and delivery and am now 3 weeks post partum. I am finished having children and am desperate to get back to my exercise which has been so important to me throughout my life. I also have Diastis recti and was given a splint/ waist band to wear to help heal the abdominal muscles. I’m assuming my prolapse healing is more important than wearing the waist band at the moment?
    I seem to feel worse after wearing the waistband. I am going to take my return to exercise and particularly running very slowly and cautiously as I want to have long term vision/goals. Because I plan to mostly swim/spin could you let me know if rowing is a safe exercise postpartum for prolapse? Thank you so much for your time.

    • Michelle Kenway says

      Hi Ruthann
      Thanks so much for your comment, you raise so many good points i.e.lack of information & education for women returning to exercise, rectus diastasis & prolapse issues for new mums returning to exercise.

      Can I just mention that if the abdo brace/band is too firm it can sometimes increase the prolapse symptoms by squeezing your middle and increasing downwards pressure on the pelvic floor. Abdo bands are a great way to initially manage rectus diastasis but they need to be comfortable fit and not too tight. Sometimes a high top pair of tights or briefs that cover above the navel can work really well for diastasis support.

      Good question re rowing too – I wonder if you are thinking machine or outdoors as I suspect that if you pull on heavy machine resistance and lean too far forwards on the slide in return when you bend your knees there may be an increase in pelvic pressure. I usually suggest to keep rowing resistance manageable to avoid strain and to try to maintain the inward curve in the lower back as you slide forwards and your knees bend. I think if you are doing outdoors rowing this will involve speed where faster rowing will obviously increase water resistance and the pressure on your body so wise to take it slow and steady.

      Spinning is terrific – keep resistance light, aim for speed, intervals, and stay seated in the saddle (avoid heavy climbing) for pelvic floor protection.

      Best of luckRuthann please feel welcome to comment further if desired

  10. HI Michelle,
    When is the best time to do Kegels. I have been doing them when I first get up in the morning. If I should do them more that once a day I feel like my muscles or too fatigued. If I do them laying down I can feel it better. Also I have a bulge (had surgery already for prolapse) that my doctor says that was the best they could do and its not the bladder but more of the uretha. Any comments on that?
    Thanks so much for you input and all your great information on your website

  11. Hello Michelle,

    I am hoping you’ll be able to answer a question for me that I have had for sometime (I’ve haven’t been able to find the answer on your site, or elsewhere): What is air exiting the vagina a symptom of? I am assuming weak pelvic floor muscles but am not sure. When ever I do shoulder stand, when I come down from it a I have the vagina flatulance and then a few years ago it started happening with headstand and handstand. This are positions/ postures/ movements that I haven’t seen discussed on the website so am not sure their impact on the pfm and how to work with it. Many Thanks

    • Michelle Kenway says

      Hi Laura
      Air exiting the vagina is a symptom associated with prolapse or the upper part of the front wall of the vagina (known as “upper anterior vaginal wall prolapse”). The laxity or looseness of the vaginal wall traps the air and then with position change the air escapes. This symptom also occurs quite commonly in women during intercourse.

      A shoulder stand wil not increase pressure on your pelvic floor, in fact quite the opposite since you are upside down during the shoulder stand.

      Hope this helps!

      • Thank Michelle :)
        Yes it does help; so is it possible then to have weak vaginal walls/ prolapse and also tight pfm’s at the same time? how does one relax the pfm and tone the walls? phew… practice and listening i guess.

        • Michelle Kenway says

          Yes absolutely possible but usually women with prolapse have some form of pelvic floor muscle dysfunction – this can even include pelvic floor muscles that are too tight. I have a post on how to manage and relax tight pelvic floor muscles you may like to read here Unfortunately the vaginal walls are tissue that we can’t actively strengthen with exercises unlike the pelvic floor, babies stretch them and they weaken with menopause. Vaginal oestrogen can thicken the vaginal tissues for women peri and post menopause.

          Best of luck Laura, let me know if you have any further qns

  12. been doing excersices for many, many years, for years without knowing it even had a name
    bladder prolapse I had after my 9 pound daughter , started doing the excersices more frequently , but for ever I have had tightening with orgasm, but now it is a very strong clamp down , should I stop doing the excercises ?
    or cut down to a couple times a day ?
    it helps with my bladder problems

    • Michelle Kenway says

      Hi Alexa
      Pelvic exercises are more like a lift and squeeze than a strong clamp down. The muscles need to be fully relaxed back to resting before the next attempt. Ensure that the pelvic floor lifts, rather than pushes down, relax and rest between each attempt.
      Hope this helps a little

  13. hi, i bought your ebook yesterday and thankyou!!! it is a wealth of information that I had no idea about. In brief – I am about to turn 54. I am (was) still kind of are very fit and strong. Weight training 3 times a week, cardio twice for the past 8 years
    In Oct 2012 had tvt and A & P repair.
    I was told no proper exercise other than walking for 100 days!!!!! I did exactly as I was told and on day 101 I went back to gym and started slowly – I was told no weights heavier than 20kg – I obeyed. I tried to get definitive answers on exercise but i was met with raised eyebrows and a blank stare, so I asked could I box, play tennis, run, play golf – to which surgeon said YES – for me I didn’t understand any of that logic as those sports are high impact with a lot of twisting – I didn’t do ANY of them, I just wanted to see what he said, it just proved to me that surgeon didn’t have any idea – they perhaps just say no weight lifting to cover their own backsides. On my 6 week checkup I asked about pelvic floor exercises and what should my rehab be – to which he said if you want to do them! Really? How about giving us a list of Womens Health Physios and MAKING us go to rehab for the pelvic floor! Instead of sending us off with a multitude of questions and no answers. I trawled the internet for months trying to find girls like me that were fit and wanted to resume their fitness once healed to see what they did and how they coped – but everyone was the same – no one knew what to do or how far to push themselves. My surgeon said to me – if you overdo it in the gym with weights I will just see you back here. It was a terrible scenario. So we are now 7 months on and last month maybe I pushed myself a little harder with cardio circuits, as from that day I felt like I had a UTI wanting to go to the loo a lot and a heaviness that scared the living ** out of me. I had a funny slightly heavyish tingling sensation 24 hours a day. Then someone mentioned Womens Health Physios so I started reading again and found you and now from what I have read I know that it is my pelvic floor causing my issues and it needs strengthening properly before I continue with anymore weights no matter how light – I have ceased all exercise as of Monday this week to see what happened and each day i felt better as I have also begun doing all the kegel exercises. I have booked in to see a WHphysio but couldnt get in til Jul 10 so fingers crossed I am doing it all right in the next month before I see her.
    I am seriously going to hit those forums and tell all those girls to make appointments with you all BEFORE surgery and then at least as soon as they leave hospital after surgery so they don’t end up second guessing everything like me and millions of others – I didn’t even know that there was such a thing as a womens health physiotherapist.. I think that you should advertise yourselves on the backs of loo doors in gyms – I mean you have a captive audience!! Instead of reading about teena pads we can be jotting down the phone number of womens health physios. women need to know that you exist. I am certainly going to add your website to the back of my gym door underneath the Teena ad hahaha
    thanks for such a great website I have told my friends about it.

    • Michelle Kenway says

      Hi Chris

      What can I say – you’ve summed it all up so well, thank you!

      You are spot on, get your pelvic floor back in shape and you will be able to keep the rest of you fit and well. Sounds as though you are on track, what a shame you had to find this all out for yourself rather than seeing a women’s health physio as part of routine pre and post op management to help you optimise your prolapse surgery outcomes. Chris take comfort in the fact that some specialist’s are now seeing the value in this for this patients, let’s face it, it can only help make them look good by helping to ensure that the surgery they perform is supported with appropriate exercises (general and pelvic floor) and that the woman’s potential risk factors for repeat prolapse are nipped in the bud. It really is win win for everyone involved.
      Best of luck and thank you for taking the time to comment

      • Michelle, do you believe that in time, with all the right PF exercises, I can strengthen my pelvic floor enough to resume a NORMAL physical life? of course within its new boundaries?? or are my post op insides doomed for a dull life of limited yawn exercises :-(

        • Michelle Kenway says

          Chris unfortunately I can’t say exactly what your prognosis will be – depends in part on whether your pelvic floor muscles are in tact, and how well you can get them functioning plus other factors that impact on your pelvic floor (body weight, ligament laxity, heavy lifting, other coexisiting general health or lifestyle factors that might impact) however I do believe that most women including women with pelvic floor problems and those after prolapse surgery can perform a varied and interesting/challenging exercise program. It may not mean pounding the pavements or burning the abs, but women can usually still enjoy exercise and get a great workout. Hope this helps you a little, I do not believe for one minute you are doomed to a lifetime of boring exercise.

          • That’s good to hear I have just been diagnosed with a rectocoele and cystocoele, and feeling like I am Doomed to never exercise again, I love the gym , especially my aerobic class. I have also just started fly yoga (you are suspended on a swing like set up ) not sure if I should do it or not.??. The doctor bombarded me with a lot of Information , I came home feeling so depressed. I am booked into a Physio that specializes in women’s health but have to wait a few weeks to see her. I have had signs that something was not right for quite a while but it didn’t present as a problem. After a UTI I end up with the prolapse which scared the dickens out of me. I am 49. I stand up a lot as I work with children so by the end of the day I feel like every thing is about to drop out . It’s super uncomfortable. The Doctor has started me on the Ovestin cream but an not keen on it, due to its possible side affects. My question is will it improve with the exercises the Physio will help me with or will I always feel this uncomfortable?

            • Author: Michelle Kenway Pelvic Floor Physiotherapist says

              Hi Shelley it’s great that you’re booked in to see the Physio – she will be able to answer your questions once she has examined you and knows your pelvic floor support. Most women can exercise with prolapse issues, it may involve changing your routine according to what your body can withstand.

  14. Pat from Ontario says

    Hi Michelle,
    Your website has been very informative and helpful for me. I had been a jogger for many years until I developed a prolapsed bladder and bowel. For 2 years my exercise intensity changed to just walking and I gained aprx 7 pounds. Last year I had the corrective surgery and was since encouraged to read about the stationary cycling study for abdominal fat weight loss on your website.
    I cannot cycle due to an ongoing sciatic problem so I experimented with indoor rowing. I went to a gym 3 times a week for a month. The first week my buttock (and sciatic nerve) was a little tender from the rowing, but soon after, I was able to increase the intensity and got stronger. I did interval training of 8 strokes at a higher intensity and then 12 at a lower (similar to the cycling study). I began to notice that I was losing some body fat by the end of the month.
    I now have an indoor rower at home and just began my workout schedule again which is 3-4 times per week. Once again I can get my heart rate up and get the ‘feel’ of running which I have missed.
    I don’t believe there is any pressure on my pelvic floor, but I was interested to hear if you thought it was a safe exercise for me. Your comments would be great appreciated. Thank you for all that you do for women around the world, Michelle!

    • Michelle Kenway says

      Hi Pat
      Thanks for your comment! I am so glad to hear you are doing so well. Yes I believe that the high low intensity exercise has been shown to be effective in a range of different exercise modalities (i.e. running, outside walking, swimming, rowing, boxing, skip jumping, stair walking, and arm ergometry) all these modalities have been reported as getting the heart rates in the high range except for swimming and outside walking, so rowing is most appropriate in this regard.

      Pat I haven’t been able to find information on the abdominal pressure/pelvic floor pressure with rowing. If you look at the muscles involved, I think if you keep the inward curve in the lower back, then pressure on the pelvic floor would be minimal in the pull back which uses back and shoulders. One question is on the lean forward where I suspect the leaning forward does increase pelvic floor pressure a little but it is not resisted movement, and if the spine is held tall and the bending forwards movement kep to a minimum, then I don’t see that the abdominal muscles would generate excessive pelvic floor pressure. My other question is how much force needs to be pushed through the legs on the push back to avoid making the exercise like a leg press if this makes sense – again this could be minimised by keeping resistance manageable and working at speed rather than strength.

      Keep me posted Pat, and keep up your great work! Hope this helps a little.

  15. Hi Michelle, is there any problem in holding a pelvic floor contraction for longer than 10 seconds? I am particulary interseted in long contractions during excercises such as lunging and squats. The individual has had anterior and posterior vaginal repairs as well as a TVT bladder support. There was also a history of pelvic floor tension which has been resolved through physical therapy.


    • Michelle Kenway says

      Hi Yan
      With a history of pelvic floor tension I would really be avoiding long sustained pelvic floor contractions with lunging and squatting. I really think it is difficult for many women to control (contract & relax) their pelvic floor muscles during repeated squats and lunges. I would suggest actively bracing the pelvic floor muscles for intense or weight loaded exercises. However I think that pelvic floor muscle training should provide sufficient support and strength that the pelvic floor requires during active strength exercises such as lunge and squat, especially if these exercises are done with pelvic floor safe techniques i.e. not too deep, avoiding heavy weights, narrow leg stance etc. Sometimes I hear that women actively contract their pelvic floor muscles when walking/running and in this way too I suspect that pelvic floor muscle tension may develop with exercise as the woman may then be unable to sufficienlty relax her pelvic floor one the exercise has ceased. So in summary I would discourage this with repetitive exercises in a woman with a history of pelvic floor muscle tension. Not to say that women can’t practice their pelvic floor endurance holds for longer than 10 seconds either, just ensure that the pelvic floor muscles are fully relaxed having once contracted.

      Let me know how this goes and what you think

  16. Hi Michelle,

    have bought your book and dvd. i do have a question regarding exercises. In your book you mentioned that before we do any lifting, we should ‘activate’ the pelvic floor. Im’ a little confused here. When you say activate, do u mean only to lift it and hold it up throughout the exercise and release it after we are done with the exercise? or should we lift and let go, lift and let go during the exercise itself?



    • Michelle Kenway says

      Hi Rai
      Thanks for your email – yes agreed this is a tricky issue.

      I think it is very difficult to activate and sustain pelvic floor muscle holds during many routine exercises, so let me qualify this. When lifting a heavy object, or something from below waist level height, try to activate your pelvic floor immediately before and during the lift. However with many general strength exercises, I find it is very difficult to sustain the pelvic floor activation throughout so I modify this – if the load is heavy (which it really shouldn’t be) then activate pelvic floor muscles before the lift and try to maintain that contraction. If the load is light to moderate and the exercises are repeated for example seated biceps curls, I don’t cue to activate pelvic floor muscles. The pelvic floor muscles should be voluntarily activated for that intense effort but otherwise regular pelvic floor exercises should ensure that th pelvic floor is fit and functioning well to support your chosen exercises.

      Rai let me know whether or not this clarifies this issue for you.

  17. Hi Michelle,
    While I am contemplating the chance that I may need to have prolapse surgery again, in your opinion, can a second prolapse repair surgery be as successful as the first?  I'm just hoping that I haven't ruined my only chance of feeling normal again since having  the surgery the first time.  Looking forward to hearing your response.  Erin

    • Hi Erin
      JUst wondering why do you think you may need repeat prolapse surgery? Have you had repeat prolapse medically diagnosed following your initial repair or is this because you are concerned about the exercises you have been doing?
      The success of repeat prolapse surgery depends on many factors other than the surgery alone: age, pelvic floor strength and support, heavy lifting and work demands, hormonal status and more. In general it is said that the first repair is the best however you can see that many factors come into play.
      Kind regards

      • Hi Michelle,

        The reason I feel that I may have done some damage is because all of a sudden about 3 weeks ago now, I started having trouble going to the toilet again and I can feel some pressure in my back passage. I had a rectal prolapse originally caused from trauma during childbirth (4th degree tear). I have also had a hysterectomy (leaving one ovary) about 4 years ago now. Around a year ago my vagina started prolapsing and I also have a rectocele. Wonderful stuff isn’t it? I haven’t seen my doctor yet to discuss the changes I have felt. I am booked in to see him on the 9th July (that was the earliest I could get in). Not sure yet what is going to happen and am feeling quite vulnerable. If I do end up needing repeat surgery, I would hope that my age (38) will work in my favour and the fact that I will not be doing Kinesis or anything of the sort ever again as I have been freaked out by how easily you can hurt yourself with this condition. As I said I have purchased your Strength DVD and will only be doing those exercises that are perfectly safe for my pelvic floor. I will let you know how I go with the doctor’s appointment. Thanks.

    I had a prolapse operation a year ago now and I am wondering if using 3kg
    weights for bicep curls is safe for me and isn't putting any pressure on my
    pelvic floor.  I have always enjoyed exercising throughout my life and now I
    feel scared to do anything that might risk damaging my pelvic floor.  
    During one of the classes at the gym where I have been going, the instructor
    put in the routine a bar with 5kg weights on each end and I did bicep curls
    and lat raises from the waist up for 1 minute.    I haven't 
    been squatting or lunging since the operation as my doctor told me not to.
    He also told me not to lift heavy weights.  But what do you class as a
    "heavy weight"?  I lift more than 3 kg when I'm carrying in the groceries
    from the car.  My laundry basket with wet clothes in it weighs between 7 to 9kg.
    Please put my fears to rest as I am really scared to do any
    damage as I do not want to go through having this operation again and am
    more than happy to follow whatever rules apply in doing so.
    Please help me put my fears to rest.  Thanks.

    • Hi Erin

      When it comes to safe lifting weight after prolapse surgery there is no one rule fits all. You can well imagine that a frail little elderly lady can lift much less without straining than a young fit robust woman. Many factors come into play including:
      – strength and function of the pelvic floor muscles to withstand the associated force of lifting
      – weight lifted – how heavy, how often, from what height (safe to lift from waist height than ground height) etc
      – overall strength of the individual since a stronger woman will have the capacity to lift heavier weight without straining.

      First and foremost be guided by the lifting weight set by your surgeon – he/she understands your surgery.
      Some thoughts for pelvic floor safe exercise/lifting related to your question:
      – Always avoid straining to lift anything if it causes straining then it is too heavy.
      – Try to avoid lifting anything heavy from ground height.
      – Laundry and groceries weight can be readily decreased into smaller bags/loads to reduce general pressure over time.
      – When lifting weights for the upper body, exercising one arm at a time places less pressure on the pelvic floor than a combined weight using both arms and can allow for slightly heavier lifting.
      -Always perform upper body weights in sitting (ball or bench) and back strength exercises in antigravity or seated positions – these exercises are demonstrated see Inside Out Strength DVD.
      -Perform regular daily pelvic floor exercises to ensure long term pelvic floor support.

      Most women can perform strength exercises and minimise pressure on their pelvic floor by adhering to the pelvic floor safe strength principles outlined in this article.

      I hope this information helps you to continue your exercise with confidence and enjoyment.

      • Hi Michelle,
        Thank you so much for how much detail you give when answering other's questions.  I know I wouldn't be the only one that appreciates the time you put into making us women feel less anxious about what is happening with our bodies.  I am finding your book very valuable with very clear instruction on what to do and what not to do in my situation.    Thank you again.

      • Thanks Michelle.  This morning I purchased your Inside Out Strength DVD and intend to use this as my only strength training exercise from now on.  Perhaps some walking on my treadmill at home as well.  I am strongly considering leaving the gym where I have been going for the past 3 months so I can be in a safe place of not getting caught up in perhaps doing an exercise that I shouldn't be doing.  Not only was I doing the cycle class but also a Kinesis class which involves resistance training in a standing position from the waist up.  Although I believe I have been lifting a careful load (no more than 10kg as suggested by my specialist), I wasn't aware that I should've been sitting down whilst doing this type of training.  I also didn't realise that  the exercises that I chose to be safe ones not only had to be low impact, but also low resistance (such as using the elliptical machine with moderate to high resistance, and not standing up on the bike or using high resistance in a spin class even while sitting in the saddle). So after making myself physically sick over this, I have now accepted that it is possible that I may need to have this operation again as I am definitely now more informed about how hard I can exercise even with low impact exercise.  Someone told me once – you can only make decisions based on what you know at the time.  At least I know now that another operation will rectify my situation as my last operation proved this and I guess it will be something that I will just have to cop from the choices that I made at the time.  I have made an appointment with my specialist again which unfortunately won't be for another 8 weeks, however I will be making a huge effort in the meantime in doing my pelvic floor exercises to hopefully regain any damage that has been done.  Thanks again for your encouraging and helpful information.  I truly appreciate it.

  19. Hi Michelle,
    I've just been diagnosed with a cystocele and rectocele after the birth of my first baby 11 weeks ago. I was using kettlebells regularly before I got pregnant and wondered what your opinion was on using these with a prolapse?

    Many thanks,


  20. Hello Michelle!
    I have just been told I have some prolapse with my bladder and uterus. I like to go to the gym and exercise but I am getting mixed feed back on which exercises I should avoid doing! The gynaecologist whom I have just seen told me I can continue with all my exercises apart from lifting heavy weights. This confuses me as my research on the Internet says different. Now I don't know what is right or wrong for me. I usually do 20 – 30 minutes ab work which consists of using the medicine ball. The rest of my workout consists of using the elliptical for about 30 – 40 minutes and some weight machines for my upper body. Please can you give me your guidance and expertise if the exercises I am doing are causing more harm than good to my pelvic floor? I have always loved to work out at the gym and run but now I am worried to exercise the way I use to.
    I look forward to hearing from you!
    Thank You

    • Pelvic Floor safe exercise with a prolapse

      Hi Donna
      Yes exercise with a prolapse can be such a confusing issue for women. In short you need to be very careful about the abdominal exercises you do. The better functioning the pelvic floor is, the more women can typically do however with a prolapse it is wise to avoid intense core exercises long-term, there is no benefit for flattening the stomach and it is a mystery why this myth continues to persist in the community. I strongly suggest you read some of our articles on this topic such as abdominal exercises to avoid with prolapse.

      Yes low resistance elliptical is a nice low impact exercise and hence pelvic floor friendly for most women.

      For free information on strength exercises you will see numerous articles on pelvic floor safe strength exercises in our Prolapse Surgery category.

      This topic is quite involved and I am sorry I am unable to do it justice in a simple comment box. For a complete overview of pelvic floor safe exercise you may wish to refer to the Inside Out Program which consists of complete pelvic floor safe strength exercise DVD and the Inside Out book that teaches how to exercise safely with prolapse.

      I hope this helps you in the right direction Donna

  21. Hello,
     I'm 32 years old and I have one child (2years). And I've been recently diagnosed with both uterine and bladder prolapse. On top of already being diagosed with Diastisis Recti & Anal Fissures.  I did give natural birth to a healthy 9lb baby but I thought I shouldn't  be feeling like I'm just falling apart , it all seems confusing. I'm so glad to finally read and see that "pelvic prolapse" its more common than some think. I've ordered your book Inside Out and I'm so excited! It's been nerve racking trying to find decent info on what kind of exercises I can  do at the Gym. I can't  wait to share this website and info with my dr and friends. I definetly agree with the other replies that this info needs to be spread throughout all the health clinics and dr.s offices. Thanks sooo much!!

    • Hi Misti
      Glad to help out. Yes it can seem confusing at first knowing what is safe and what to avoid. It can be especially confronting to experience a prolapse at such a young age. Thanks so much for helping to spread the word about pelvic floor safe exercise for women and good luck on your journey!

  22. Thanks so much Michelle ; feeling a bit better now !

  23. Hi Michelle

    I have asked you a question before and have stopped high impact step aerobics, also pilates and yoga as not sure which exercises to do. Just wondered if an intense spin class ( if I didn’t stand) needing leaning forward on the seat would do any harm. It can be as hard as an aerobic class but if done sitting, would I be safe in not worsening my stage 1 cystocele. I am already doing my pelvic floor exercises but find that am gaining weight as walkinmg is not enough to burn off the calories ! Always been used to intense cardio exercise.

    Would appreciate your advice !


    • Avoiding weight gain, exercise and prolapse

      Hi Charu

      Yes I understand your concern about weight gain and I think it is wise to stop high impact aerobics with a prolapse. Weight management is particularly important for prolapse protection. Adipose tissue (fat) on the pelvic organs will weigh down the pelvic floor.

      I think cycling is a great low impact exercise for fat burning, fitness and pelvic floor safe exercise. It uses the large muscle groups of the legs which use a lot of energy. Whiles seated your pelvic floor is supported and there is no impact. Avoiding high gears will help to avoid strain and keep the pressure on the pelvic floor low. Avoiding standing in the saddle and pushing down with high gears also helps to minimise potential pressure with spin. I think the lean forward with regular cycling is not an issue for the pelvic floor in terms of potential compromise of prolapse.

      Also consider the additional benefits of resistance training with pelvic floor safe resistance exercises for strength, toning and weight management when combined with spinning cardiovascular exercises. You will read about the safe resistance exercises appropriate for you In Inside Out.

      It is a shame to cease yoga and Pilates altogether, there are wonderful benefits to be gained from both particularly if you can avoid the intense core exercises and compromising positions or poses. Reading this article on 7 Pilates exercises to avoid may also assist you.

      Good luck and let me know if you have any further questions.

      • I was just reading your reply to Charu and the part about avoiding standing up on the bike in a spin class  –  I am now confused because I asked my specialist about this and he said cycling is great and that standing up on the bike would be fine.  Please explain further whether I have been doing the right thing.

        • Hi Erin
          Standing in the saddle is a little like a leg press exercise. It places a large degree of downward force or pressure upon the pelvic floor with the associated abdominal muscle contraction. Standing in the saddle is usually performed with heavy gears so the resistance through the legs is high and the likelihood of strain increased when compared to seated cycle where the pelvic floor is supported. Cycling is a great low impact exercise for pelvic floor support and one definitely worth considering as a part of low impact exercise program with a prolapse so enjoy.

          • Hi Michelle,
            Oh No!  Now I am feeling physically sick with worry.  My main priority when I returned to exercise after my operation (vaginal/rectal prolapse repair/rectocele/part bowel removed, ovary cyst) was to only perform excerises that were safe for me.  I thought I was doing the right thing going to a spin class as my specialist told me cycling was great and that I could stand up on the bike.  I vaguely remember him saying to just take it easy though.  I think I had in my head that I was doing a safe class so as the weeks went on,  my fitness improved and the strength in my legs improved so I naturally challenged myself more.  I am a strong 38 year old who has exercised my entire life (except on and off while having children).   I have recently felt a slight pressure in my back passage and I am so scared that maybe pushing myself on the bike has ruined all the surgery that I've had – the very opposite to what I was trying to do. I have been going crazy at safely strengthening my deep core abdominals (as per your book) and doing my pelvic floor exercises 3 times a day instead of once a day.  Having maybe done the cycle class incorrectly (eg. standing up on the bike and using harder gears) for 3 months, a couple of times a week (with some weeks missing a whole week or two) is it possible I have done damage and can it be corrected?  I have felt so frustrated not being able to do SO many other exercises that I have always done in the past that when I was given the green light to do a spin class and also being allowed to stand up on the bike I was estatic.  I allowed myself to be pushed as my fitness improved and worked harder in the class as the time went on, thinking it was a safe class for me.  I am truly gutted and hoping and praying that no damage has been done at all.  I would really value your professional opinion as getting an appointment with my specialist again could take 6 – 8 weeks.  With much appreciation,  Erin

            • Hi Erin

              First of all take a big breath and try to relax. The information here is only intended as a general guide – just because you have been standing in the saddle doesn’t in any way mean you have reinjured your pelvic floor. Standing in the saddle is simply one of those exercises to be cautious with long-term, in no way is it set in stone that it will cause any woman a prolapse or prolapse recurrence. Too many other factors come into play; the level of resistance, pelvic floor strength and support, whether breath holding and straining is involved…cycling and spinning is a wonderful way for a woman with pelvic prolapse or previous prolapse surgery to get a great cardiovascular work out with pelvic floor support.

              It sounds as though you are being mindful of what you choose and what you avoid and this in itself is a key step towards the longevity of your prolapse repair. Keep up your great work Erin

  24. Hello,

    I just purchased and received the downloaded version of Inside Out. I am so excited that someone is out there addressing these problems!

    I have mild to moderate prolapse (moderate cystocele, mild rectocele) On ocassion, the cystocele has been more severe due to the lifting of my son who has cerebral palsy (I now only lift him when there is an emergency, as he weighs 85 lbs and cannot support any of his weight during transfers). I am 59 years old, generally thin (124 lbs), 5 ft. 5″ and a non-smoker. I was always quite active, but stopped exercising 2 years ago after a benign tumor was removed from my bladder. After that surgery I had a severe cystocele. I recently had a a cystocopy and now show no signs of tumors or cysts. I have not had any pelvic prolapse repair but have limited most strenuous activities. Now even a 1 mile walk in the late afternoon leaves me with a heavy-bulging feeling.

    Before my bladder surgery I did cardio and strength workouts at a local gym. After reading your book, I see how a lot of the equipment and techniques, having 2 children, lifting my son for 20 years, having a chronic cough several years ago and bladder surgery all made me destined to have prolapse problems.

    I am not totally clear about some things and I was wondering if you might help me with a few questions that I have:

    1. How long should I perform the pelvic exercises before beginning any weight/strength training? And, At what stage do I know that it is safe to start?
    2. Does an eliptical machine and a rowing maching fall in allowable equipment? Are they totally safe or is it a “use with caution” choice?
    3. Are stretching activities ok? (I am starting to have some arthritic stiffness)
    4. Will I reverse any gains if I have to lift and transfer my 85 pound son? Will this type of “dead lift” ever be safe for me to perform? How will I know safe lifting limits?
    5. One of my Dr.’s explained that the cystocele is a “hernia” that could only be fixed by surgery. With the pelvic exercises will the hernia get smaller or go away? and if it never goes away without surgery do the exercises just help support it from “falling out” so much? Please clear up this confusion.

    I am very excited to start your recommended program and look forward to your response.

    Thank You,

    • Prolapse, gym exercises and lifting

      Hi Carol

      Thanks so much for your questions regarding pelvic floor safe exercises and care of your son. I will answer each of your qns in turn.

      How long should I perform the pelvic exercises before beginning any weight/strength training? And, At what stage do I know that it is safe to start?
      This depends very much on your pelvic floor function at the outset and whether or not you have had any pelvic surgery and when. If you have had pelvic surgery such as prolapse repair or hysterectomy then wait until you have your specialist’s approval to commence general exercise. This can vary from woman to woman depending on her pre surgical fitness, type of surgery and overall recovery factors. Otherwise the exercises show in the Inside Out strength program are those suitable for most women even those with a mild to moderate prolapse as all have been modified and/or place minimal pressure on the pelvic floor. Every woman is different in relation to her pelvic floor function and this is what counts when it comes to knowing what level of intensity of general exercise can be safely progressed to. If unsure I suggest seeing a women’s health physiotherapist for a pelvic floor assessment.

      2. Does an elliptical machine and a rowing machine fall in allowable equipment? Are they totally safe or is it a “use with caution” choice?
      The rowing machine is one to use with caution – if you lean forward on the return you increase pressure within the abdomen. The key here to modify is to use low resistance, row slowly and maintain the inward curve in your spine though out. The elliptical machine is another for caution, just slow down with the arms. It is a nice low impact machine.

      3. Are stretching activities ok? (I am starting to have some arthritic stiffness)
      Like most exercises there are potential risks in some stretching exercises such as legs wide apart forwards bend and deep squatting exercises. I think generally most moderate stretching exercises are pelvic floor friendly.

      4. Will I reverse any gains if I have to lift and transfer my 85 pound son? Will this type of “dead lift” ever be safe for me to perform? How will I know safe lifting limits?
      Dead lifts are a gym exercise to avoid for your back and your pelvic floor, especially with 85pounds (38kg). Safe limits for lifting depend on your current condition. Some surgeons suggest 10kg (22 pounds) as a maximum post op.

      Carol your situation caring for your son does add to the challenge and will require that your pelvic floor is functioning to the best possible level for you, to manage this physical workload. It will also mean minimising lifting where possible, using hoists etc if required where possible and keeping yourself strong as well to minimise the pressure on your pelvic floor. Have you received education on safe lifting? Also refer to the pelvic floor lifting principles on pages 49-50 of Inside Out. I think these will help you with the lifting that you do have to do – using supported positions, exhaling with your lift and bracing your pelvic floor muscles prior to and during every lift/transfer.

      5. One of my Dr.’s explained that the cystocele is a “hernia” that could only be fixed by surgery. With the pelvic exercises will the hernia get smaller or go away? and if it never goes away without surgery do the exercises just help support it from “falling out” so much? Please clear up this confusion.
      Yes gladly. I often describe a vaginal prolapse a little like stretched plastic (I know not the best analogy but it gives you the right image). Do you know when you stretch firm plastic and it becomes slightly puckered and loses its’ form in places where stretched? This is the case with the vaginal wall with a cystocoele – the front wall vaginal tissues are stretched in this manner and similarly with the back wall (rectocoele). This allows the bladder or rectum to bulge into the vaginal wall and this is the prolapse of these organs. This means that exercise will not and cannot repair a prolapse. However what pelvic exercises do is they thicken your pelvic floor, lift your pelvic floor in your pelvis so that it sits higher, they make your pelvic floor firmer and more resistant to stretch, and also better able to withstand downward pressure.

      Pelvic exercises can thereby reduce prolapse symptoms of bulging and dragging in women with mild to moderate prolapse. In severe prolapse symptom reduction with pelvic exercises would be highly unlikely. Pelvic exercises would appear to be vital in terms of long-term protection following prolapse surgery and perhaps contribute to prevention of prolapse recurrence after surgery and prevention of prolapse worsening although to my knowledge this hasn’t yet been demonstrated in studies.

      I really hope this information assists you a little in managing your family and your health Carol
      Kindest regards

  25. Hello, I am a 41 yr old crossfitter and have developed a uterine prolapse. Crossfit is heavily strength based (I was back squatting 70kg when the prolapse occurred). In the last four months I have been managing the prolapse by avoiding the heavy strength but have been able to do most of the crossfit movements without aggravation. I see a specialist next month to discuss treatment options, and I would dearly love to be able to return to the strength element of crossfit. In your experience, is it possible for women to return to heavy strength work with any of the repair options (ie. non-surgical repair/pessary, surgical repair or hysterectomy)? It sounds stupid, but crossfit has become a way of life and I would be devastated to have to give it up. Aside from that, I am also a keen runner and am desperate to return to that also. Thanks, Lori.

    • Re heavy lifting, running and prolapse
      Hi Lori
      Thankyou, his is a tough question and I do understand what you are saying in terms of this type of exercise being a way of life for you.

      Unfortunately heavy lifting will increase the pressure on your pelvic floor, and your prolapse. It would be very unwise to return to heavy lifting exercise after prolapse repair should you go ahead with this. Having a prolapse repair increases your risk of future prolapse as it is, let alone combined with the added risk of heavy lifting. I think the jury remains out on the effect of heavy lifting with a pessary in place. The pessary if correctly fitted and suitable for your prolapse serves to hold up the prolapsed vaginal tissue. It won’t however hold up your pelvic floor where the pressure will be directed and so your pelvic floor muscles and other tissues will still be under strain, especially back squatting heavy loads.
      As far as running and prolapse the same applies. High impact exercise increases the downward force on the pelvic floor tissues. It is really wise for women with prolapse to consider low impact forms of exercise, for a really good workout I always recommend spinning/cycling with sitting in the saddle and low gears or high speed.

      I wish I could say that your previous exercise program would not affect your pelvic floor as I really support and encourage women to exercise. It sounds as though the heavy lifting may have contributed to your prolapse in the first place and I think this speaks for itself.

      Best wishes and good luck

      • Thank you Michelle, I appreciate your advice. Interestingly enough, I found your site through another site called pelvicfloorfirst, which I read about in a magazine – neither my GP nor physiotherapist (who specialises in pelvic floor problems) suggested it. I will be letting them know about it as it is a great resource.

        • Hi Lori
          Yes Pelvic Floor First is a great site for information on pelvic floor safe exercise. They have kindly published some of my material on strength training pelvic floor protection principles. Good luck Lori!

  26. I have another question. I love to dance, I clogg (like tap dancing) and country line dance. I know that might not be so good for me. Is there anything you can suggest to help prevent worsening Propapse from dancing? After having the sugery should you be able to return to dancing? I know not for several months, but I am hopeful that I will be able to dance again. Thanks,

    • Prolapse surgery and dancing

      Hi Debra
      The main thing to consider with dancing exercise is the impact associated with it. An exercise or activity is classified as high impact if both feet are off the ground at once. It is low impact if at least one foot maintains contact with the ground throughout. Pelvic floor safe exercise involves low impact exercise rather than high impact exercise to reduce pressure and loading of the pelvic floor. Most high impact exercise or dancing can be modified to low impact. In order to keep dancing a safe exercise after prolapse surgery It is wise to keep it low impact.

      • Thank you for this. I have just found out at 32 with three young kids that I have a mod prolapse and I am a dance teacher. It is healing news to hear that I can still do the things I love.
        Thank you

  27. Thank you so much for the information. I am glad I found your website.

  28. I am 61 and have been diagnosed with pelvic organ prolapse. The Dr. said my uterus, bladder and rectum are all prolapsed. He is recomending Davincie Robotic Sacrocolpexy sugery. He would also do a hysterectomy. If I have the surgery I will have it over Christmas break. I teach school. I am very apprehensive about surgery. Do you have any advice?

    • Pelvic Prolapse Surgery and Recovery
      Hi Debra
      Yes prolapse repair surgery is a daunting prospect for many women and not to be taken lightly. It is a great idea to be able to rest up and fully recover following your prolapse surgery and I think many of our readers will agree.
      We know that full healing after prolapse repair for most women takes up to 3 months, we normally call the first 6 weeks and maximum protection phase and the next 6 weeks moderate protection with respect to returning to activity and exercise. It is my feeling that far too many women are poorly educated about what to do following their surgery and often launch back into regular work/ exercise schedule with insufficient pelvic floor rehabilitation and understanding of the increased risk of recurrent prolapse having already had a prolapse repair.
      You will find that we have a library of free information you can access here regarding initial recovery from prolapse surgery and return to exercise and activity. I would suggest you see our exercise after prolapse surgery library at and our exercises after hysterectomy library at Sue Croft’s fantastic book Pelvic Floor Recovery is an excellent and comprehensive source of very practical information that would undoubtedly assist your recovery. I can highly recommend her book, she is a very skilled and experienced pelvic floor physiotherapist.
      I hope this information helps you Debra. Please do not hesitate to ask specific questions you may have.
      Regards and best of luck

  29. Hi Michelle, Thanks for the helpful website and book. I am in my late 40s, post menopausal, and have a bladder and bowel prolapse which I am trying to manage without surgery. I have a problem in that when I start on a program of pelvic floor exercises, they exacerbate my hemorrhoids which are usually OK the rest of the time. Is this avoidable? Also, if I were to lift 1 kg weights for general strength, will my strength improve if I just keep using light weights? Or do I have to progress to heavier weights, which I’m worried may cause problems with my prolapse? Are there alternatives to weights for strength training for women with prolapse? Many thanks.

    • Hi Cheryl

      Really interesting that your exercises exacerbate your hemorrhoids. Are you sure about your technique and that you are lifting your pelvic floor up rather than pushing down? What position do you do your epelvic floor exercises in, lying, siting or standing?

      Yes I agree completely, strength training is a challenge for women such as yurself. There is an enormous amount that can be done safely! The benefits are many including weight management, prevention of osteoporosis, emotional well being with all those wonderful endorphorphoins and stress release, physical strength and endurance. Yes the weight lifted for strength gains needs to be more than 1kg. Cheryl you will need to be careful about the types of exercises you choose, the positions of your exercises and your exercise technique in particular. This is not a plug for Inside Out the book, but it really outlines this in much more detail than I can write here on safe exercises for strength training for women with pelvic floor prolapse. For free information have a look at our articles such as and run through the many other articles and videos on this subject at this link This is such a big area, I hope this info helps you a little on your journey. Please let me know how you go.


      So it is possible to strengthen safely with prolapse

  30. Good morning I am a 54 year old woman and I had a rectocele repair surgery
    in January and am now going to biofeedback therapy. When I am in the
    resting stage of the therapy I am at a 5-7 and the therapist wants me 2 or
    below. So for the next 2 weeks she only wants me to be doing relaxation
    exercises. Can you suggest any for me?
    I also do a P.A.C.E. workout on my treadmill every other day where I walk
    slow for 3 minutes, run at 7 for 45 seconds, run at 5 for 2minutes and
    repeat with a final cool down walk at 3 for 3 minutes for a total of 20
    minutes. On the other days I do light weights for upper body strength. Is
    this type workout of for me to be doing?
    Thank you so much for any help you can give me.

    • Pelvic Exercises says

      Hi Peg

      Thanks for your email. In response to your qns…

      1. To overcome pelvic floor muscle tension and relax pelvic floor muscles see our information on an excellent downtraining regime . It is very
      important to be able to fully relax pelvic floor muscles before starting to strengthen them.

      2. High impact exercise such as running will increase pressure on the
      pelvic floor, treadmill is a reasonably hard surface so there is less impact walking
      briskly or cycle especially following repair especially when the risk of recurrent
      prolapse is increased.

      3. Just because weight training is light does not necessarly make it safe, some specific
      exercises definitely have the postential to increase pressure on the
      pelvic floor and these are detailed at length in Inside Out. For
      further information on safe exercise after rectocoele repair we have an
      extensive library of free prolapse surgery exercises in
      particular check out pelvic floor protection principles with strength

      Peg, I hope this information helps you with your recovery and safe
      exercises. Michelle

  31. I have been diagnosed with uterine and bladder prolapse. I have a 15 month old son who hasn’t started walking yet. I am a stay at home mother and have no help during the day while my husband works. I frequently need to lift and carry my son to take care of him properly but I am now concerned about making my prolapse worse. Can you please give me some pointers on how to lift him properly? Is there a “best way” to carry him or hold him when I must stand or walk with him? Am I likely to cause further damage to myself by caring for him?

    Also, I have frequently read to avoid “heavy” lifting but I don’t see a weight associated with the statement. What is considered “heavy”? For example, can I lift my baggage out of the airport carousel when I travel or do I need help?

    Thank you so much for your help, I am very grateful to have your website and book as a resource.


    • Pelvic Exercises says

      Hi Tamara

      Thank you so much for your for your comments. I feel for you and understand exactly
      what you are saying and yes there is just not enough information around!

      Don’t despair – there is alot you can do to help. I am going to list
      them in point form below, you are welcome to correspond with me further on
      anything you are not sure of.

      1. Get to work on your kegels…even if you have surgery down the track
      they will help to suport your pelvic floor long-term. If you are not sure can you access a
      pelvic floor physical therapist in the states?

      2. Have you spoken to your OB about a pessary? These come in a number of
      shapes and can be useful to help hold a prolapse up especially while you strengthen your pelvic floor muscles. No
      one will know it is there, pain free and you can still have sexual
      relations with your partner with most pessaries.

      3. As far as lifting goes I wouldn’t squat, well not deeply anyway and
      knees close together – rather lunge / stride stance which is a little
      tricky with your SIJ issue. Encourage your little one to climb up
      themselves as much as possible and maybe get a cheap plastic stool that
      they can climb on. Every time you lift you must brace your pelvic floor
      muscles before and during your lift to help hold everthing up as you lift.
      Also do this before every sneeze/cough/nose blow to minimise downward

      5. As far as exercise goes I don’t see that you need to stop if you exercise safely, that is of course unless your specialist has advised you otherwise. Stationary
      bike would be great you will read all the solutions to this in my book Inside Out as
      well as a safe gym program. it sounds strange but the fitter and stronger
      you are the less pressure on your pelvic floor.

      6. Get some good support knickers. They will help support the SIJ and help pelvic support. No tight waist bands
      which will cinch you in and push everything down!

      Tamara if it makes it any easier know that you are not alone and many
      other young women suffer prolapse too. Again sadly not spoken about nearly
      enough publicly. Thanks so much for sharing your experiences and concerns. Michelle

      • Thank you so much, Michelle. You have given me more information and helpful advice in one reply than I have had from multiple doctor visits and countless hours of research. I can not thank you enough! I am very eager to read your book when it arrives.