Help! I’ve got a pelvic organ prolapse- should I exercise or not?
What is a pelvic organ prolapse (POP)?
A POP is when one or more of the organs of the pelvis, such as the uterus, rectum or bladder, descend and cause a feeling of a bulge, pain and/or a feeling of not quite emptying your bowel or bladder fully. It happens for several reasons, but mainly due to weakness of the pelvic floor muscles or connective tissues that support the organs.
Why is it important to exercise?
Some people are discouraged from exercising due to discomfort from a prolapse or concerns about leakage. However, regular physical activity is essential for building and maintaining both muscle and bone strength, which can help reduce the risk of pelvic organ prolapse (POP) and, in many cases, aid in its management. Women going through menopause are particularly vulnerable to POP due to declining oestrogen levels. For them, exercise offers multiple benefits:
It helps preserve muscle strength, and
It supports bone density.
Additionally, staying active supports healthy weight management, which can significantly ease POP symptoms, as excess body weight can increase pressure on the pelvic floor.
But how to find the exercises that suit you?
This very much depends on what happens when you lift weights or jump, or run. The evidence for whether you should lift heavy weights or do high-impact activities is currently quite mixed. Yes, the prevalence of POP is the highest in Olympic weightlifting and power lifters (Bø, 2023), however, Forner (2020) found that physically active women lifting weights ≤15 kg were more likely to report symptoms of pelvic organ prolapse than women lifting weights greater than 50 kg.
Any clearer? Probably not!
That is why each person with a POP should be treated as an individual and their goals listened to. When I assess someone who wants to lift weights, I will assess them in standing to see what happens to the prolapse when they lift a variety of weights, look at how they are lifting and whether they are holding their breath or not.
If someone wants to run, I will focus on the capabilities of the pelvic floor, but also look at the muscle strength of their legs, balance, and how they feel under load and impact.
Some of my patients like to join my clinical Pilates sessions that I run weekly. Pilates is a pelvic floor safe way of exercising, as the intra-abdominal pressure changes (the pressure builds up within the abdomen and pelvis on movement) in Pilates exercises are the same as when someone moves from sitting to standing (Coleman, 2015), thus supporting the body in day-to-day movements.
Additionally, in 2017, Hagen found that Pilates-based exercises that incorporate pelvic floor contractions led to a small, but probably important, reduction in prolapse symptoms.
Even though Pilates is considered safe for those experiencing pelvic organ prolapse, I would still recommend an assessment first with a pelvic health physiotherapist. This would then allow for tailored guidance to be offered in class, to avoid straining, breath holding and ensuring that a person knows how to do a pelvic floor muscle contraction.
I offer a variety of classes from beginner and intermediate classes, in-person or ,online plus my balance, strength and mobility Pilates class that is chair and standing-based. Please contact me if you would like more information on any of these.
Bø, K., Anglès-Acedo, S., Batra, A. et al. Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review. Int Urogynecol J 34, 1153–1164 (2023). https://doi.org/10.1007/s00192-023-05450-3
Coleman, T.J., Nygaard, I.E., Holder, D.N. et al. Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. Int Urogynecol J 26, 1123–1130 (2015). https://doi.org/10.1007/s00192-015-2638-4
Forner, L.B., Beckman, E.M. & Smith, M.D. Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. Int Urogynecol J 31, 1551–1558 (2020). https://doi.org/10.1007/s00192-019-04163-w
Hagen,S et al Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. The Lancet, Volume 389, Issue 1l0067, 393 – 402 (2017)