Pelvic Organ Prolapse (POP) is common, and can affect women young or old, most commonly post-natally. Almost one in five Australian women will need surgery for prolapse during their lifetime.

There are 5 types of pelvic organ prolapse: rectocele (large bowel), cystyocele (bladder), enterocele (intestines), vaginal vault (occurs after a hysterectomy), and uterine (uterus). There are also various stages of prolapse (stage I to stage 5, which usually requires surgical intervention). Whether you are a candidature for surgery, or during rehabilitation from surgery, exercise has an important role in reconnecting and strengthening your pelvic floor muscles and strengthening the musculature surrounding them.

Each of these 5 types of POP has its own symptoms, but in general symptoms can include:

• Pressure, pain, or fullness in vagina, rectum, or both.
• Feeling  a downward dragging or like your “insides are falling out”
• Urinary incontinence, stress incontinence
• Constipation
•  Lower Back, pelvic or abdominal pain
• Lack of sexual sensation or painful intercourse
• Can’t keep a tampon in

Women can be hesitant to openly discuss these symptoms with family, friends, personal trainers or GP’s, but prolapse is very important to identify, and modify exercise to be performed safely. If you think you may have prolapse, first seek guidance from your GP.

WHY IS EXERCISE IMPORTANT?

Exercise is important for your general health and fitness, and especially important for maintaining bone mineral density and mobility moving towards menopause. Specific exercise for prolapse can greatly improve and manage symptoms, however certain exercises are contraindicated for prolapse – and can make things worse.

An Accredited Exercise Physiologist can help create an individualised exercise program for you, that is pelvic floor safe and may improve your symptoms.  AEPs can check you for diastasis recti, program safe individualised exercises and work alongside other allied health professionals including Women’s Health Physiotherapists, Psychologists and obstetricians/gynecologists. Working with an AEP can help transition you back to a full gym program safely and appropriately, to help you return to sport and reach your personal fitness goals.

WHAT TYPE OF EXERCISE IS BEST?

20 to 30 minutes of aerobic exercise three to five times a week (walking, cycling, swimming etc). Aerobic exercise helps your cardiovascular system, muscles, tendons and ligaments to stay strong and will also help you maintain to the correct weight (BMI) for your height and age.

Resistance training two to three times a week. Resistance training is fantastic for increasing your muscular strength, and integrating your core into more functional tasks. Strengthening your glute muscles, hamstrings, adductors, lower back and abdominals can all help in gaining and maintaining pelvic floor strength. Exercises such as squats, lunges, or seated dumbbell exercises can achieve this. Keep rep ranges high (12-15) and dumbbell weights lower to begin.

Pelvic Floor exercises (also known as ‘kegals’) also have their place to help improve motor control of pelvic floor, however a program of kegals alone will not improve your symptoms or your pelvic floor weakness.

An Accredited Exercise Physiologist (who works in Women’s Health) can provide you with a program tailored to your own level of fitness, and assist you to correctly activate your pelvic floor through cueing, posture and good exercise technique.

THINGS TO CONSIDER?

• Lighten your weights or resistance so that you don’t feel pressure down on your pelvic floor as you move – no heavy lifting with a valsalvar manuover
• Avoid holding your breath by exhaling with effort (e.g. when you pull, push, lift or lower weights) using your ‘core’ breath (see Pelvic Floor exercises)
• Maintain good posture
• Reduce the depth of your squats and lunges – aim to keep your hips at a higher level than your knees
• Avoid all abdominal exercises (e.g. sit ups, curl ups, crunches, double leg lifts, and some Pilates moves) and instead chose abdominal exercises that resistance lateral and frontal flexion (eg. Pallof press, side planks)
• Choose supported positions (eg seated machines or sitting on a fit ball to use hand weights)
• Keep your legs closer together during exercise, no wide legged squats or squat jumps
• Lift your pelvic floor before you move and relax afterwards. Notice how many reps that you can do before your pelvic floor muscles tire
• You may need to add some rests, or reduce the number of reps that you do in a row, while your pelvic floor muscle fitness improves.

Expert advice provided by Accredited Exercise Physioloigst Esme Soan.

References:
http://www.continence.org.au
http://www.pelvicfloorfirst.org.au