6 Top Tips For Exercising With Prolapse

Expert Spotlight by Katy Megson, Specialist Pelvic Health Physiotherapist – @katymegsphysio

Up to 31% of women are affected by symptoms of pelvic organ prolapse (Bo et al., 2023). The most common symptoms include the awareness of a vaginal bulge, vaginal heaviness and the sensation of dragging or ‘something coming down’ in the vagina. Activities such as heavy weightlifting and high impact have been identified as potential risk factors for prolapse alongside parity and vaginal birth with pelvic floor injury. However, a recent survey reported that there was no significant association between exercise and symptoms of prolapse in women who exercised recreationally. Understandably though many women with prolapse feel they need to stop exercising altogether or modify what they do in fear of worsening their symptoms or due to discomfort. 

There are so many benefits of regular exercise for both overall health and wellbeing and so managing lifestyle factors and exercise play a huge role in the conservative treatment of prolapse. Here are my top 6 tips on how to continue to stay physically active!

There’s a lot more to pelvic health physio than just doing kegels! A pelvic health physiotherapist specialises in symptoms of pelvic floor dysfunction and will thoroughly assess your pelvic floor, breathing patterns, posture and abdominal wall and movement in relation to your prolapse symptoms. Having an increased awareness of lifestyle and conservative treatment options and an individually tailored pelvic floor rehab and exercise plan can lead to significant improvements in symptoms and increased confidence and enjoyment with exercise. Pelvic health physiotherapists work alongside exercise professionals to help you understand when to cue and relax your pelvic floor with certain movements and activities to enable you to exercise effectively without feeling symptomatic. 

1. See a Pelvic Health Physiotherapist

There’s a lot more to pelvic health physio than just doing kegels! A pelvic health physiotherapist specialises in symptoms of pelvic floor dysfunction and will thoroughly assess your pelvic floor, breathing patterns, posture and abdominal wall and movement in relation to your prolapse symptoms. Having an increased awareness of lifestyle and conservative treatment options and an individually tailored pelvic floor rehab and exercise plan can lead to significant improvements in symptoms and increased confidence and enjoyment with exercise. Pelvic health physiotherapists work alongside exercise professionals to help you understand when to cue and relax your pelvic floor with certain movements and activities to enable you to exercise effectively without feeling symptomatic.

2. Breathe and let go!

Your diaphragm, abdominal wall and pelvic floor work together as a team and form our ‘core cylinder’. As we breathe in our pelvic floor naturally relaxes and as we breathe out our pelvic floor naturally becomes more active. Women with symptoms of prolapse often tend to grip or hold onto their abdominals and/ or pelvic floor and breathe more shallowly. In actual fact, this can worsen feelings of vaginal pressure and heaviness. Instead, focus on breathing well using the bottom and back of the lungs and letting go of any tension in the abdomen or pelvic floor, this will allow your pelvic floor to move more flexibly and manage load.

3. Manage intra-abdominal pressure 

The key to exercising with prolapse is in learning to manage intra-abdominal pressure, this means initially experimenting with load, intensity, breathing and posture to find the ‘sub-threat’ level which is totally asymptomatic for your pelvic floor. Once you’ve set this foundation, you  can gradually increase the load or intensity as your pelvic floor and symptoms allow! This may start in lying or side lying before you can progress into all fours, kneeling and then hopefully standing. You might also want to consider how exercising at different times of the day may impact your symptoms. 

4. Learn how to reset your pelvic floor

Whilst we want to keep exercise within the ‘asymptomatic range’, you may still experience heaviness at times. Pelvic floor positions of ease are great for resetting your pelvic floor and reducing your prolapse if you notice heaviness or dragging after a certain exercise or prolonged period on your feet. Lie on your back with a small cushion underneath your pelvis and your legs up against a wall or back of a sofa. Place your hands on your lower abdomen and practice some deep breathing. Hold this position for 5-10 mins until you feel relief.

5. Gradually build up to impact 

Once you’ve learnt how to manage load and intra-abdominal pressure well, you can start to experiment with impact. As always, we want to stay with the ‘asymptomatic zone’ for your pelvic floor so initially this might look like elevated mountain climbers before progressing to single leg hops, jumps and then eventually running. Working with a Physio or trainer can help you to feel supported through these progressions when the time is right.

6. Consider a pessary

Vaginal support pessaries are silicone or plastic devices which are inserted inside the vagina to provide increased vaginal wall support and reduce prolapse. Pessaries are a great way of increasing vaginal support to enable you to perform at a higher intensity without becoming symptomatic They can either be used temporarily e.g. inserted before a run or gym session and then removed afterwards or used more consistently for every day support. 

There are many different shapes and sizes of pessary and the type of pessary used is based on your type of prolapse and anatomy. Initial pessary fitting is ‘trial and error’ but once fitted correctly you should have good symptom relief!  Chat to your gynecologist, pelvic health physiotherapist or specialist nurse who is trained in pessary fittings for more information on how a pessary could support you. 

I hope that these tips will enable you to feel confident in managing your prolapse whilst continuing to stay strong and active and most of all enjoy the movement you choose!

With love,

R & K x

NEXT STEPS: Dealing with prolapse and need support on your journey but don’t know where to start. My signature 1-2-1 programme Strong, Free & UPLifted is designed to get you a strong, powerful, purposeful body whilst combatting prolapse symptoms.

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