What is Pelvic Organ Prolapse and What Does It Mean For Exercise?
What is Pelvic Organ Prolapse (POP)?
Pelvic organ prolapse (POP) is a condition that occurs when the muscles and tissues that support the pelvic organs become dysfunctional and are either:
Weaken
Become damaged (from pelvic trauma, birth, surgery)
Have abnormal pressure or tension but onto them from surrounding musculature and intraabdominal space
causing one or more of the pelvic organs to descend or bulge into the vaginal canal or even protrude outside the body. The pelvic organs that can be affected by POP include the:
Bladder: This can lead to a condition called cystocele, where the bladder drops into the front wall of the vagina.
Uterus: This can result in uterine prolapse, where the uterus descends into the vaginal canal.
Rectum: Rectocele is a condition where the rectum bulges into the back wall of the vagina
Small intestine: In rare cases, the small intestine may prolapse into the vaginal canal.
The severity or grade of pelvic organ prolapse can vary. Some individuals may experience mild symptoms or discomfort, while others may have more pronounced symptoms that interfere with daily activities and quality of life.
Grades of POP
POP is diagnosed by grades 0-4 and determined by the pelvic organ’s position within the vaginal canal.
A VERY IMPORTANT POINT TO NOTE IS THAT THE GRADE OF PELVIC ORGAN PROLAPSE DOES NOT ALWAYS CORRELATE TO THE SEVERITY OF SYMPTOMS OR TO HOW BOTHERSOME A PERSON PERCEIVES THEIR PROLAPSE AS.
Common Symptoms of POP:
A feeling of pressure or fullness in the pelvic area or vagina
A sensation of something bulging or protruding from the vagina
A sensation of a tampon that is ‘half in, half out’
Pelvic pain or discomfort
Urinary problems, such as urinary incontinence or frequent urination
Bowel issues, such as constipation or difficulty with bowel movements
Sexual dysfunction (low libido, difficulty with arousal, pain with sex and/or penetration)
Problems with inserting a menstrual cup/disc or tampon
The causes of pelvic organ prolapse can include factors such as childbirth, pregnancy, obesity, chronic coughing, and aging, all of which can weaken the pelvic floor muscles and supporting tissues.
Pelvic Floor Treatment Options for POP:
Biofeedback training
Pelvic floor muscle cooordination
Posture changes
Pressure management techniques
Positioning for exercise and movement
Lifestyle changes
The use of pessaries (devices inserted into the vagina to provide support)
It's important to consult a healthcare provider if you suspect you have pelvic organ prolapse, as they can assess the severity of your condition and recommend appropriate treatment options based on your individual circumstances.
Important POP Points
POP symptoms can be transient - they can worsen with prolonged standing; increased stress; increased muscle tension in low back, hips and core; our menstrual cycle; constipation or changes in bowel habits; a full bladder; and more!
Just because you have a grade 2 POP at the end of the workday, doesn’t mean it is always a grade 2 - you could start off with a grade 0 and end up with a grade 2 end of day from poor pressure management strategies, pelvic floor fatigue, prolonged standing or sitting, etc.
Grade 0-3 POP does not require surgery, gold standard for POP management is conservative care (AKA pelvic floor physiotherapy and exercise rehab)
There are many different pessary options for POP management
Pessaries aren’t just for the geriatric population - many individuals use pessaries are a management tool during exercise only during the rehab period
Strength training is an absolutely incredible way to manage POP symptoms and strengthen our core and pelvic floor muscles to prevent or reverse POP completely
We monitor exercise with POP by symptoms and not the grade of POP. I consider it a success if a woman has 0% bothersome or heaviness reported, even if they have some degree of POP remaining.
You DO NOT have to wait until you’re “done having children” before addressing your POP symptoms. Address them immediately to change your strategies and experience relief sooner!
POP may be linked with risk factors including: genetics, prolonged pushing during vaginal birth, use of forceps or a vacuum with vaginal birth, obesity, chronic cough, job or lifestyle involving repetitive heavy lifting, use of Valsava breathing with exercise
You CAN have sex and penetration with POP - the organs simply move back up inside of you and it is not damaging or going to worsen your POP grade. Sex may be painful with POP depending on the pelvic floor muscle behaviour, tension and sensitivity and this should definitely be addressed with your pelvic floor physiotherapist.
You CAN lift > 10lbs with POP, your lifestyle and daily activities demand it of you and so should your exercise! Work with a perinatal fitness professional and pelvic floor physiotherapist to help you find comfortable and effective ways to lift heavy things! It can actually be a great way to rehab your POP.
POP Stats
50% of all women will have some degree of POP after giving birth (Hagen & Stark, 2011)
50% of women who have surgery for POP will experience a recurrence (Whiteside et all., 2004)
30% of those who have surgery will have a second surgery within 2 years (Salvatore et al., 2010)
Pelvic floor physiotherapy is effective at reducing POP symptoms and should be the first line of defense for individuals with urinary incontinence and POP (Bo & Hilde, 20130; Dumoulin & Hay-Smith, 2010).
Can I Exercise with POP?
Short answer is, yes you should!
Exercise can be a beneficial part of managing pelvic organ prolapse (POP), but it needs to be tailored to the individual's specific condition. The type and intensity of exercises should be determined by an individual’s goals and fitness interests, after assessment by a pelvic floor physiotherapist, in alignment with their level of comfort and confidence.
Exercise Program Assessment
Before an exercise program is begun, an individual with POP should consult with a pelvic floor physiotherapist or perinatal fitness coach.
This appointment should include:
Subjective history of prolapse signs and symptoms
Aggravating movements or triggers
Easing movements or positions
Education on pelvic floor anatomy and contributing factors
Assessment of posture and diaphragm involvement
Assessment of breathing techniques with lifting, exertion, bending, exercise of choice
Assessment of core strategy and core function
Strength testing of superficial core muscles and deep core muscles
Assessment of pelvic floor muscle tone, coordination, strength, endurance
Assessment of pelvic organs position and behaviour with Valsalva (bearing down), in standing
Tension in hips, low back and core muscles and contribution to tension and pressure in pelvic floor
Early Exercise Program
Early intervention for return to exercise with POP should include:
Involving breathing strategies to reduce pressure on intra-abdominal space and on pelvic floor
Posture strategies to allow individual to connect with their breathing, core and pelvic floor muscles
Position cues for exercise and daily movements
Discussion of individual’s readiness for exercise and tolerance of symptoms
Discussion of symptoms to look out for - symptoms and level of bothersome will be the navigating factors in progressing exercise with POP, not the actual grade of prolapse
Deep core and pelvic floor engagement exercises done with breathing to learn how to coordinate use of diaphragm, core and pelvic floor
Hip mobility and strengthening to restore normal muscle tension in lumbopelvic region
Exercise Ideas For the Early Stage:
Pilates
Low load strength circuit work, incorporating the full body as to not fully exhaust the pelvis
Yoga
Unilateral body training (single side training to address balance and symmetry throughout body, also challenges the core and pelvic floor)
Important note: during this stage we are monitoring level of discomfort or heaviness during and after exercise to dictate our progressions
Always try different ways to achieve a movement - change the position, the speed, the load, the direction of the movement before scrapping it
Exercise Ideas For Ongoing Athletes:
Strength training with heavier loads (incorporate longer rest periods in between to help manage symptoms if needed)
More body region dominant strength training (e.g. can return to training ‘Leg Day’ as opposed to Full Body workouts) due to increased pelvic floor muscle endurance
Layer in intensity, power, speed, impact
Return to running, plyometric training, HIIT, sports
Regularly check in on POP symptoms and if they return, scale back one of the following: intensity, work:rest periods, load/weights, speed, volume of exercise
Reflect on where you are with lifestyle factors in regarding to progressing exercise: menstrual cycle (if applicable), stress, constipation, muscle tension in hips and low back, diet and nutrition
Lifestyle Factors
Manage stress - we physically manifest stress in pelvic floor muscle tension and this will affect the muscles’ performance
Manage constipation - extra load in the pelvic bowl will increase POP symptoms
Manage hip and low back and core muscle tension - extra muscle tension from above will change the pressure in the intra-abdominal space and affect POP symptoms
Next Steps
If you suspect you have POP or have been diagnosed with POP, please seek out a pelvic floor physiotherapist and/or perinatal fitness coach who is well-versed in working with individuals with POP.
The information provided here is not intended as medical advice. It is for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.
