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Continuing on the topic of Pelvic Health I wanted to highlight the condition of prolapse and how exercise can be used to make positive change or a negative, if performed incorrectly and the wrong exercises used.
Pelvic organ prolapse (POP) is a common, fixable and manageable condition that can occur in both men and women, but is more commonly seen in women. In fact current statistics estimate that 75% of women will experience some degree of prolapse across their lifetime which is somewhat staggering given the lack of education and discussion around it in the fitness industry.₁ 50% of women over 50 have some degree of prolapse and 1 in 3 women who have had a baby will experience some form of incontinence. Despite these numbers being so high it is rarely talked about and many people leave it far too long before reaching out for help.₂
POP is the displacement of a pelvic organ being the bowel, bladder or uterus (Posterior wall, Anterior wall or Uterine wall). A prolapse can also be graded as a stage 1-4 with stages 1 & 2 being the most common, particularly postpartum and are reversible with conservative management. Stage 4 being a complete eversion, will typically need surgery in addition to conservative treatment pre and post surgical repair.
So what are some signs and symptoms of POP: ₁,₂
A feeling of not being able to empty the bowel or bladder fully
A heaviness or downward drag
Urinary or stress incontinence
Lower back, pelvic or abdominal pain
Lack of sexual sensation or painful intercourse
Difficulty keeping a tampon in.
Recurring urinary tract infection
And what are the causes or risk factors of POP₁,₂
Childbirth via vagina, particularly if there was a delayed 2nd stage of labour or a forceps or vacuum delivery
Too high a load to pelvic floor (PF) due to
Persistent coughing
Lifting very heavy weights
Chronic constipation with persistent straining
High load HIIT with poor PF control
Poor valsalva technique
Decreased integrity of the pelvic floor muscles which can be caused by:
Poor posture
Poor muscular function
Poor strength and control - both lift and relax technique
Pelvic neuropathy
Childbirth
Without getting too technical it is important to have a basic understanding of the anatomy of the core muscles and the pelvic floor. There are 4 muscle groups that make up what we term the ‘true core’. The Transverse abdominus (TVA), the multifidus which are lower back muscles, the pelvic floor and the diaphragm. The diagram below gives a great visual of how these four groups are placed around the core and also how they work together to support the core.₂ Specifically, the Pelvic floor complex works like a basket and is made up of four muscles. Given the way they should move and function they are sometimes referred to as the ‘pelvic diaphragm’. The three main functions of the pelvic floor are to support the pelvic organs, resist downward forces from intra abdominal pressure (IAP) and to close the sphincters. When training the core muscles it is essential that the pelvic diaphragm is activated in synergy with the true core group to ensure healthy and structurally safe contraction. Many people over activate or incorrectly recruit the core muscles which puts one of the group at risk. This is what we commonly see in clients with incontinence, POP or DRAM (Diastasis Recti) post partum - a loss of synergy between the PF and TVA.₂
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So how do we help ourselves and/ or our clients? First and foremost ensure the core musculature group is correctly engaging as well as relaxing. Train the breath and diaphragm to work with, not against the muscles and ensure we are cueing to lift heavy items or children in a functional manner with correct activation of the deep musculature! The key here is to train the true core and PF in particular, to work functionally so it automatically recruits during our daily activities. It is also important to note that incontinence and PF issues are not always due to weak muscles, but often in the way the muscles work together hence the importance of training the muscles to work in both directions - contract/ lift and relax/ drop. Real Time Ultrasound used by pelvic health specialists is the most powerful tool to ensure this is occurring.
And what do you do if you think you might have a POP? First and foremost get an assessment with a Pelvic Health Specialist. I highly recommend Pelvic Health Melbourne for a diagnosis and initial exercise program and then of course it's important to engage the assistance of a Women’s Health Exercise Physiologist or trainer to ensure you are supported and prescribed the right types of movement for you moving forward. There is plenty you can do it's just important you are guided down the right path to ensure longevity and safety of exercise.
If you have had a diagnosis but you are still not sure what you can do then again seek out a fitness professional who specializes in and understands Women’s Health. It is so important we don’t fear movement as when done the right way will help you in many ways! You should be aiming for a training program that is functional with the predominant focus being on maximising your ability to engage in your lifestyle activities. Most often it isn’t the exercise that is bad, but more so the way it is performed or the speed at which the exercise or weight lifted is progressed. Low impact cardio, jogging uphill, brisk walking, swimming and high rep, lower weight resistance training are all good places to start when returning to exercise but a qualified and experienced AEP or trainer will be able to guide you through the exercises to correct imbalances and ensure you achieve positive change as opposed to exacerbating the symptoms. Some exercises to be cautious of include high impact work, plyometrics, some core/ abdominal exercises, extended time in static standing and wide leg or staggered leg lifting postures and of course breath holding and downward pressure when performing lifts as well.
Finally, I cannot stress enough please don’t be fearful of movement! Correctly performed and supervised exercise will create positive change! Exercise with the aim to improve functionality and do it mindfully. Practice good posture both during your training and throughout your day and ensure you seek assistance to confirm you are getting the right activation and using the correct breathing technique to achieve the activation you are seeking.
If anything in this blog resonates with you please reach out and ask any questions you have.
I am in no way affiliated with Pelvic Health Melbourne, nor do I receive any compensation or reward for recommending them. I recommend them due to my own first hand experience with their treatment and having attended Professional Development on site.
References:
Continence Foundation of Australia. https://www.continence.org.au/who-it-affects/women/prolapse
Prolapse - An Exercise Approach, Esme Soan. Women’s Health Collective. https://www.thewomenshealthcollective.com/
