Pelvic floor muscle training is where it's at
I spent a lot of time last article talking about the importance of managing intra-abdominal pressure (IAP). Prolapse is truly more of a top-down issue than a bottom-up one! But after you are better at managing your IAP and not holding your breath, then the first-line intervention always recommended in the literature is pelvic floor muscle training.
Notice I keep saying "pelvic floor muscle training," NOT just Kegels. There isn't anything wrong with Kegels, but hopefully as a MommaStrong member you know that working your pelvic floor goes well beyond just Kegels! We want the pelvic floor to be dynamic and responsive like a trampoline, not hard and stiff like concrete. So working on both strengthening AND relaxing the pelvic floor, longer holds AND quicker flicks, applying pelvic floor muscle activation to exercise AND daily tasks, etc. is all important!
Here's some of the benefits of pelvic floor muscle training when you have a prolapse:
Improvement prolapse symptoms (pressure, heaviness, etc) especially in those with mild to moderate prolapse
In prolapse grades 1-3, reduction of the grade of the prolapse
Reduction of the long-term risk of hospital-based treatment for prolapse (i.e. surgery)
How much pelvic floor muscle training is enough?
This is the million-dollar question, right? Fortunately for prolapse in particular, we do have some decent evidence on how long it takes to see changes with pelvic floor muscle training.
2 weeks is enough to start to notice a change in symptoms
6 weeks will show more marked improvement in symptoms
16 weeks may be needed to show improved pelvic floor muscle bulk
6 months may be required before a change in the grade of prolapse is seen
After 6 months, frequency of exercise can be decreased to maintain strength gains, or you can just incorporate the pelvic floor into other exercises
Are there specific recommendations for pelvic floor muscle training?
In a word (or two :), not really. There isn't enough evidence to say how many sets and repetitions of pelvic floor exercises you need to do. But there are some general guidelines to follow, like:
Work on your pelvic floor in multiple positions: laying, sitting, standing, squatting, etc
Choose at least 2-5 days/week to focus on pelvic floor exercises
Do this for at least 16 weeks
And then, don't forget about your core as well! Core stabilization, when added to a regimen including pelvic floor muscle training, can also improve prolapse symptoms. So this basically means, don't forget to incorporate abdominals, multifidus (lower back muscles), breathing, etc. while also working on your pelvic floor! This is basically everything we already do at MommaStrong :)
What about different positions just to get some relief from the prolapse symptoms?
Many people with prolapse will find that laying in a position with the pelvis elevated, or even doing exercises in this position, is really helpful. Basically by elevating the pelvis you are using gravity to help reduce your organs back towards their original position. And then, with the organs not putting so much pressure on your pelvic floor, you will have an easier time activating your pelvic floor too! So some of these positions can include:
Laying on your back with your bottom elevated on pillows or a wedge (basically a supported bridge)
Bridges
Laying down with legs propped on a chair or up the wall (this doesn't technically elevate your pelvis, but can relieve some pressure on the pelvic floor)
So what should I NOT do if I have prolapse?
As with almost all questions similar to this (such as: what exercises are bad for DR?), it's more about HOW you are doing the exercise vs. WHAT you are doing. And of course, it depends. It depends upon the grade of prolapse, it depends upon how much control you have of your pelvic floor (or not), it depends upon how bad your symptoms are, etc.
If prolapse is a new diagnosis for you, we do recommend you avoid impact exercises until you have good control of your pelvic floor, and you know that impact won't exacerbate your symptoms. But once your pelvic floor is strong and still responsive, you have your breathing and abdominals coordinated well with all exercises across all positions, and your symptoms are minimal—you can go back to doing just about anything you want! People have even successfully gone back to higher-level weight lifting, running marathons, etc. with prolapse. The key is managing that intra-abdominal pressure that I talked about last week, and keeping up your pelvic floor strength. Once you have a handle on your IAP and your pelvic floor is working well, the world is your oyster.
Sometimes in order to return to higher-level activities, you may need a little extra help for your prolapse, such as wearing a pessary. It can be inserted for exercise and then removed when you are finished (if you choose not to wear it all of the time). And pessaries are exactly the topic we cover in the next article! So definitely check that one out.
References:
Fenocchi, L., Best, C., Mason, H., Elders, A., Hagen, S., & Maxwell, M. (2023). Long-term effects and costs of pelvic floor muscle training for prolapse: trial follow-up record-linkage study. International urogynecology journal, 34(1), 239–246. https://doi.org/10.1007/s00192-022-05272-9
Kashyap, R., Jain, V., & Singh, A. (2013). Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapse. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 121(1), 69–73. https://doi.org/10.1016/j.ijgo.2012.11.012
Özengin, N., Ün Yıldırım, N., & Duran, B. (2015). A comparison between stabilization exercises and pelvic floor muscle training in women with pelvic organ prolapse. Turkish journal of obstetrics and gynecology, 12(1), 11–17. https://doi.org/10.4274/tjod.74317
Wang, T., Wen, Z., & Li, M. (2022). The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis. International urogynecology journal, 33(7), 1789–1801. https://doi.org/10.1007/s00192-022-05139-z
Photo by: https://pxhere.com/en/photo/634799?utm_content=shareClip&utm_medium=referral&utm_source=pxhere