It’s been several weeks since you’ve delivered your baby and you’re feeling ready to try a short run. You expect that your muscles may feel weaker and joints may ache a bit, but you never imagined that you’d experience a sensation of something bulging from your pelvic floor with each step.
It’s not surprising that most postpartum women are shocked when they experience symptoms of pelvic organ prolapse. It’s a rarely discussed, yet common condition that can occur after pregnancy and delivery.
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Many postpartum women aren’t even aware that they’ve developed pelvic organ prolapse. Plus, in minor cases, the condition doesn’t always have symptoms. For others, symptoms can impact their daily life and ability to exercise.
What is Pelvic Organ Prolapse?
The pelvic floor is made up of hammock-like muscle support. When functioning correctly, the muscles and ligaments keep the pelvic organs in place. For some women, the stress of pregnancy, labor, and delivery can weaken the pelvic floor muscles and support tissues of the pelvic organs, resulting in prolapse. Pelvic organ prolapse can involve the uterus, bladder, vaginal wall, and rectum.
The symptoms of pelvic organ prolapse include incontinence (especially when laughing, coughing or sneezing), low back discomfort, painful intercourse, and a feeling of something out of place or bulging out in the pelvic floor. There may be an increase in constipation and problems with urination, such as a weak urine stream or incomplete bladder emptying. The symptoms can increase when standing or walking and may improve when lying down.
The severity of symptoms increases with the degree of prolapse, and diagnosis of the condition and degree can be determined during a pelvic exam and or additional diagnostic tests. The treatment options vary depending on the degree of prolapse. However, in most cases, you can treat it with physical therapy, exercises, and activity modification.
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Causes
- Pregnancy, especially multiple pregnancies
- Complicated vaginal delivery, or extremely long pushing phase
- Being overweight or obese
- Smoking and smoking-related cough
- Any activity that increases intra-abdominal pressure (heavy weight training, chronic cough)
- Menopausal hormonal changes and age
- A familial link—if your mom or sisters experience the condition, you may be at higher risk of developing it.
Exercises to Avoid
Don’t do any heavy lifting, deep squats, leg presses, abdominal crunches, and planks. These exercises create intra-abdominal pressure and cause the pelvic floor to bulge. Also, high-impact exercises such as running and jumping can worsen pelvic prolapse, so swap out these activities with low- or no-impact exercise. In general, avoid any exercises that cause downward pressure or strain on the pelvic floor. Additionally, never hold your breath and bear down when doing any activity.
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Exercises to Try
Low- or no-impact exercises such as those done on stationary exercise equipment, swimming, and biking may be better tolerated. Indoor cycling (stay seated and avoid heavy resistance) and low-impact exercise classes are fine as long as you don’t feel symptoms while doing the activities. In addition, light weights with high reps (avoid unsupported standing position) are usually well tolerated, but avoid holding your breath or bearing down when doing your lifts. Sahrmann abdominal exercises are a good choice for strengthening the abdominal muscles without creating excessive intra-abdominal pressure.
Start a routine of doing pelvic floor exercises (kegels) daily. These exercises are crucial for targeting the muscles of the pelvic floor and should be done consistently. If your pelvic floor muscles are weak, start with ten to 20 short contractions, building the repetitions to 25 or more. Once you’ve increased strength, add gradually increasing contraction strengths to a count of ten, and then a gradual relaxation. Both types of contractions (quick and gradual) are important for building pelvic floor strength.
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Additional Tips
- Wear a pessary to help provide support. It’s a device that is placed inside the vagina to help provide support to the cervix and uterus.
- Avoid straining during bowel elimination—include more fiber and fluids in your diet.
- Get your weight down to your ideal number.
- Consult with a physical therapist who specializes in women’s health. A physical therapist can provide treatment options and exercises that can help restore pelvic floor strength and function.
There aren’t any hard and fast rules on which activities will affect every woman with pelvic organ prolapse. Pay close attention to your level of symptoms during and after exercise, and avoid any that increase your symptoms. It’s normal to have your pelvic floor feel strange or heavy in the first weeks after delivery, and usually, that sensation will resolve once swelling diminishes.
If you continue to feel a sensation of pelvic heaviness, bladder or bowel incontinence, or a bulging ask for a referral for a physical therapist. Prompt treatment increases your chances of restoring normal pelvic floor support. The earlier you start physical therapy, the better your chances of improving this condition.
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