What exercises can I do if have a prolapse?
What exercises can I do if have a prolapse?
“I have a rectocele which mostly makes it difficult for me to empty my bowels. It sometimes also bothers me while standing or walking and it makes me apprehensive about working out. What should I do? Can I work out with a prolapse?”Reader’s question
Rectocele is the term for when the rectum bulges toward the back vaginal wall due to a weakening of the structures in the wall between the rectum and the vagina. I have written more on rectoceles here (Swedish post).
Symptoms of a rectocele may involve feeling a heaviness in the vagina or having difficulty emptying your bowels completely. Defecation can be uncomfortable or even painful. In this post I will offer advice on what to keep in mind regarding physical exercise when having a rectocele.
A rectocele can be caused by giving birth vaginally, especially if the birth was very quick or if the baby was big. There are however also those who develop a rectocele without having ever given birth. Age, menopause and a decrease in estrogen levels can also make tissues less elastic and thereby increase the risk of developing a prolapse. Chronic constipation, chronic cough and being overweight are also factors which increase the risk.
When diagnosed with a prolapse, most receive advice to start doing pelvic floor exercises (“kegels”). This advice is based on the fact that a strong pelvic floor has the potential to better support and lift the pelvic organ that is bulging down. Pelvic floor exercises have been shown to reduce symptoms of prolapse, but cannot “fix” or “heal” a prolapse. During the months following a birth a prolapse can “heal” on its and doing pelvic floor exercises can help speed up that recovery. It is also important to try to keep your stool soft and avoid straining while sitting on the toilet. Straining to poop or pee puts a lot of pressure and a high load on your tissues in and around your pelvic floor.
- Read more about bulging, lax vaginal walls and prolapse here (English post).
- Read my advice on pooping here (Swedish post)
- Read my advice on dietary fibre intake here (Swedish post)
If you have a rectocele you should avoid long periods of constipation and long periods of coughing. If you smoke, quitting may be important in order to avoid having recurrent coughs. If you are overweight, weight loss may decrease your current symptoms and will reduce the risk of your prolapse worsening over time since excess weight means an excess strain on your pelvic floor.
If the advice above proves insufficient, there are surgical treatment options which aim to reinforce the tissues which separate the vagina and rectum.
WHAT EXERCISES SHOULD I DO?
Pelvic floor exercises (also known as “pelvic floor contractions” and “kegels”) aim to improve the strength in your pelvic floor muscles, so as to provide better support to your vagina and rectum. This is why pelvic floor exercises are recommended. Physical exercise which targets the rest of your body is also beneficial, see links below.
IN WHAT WAY WILL PELVIC FLOOR EXERCISES HELP ME?
When you do pelvic floor exercises your pelvic floor muscles will grow stronger and thicker and will be able to better support your pelvic and abdominal organs. When properly executed they may result in a reduction of symptoms and better control of your bladder and bowels. Those with milder symptoms might expect better results from pelvic floor exercises alone than those with severe symptoms. Still, even in the case of a rectocele in need of surgical treatment, having a strong pelvic floor will improve chances of recovering well after surgery.
Consequently it is wise to do pelvic floor exercises prior to surgery. However, prolapse is sometimes the result of damage to the pelvic floor muscles sustained during childbirth. In this case, doing your pelvic floor exercises won’t be enough to strengthen your muscles, since they can’t function properly. When some muscles of the pelvic floor aren’t intact and can’t contract properly, doing pelvic floor muscles may even give rise to muscular imbalances as the muscles which are still intact might become overworked and hypertonic. This can cause pain and is counterproductive. If you are uncertain as to whether you might have such muscular imbalances you ought to see a pelvic floor physiotherapist who can give you individually based advice regarding pelvic floor training.
Read more: “Relaxation of the pelvic floor”
CAN I MAKE MY PROLAPSE GO AWAY BY DOING ANY KIND OF EXERCISE?
Unfortunately, neither working out nor doing pelvic floor exercises will make the vaginal walls or surrounding fascia or ligaments stronger or firmer. Physical exercise which is properly executed, dosed and modified may however contribute to a reduction or complete withdrawal of symptoms.
HOW TO DO PELVIC FLOOR CONTRACTIONS (“KEGELS”)
First, try to contract your anus as if you were holding a fart. Second, contract you pelvic floor muscles as if holding wee. Third and last, try to lift the entire pelvic floor up and inward. Hold. Then let go, relax and rest a little before starting over.
Initially it may feel like nothing whatsoever happens when you try to contract your pelvic floor. Don’t give up, keep at it. After one to two weeks of regular training (or regular attempts) the connection and communication between your muscles and your brain should have developed enough for you to now be able to feel your muscles contract when you tell them to do so.
Prognostics and workout advice for prolapse (Swedish post)
Reducing prolapse symptoms (Swedish post)
HOW MUCH AND HOW OFTEN SHOULD I EXERCISE MY PELVIC FLOOR?
Recommendations vary. Thirty pelvic floor contractions three times a day (e.g. once in the morning, once at noon and once in the afternoon) seems to be the most common general advice. You can alter the execution of the contractions. Quick contractions, long contractions, or contracting with maximal force.
You need to train daily for three months before you can evaluate whether your pelvic floor has become stronger or if you notice an improvement in symptoms.
WHAT IF I DO THEM WRONG?
A common mistake is to push out rather than to lift up. Another is to hold your breath while contracting your pelvic floor muscles. Try to breathe normally! Many also tend to contract their glutes and thighs in the attempt to contract their pelvic floor muscles. Relax your butt and thighs! You can read more about common mistakes here. (Swedish post)
WHAT ABOUT WORKING OUT AND OTHER PHYSICAL ACTIVITIES?
The general advice is that adults should at least do 150 minutes of moderate intensity physical activity a week. This is equivalent to 30 minutes brisk walking at least five days a week. If 30 minutes is too long, you can do it in three bouts of 10 minutes, or two bouts of 15 minutes. It is the total time spent on physical activity that counts. Shock absorbing footwear and walking on flat terrain may help.
Most tolerate vigorous intensity activity well, as long as it isn’t too much of a high-impact exercise. The more high-impact, the higher the demand on your pelvic floor. Using an exercise bike or a crosstrainer may help reaching vigorous activity while not demanding maximum effort from your pelvic floor. Other examples of suitable exercises are swimming, aqua jogging and water aerobics. Preferably, dance and group workout classes should not involve jumping.
Experiencing heaviness or discomfort or pain can be a warning signal indicating that the current exercise level is too challenging for your pelvic floor. If you experience any such symptoms after a workout, try reducing the time spent exercising on that level or check your form. Read more about having symptoms during or after physical activity here: Do workouts always have to be asymptomatic? (Swedish post)
PROLAPSE AND WORKING OUT
If you have a prolapse you should avoid workouts which increase your symptoms over time. Prolapse symptoms tend to decrease during the first year postpartum. Physiotherapists usually refer to two principles when it comes to modifying workouts if our client is experiencing symptoms from their pelvic floor. These principles are “Tension to task” and “Spread the load”. Basically this means having a pelvic floor strong enough for the activity in question and to not contract your core muscles more than absolutely necessary. You should only recruit your core muscles just enough to be able to execute the exercise.
HERE ARE SOME MORE POSTS ON PELVIC FLOOR SAFE EXERCISE
Pelvic floor safe squats? (Swedish post)
Pelvic floor safe workouts (Swedish post)
How do I care for my bulging vaginal walls postpartum? (English post)
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