The term "prolapse" refers to when one or more organs in the body are displaced from their normal positions, usually downward. In the pelvis, we are referring to the bladder, uterus, or rectum. Prolapse symptoms can sometimes feel like heaviness or pressure in the pelvis, a "bulge" in the vagina, pain or discomfort with intercourse, feeling like a tampon won't stay in, or being able to see something protruding from the vaginal canal. The good news is research shows that symptoms of prolapse can significantly improve, and in many cases resolve, with conservative care. It's important to get evaluated by a physical therapist or healthcare professional to determine the best course of treatment in your individual body, but here are some general advice and tips that apply to everyone!
1. Learn what's going on in your body, what your habits are, and how to manage pressure! Prolapse, along with many pelvic issues, is often a symptom of your body mismanaging the pressure that is put through it with everyday tasks, leading to increased pressure downward through the pelvis and organs. There are so many factors that go into this and it's important to have help to figure out which are the main ones for you! The way we stand, the way we pick up our kids, the way we breathe, the way we get out of a chair, the way we work out, etc etc etc - the way we LIVE and MOVE can make a big difference in symptoms of prolapse. Find your root cause.
2. Bum Up! After a workout, at the end of the day, or anytime your symptoms seem to be aggravated, lay down with a yoga block or a few pillows under your hips (knees bent with feet flat on floor) and just relax and breathe. Let gravity help relieve some of the pressure from your pelvis.
3. Manage any constipation issues! When your pelvis is uncomfortable or when your organs feel "heavy" and low, the last thing you want to do is to have to bear down aggressively, or for a long time, to push a poo through your pelvis. This obviously increases downward pressure onto a vulnerable area. Also, being constipated tends to also lead to being bloated - an uncomfortable and tight belly will change the way your core works and will often push downward into your pelvis. Some of the many ways to manage constipation are: drink your water (half of your body weight in ounces daily - more if you workout or are nursing!), eat clean and add more fiber, move your body (especially walking and twisting stretches), use a squatty potty (or 2 yoga blocks under your feet) to get your knees up above your hips when you are on the toilet (this straightens your colon and makes a bowel movement easier), manage your stress, and take time each day to breathe deeply to stimulate your parasympathetic nervous system (see previous blog entitled "It's Vagus Baby" about the parasympathetic nervous system and the core breath). Get to know your bowels - The Bristol scale shows us what a well formed poo looks like, basically a snake. If yours is too loose or too tight and pebbly, that's a sign you have a problem that needs to be addressed! Pay attention to your gut health because it quite literally is what keeps your insides clean.
4. Don't hover when urinating! Even on a public toilet! I know I know....eeeeeeewwwww. But when you are urinating, your pelvic floor needs to be able to fully relax, otherwise your body essentially has to push the pee out, which is not good for pressure control. When you are in a squat and hovering (unless it's a deep relaxed squat like they do in some countries) your pelvic floor remains "on" because it is a part of your postural control system and you hip strength. So use a cover or wipe down that seat and sit your bum right on it and enjoy the support.
5. Re-connect to the foundation of your body and build up strength from there! In my terms, your "foundation" is your inner core - your pelvic floor, your abdominal wall (especially transversus abdominus), your spine stabilizers, and your breathing diaphragm. Your ribcage, pelvis, and hips are also involved. Your inner core can sometimes can be inhibited or lose some of its coordination and control, therefore, minimizing the ability to adapt to loads and pressure, and causing other parts of your body to kick in to get the job done. There are a variety of factors of why compensations or different engagement patterns could begin happening - pregnancy, birth, injury, surgery, and habitual posture are just a few of them. We want to get this whole system back "online" in order for it to do it's job effectively and give your other muscles a stable base to move from!
Understanding what a true and effective "kegel" is and how to practice it and integrate it into your core is an important component for prolapse. It is not only a squeeze, but a lift inside, with a full release. The ability of your pelvic floor to move through a full range of motion and to contract/lift as well as release/relax is key. This is why kegels are not always the answer - most of us are either doing them wrong or not doing it as a part of a whole system. This can actually cause more tension in the area - a tight muscle does not equal a strong muscle. Also, when you are having symptoms of prolapse or incontinence, it is easy to want to try to hold a kegel and squeeze all day. Resist this temptation! This is not functional and your pelvic floor has to be trained to be dynamic in movement in order to be effective. Finesse and control are way more important than brute strength!
6. Consider your posture! As just mentioned, posture and alignment play a big role in core control and pressure management in your body. The whole body can affect this - even the position of your toes! Everything is connected. See this blog post - "The One Thing I Teach Everyone I See" - for more information on this!
7. Consider your breathing patterns! Do you find yourself holding your breath? Do your shoulders go up and down when you take a big inhale? Does your belly and rib cage fill with air effectively? Your breathing diaphragm is a broad muscle at the base of your ribcage and is not only part of your core, but considered a driver in core control. Getting a full, 360 degree breath - like and umbrella opening and closing - allows your diaphragm to go through it's full range of motion, descending on an inhale and ascending on an exhale. This natural action causes vital chain reactions: it mobilizes the rib cage, mobilizes your abdominal organs, stimulates your parasympathetic nervous system (which helps you heal, digest, feel happy, sleep well, poop, etc), and works with your inner core and pelvic floor! Sometimes, we don't use our diaphragm to its full potential - either out of habit like shallow breathing with stress or after pregnancy or pain - or out of a physical limitation like a tight ribcage or a slouched posture. Find your full breath and make sure you don't hold your breath when you are under stress or when exercising. When you lift anything, EXHALE with EXERTION - this not only stimulates the inner core, but it creates less pressure through your pelvis.
8. Honor your menstrual cycle! At different times in our cycle, our cervix is naturally in a different position, and our uterus is naturally heavier. That might not be the time to smash your body or do high impact exercises. Learn to listen to your body and what it needs, and appreciate the cyclical nature. By backing off at certain times and choosing a different form of activity, you can often actually push harder and rock it at other times with less symptoms. Check out this blog with a lot of info on the menstrual cycle - "Your Menstrual Cycle - How to Work with It Instead of Fight Against It".
9. Meet your body where it's at! Learn your habits and be aware of your movement blind spots and movement patterns! Don't add extra impact to a faulty system. In any position and with any exercise, there is a way to do it that increases downward pressure on the pelvis, and a way to do it that minimizes downward pressure. Make sure you learn proper form and then modify to a place where your body can control and build up from there. Modifying is not a sign of weakness but a sign of good understanding and body awareness. Also, listen to your body! If you start exercising or strengthening and any symptom gets worse - STOP!! Low back pain, hip pain, pelvic pain, incontinence, heaviness, belly doming, and intercourse pain are all red flags. Go see a Pelvic PT and get evaluated! Come see me, or I can help you find someone else in your area :) There are solutions.
10. Don't let fear run you! "I'm doomed" "My organs are going to fall out of me". Yes, a diagnosis of prolapse can be terrifying, and any pelvic health issue can feel awful and vulnerable. I had a Grade I prolapse after my third birth and I absolutely freaked out even though I'm "in the know". But it's important to know that your organs are supported by ligaments, tissues, and muscles and while there may be laxity in the supporting structures or something going on where they are being pushed downward, they will not actually drop out of your body. With that being said, it's important to reverse those pressures and learn about what it going on in your body so your prolapse or pelvic pain does not worsen.
Seem like a lot? It's NOT, I promise. But it does take work. This is where I come in. Once you get into the groove and increase your awareness you will be on your way to moving differently, strengthening differently, and taking pressure out of your pelvis and off your prolapse!
I love talking about this stuff and answering questions - contact me!
Written and medically reviewed by Dr. Brenda, DPT