Exercising with Bladder and Uterine Prolapse

Exercising for Bladder and Uterine Prolapse

As a new mum, postpartum recovery can come with unexpected challenges, and for some, pelvic organ prolapse might be one of them. It’s understandable to feel frustrated, especially if it affects your quality of life and limits your ability to stay active. However, prolapse is very treatable. With specific and tailored exercises as well as proper guidance, you can improve your overall wellbeing and regain confidence and control of your body.

This guide will cover safe and gentle exercises for individuals recently diagnosed with prolapse, activities to avoid in the early stages of treatment, and other preventive measures to help reduce discomfort and improve pelvic health.

What is a Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when one or more of the pelvic organs (such as the uterus, bladder, or rectum) descend or shift out of their normal position due to weakened or damaged pelvic floor muscles. These muscles act as a support structure, holding the organs in place. When the pelvic floor is compromised, the organs may shift downward, leading to prolapse or sagging.

Prolapse can be categorised into different types depending on what organs are affected:

• Cystocele: bladder sagging into the vagina
• Urethrocele: urethra pushing into the vaginal canal or urethral opening
• Uterine prolapse: uterus falling down into the vagina
• Vaginal prolapse: top of the vagina (vaginal vault) dropping down into the vaginal canal
• Enterocele (small bowel prolapse): small intestine dropping into the vagina
• Rectocele: bulging of the rectum’s front wall into the back wall of the vagina

Generally, pelvic organ prolapse can be caused by these conditions:

• Pregnancy and childbirth, especially multiple vaginal deliveries or carrying a foetus with a weight that’s larger than average
• Declining oestrogen due to ageing
• Chronic constipation
• Frequent and inappropriate heavy-lifting
• Respiratory problems with symptoms of chronic coughing
• A family history of POP
• Connective tissue disorders like Ehlers-Danlos Syndrome, Marfan syndrome, and joint hypermobility syndrome

What are the Common Symptoms Of Pelvic Organ Prolapse?

Sometimes, pelvic organ prolapse has no obvious symptoms and is only identified during a routine gynaecological exam. However, for moderate to severe cases, common symptoms include:

• Bulging sensation in the vagina, which can be described as if something is falling out
• Low back pain
• Painful intercourse
• Leaking of urine
• Chronic urge to urinate
• Constipation or loss of bowel control
• Spotting or bleeding from the vagina

Doing gentle exercises for prolapse can help manage these symptoms without aggravating the condition. Just remember to listen to your body and take breaks when needed. Rest is a vital part of recovery, so give yourself permission to pause when necessary. 

Why Consult a Women’s Health Physiotherapist?

A Women’s Health Physiotherapist specialises in pelvic health and can provide tailored exercise plans to strengthen the pelvic floor, reduce prolapse symptoms, and prevent the worsening of the condition. Their guidance ensures that exercises are performed safely and effectively, empowering you to regain confidence and control over your body.

What Types of Safe Exercises Can You Do To Manage Prolapse?

Pelvic Floor Muscle Exercises (Kegels) are foundational for strengthening the pelvic floor and managing prolapse. Here are some pelvic floor exercises for prolapse that you can do:

Kegel exercises help strengthen the muscles that support the uterus, bladder and bowel. They can reduce symptoms in mild to moderate cases of prolapse and may also help prevent further descent of the affected organs. [1]

To get started, follow these steps:

1. Find a comfortable position. You can do Kegel exercises lying down, seated, or standing, but lying down might be the easiest way to start.
2. Try squeezing as if you’re stopping yourself from passing gas or stopping the flow of urine midstream, but avoid clenching your buttocks. You should feel a slight pull in your rectum and vagina. 
3. Contract your pelvic muscles without tightening your abdomen, buttocks, or thighs. Hold the squeeze for 3 seconds, then relax for 3. Repeat it 10 times.

Once you’ve mastered the technique, Kegel exercises can be performed while sitting or standing. Because they’re discreet, you can incorporate them into your daily routine at any time. Aim to complete 30 to 40 repetitions each day.

If you’re already comfortable doing Kegels in a stationary or bridge position, you can try performing squats. Narrow and shallow squats are more beneficial than regular squats as they better engage the pelvic floor muscles. To do this:

• Stand with your feet closer together than you would for a regular squat.

• Tighten your pelvic floor muscles, then bend your knees slightly. You don’t need to go too low—just keep the movement controlled and shallow.
• Straighten back up using your pelvic floor muscles.

• Start with a few repetitions and gradually increase as your muscles strengthen.

Bridge exercises facilitate pelvic motions to increase the muscular strength of the buttocks, hip extensors, and pelvic floor muscles, promoting trunk stability and better posture. To get started:

1. Lie down with your back flat against the ground and your knees bent at a 90-degree angle. Keep your feet flat on the floor with your arms at your side and palms facing down.
2. Gently raise your hips off the floor and hold for 3-8 seconds.
3. Relax the buttocks and pelvic floor muscles as you lower your hips to the ground.
4. Repeat up to 10 times per set.

As your pelvic floor strengthens, you will be able to do more repetitions over time. Start slow, focusing on proper form, and gradually build up as you feel more comfortable.

For those who prefer a more active workout, initially low-impact cardio is a great option without putting too much strain on your pelvic floor while it is regaining its strength. These exercises help improve circulation, boost endurance, and burn calories without the high impact that could aggravate prolapse symptoms.

• Walking
• Seated cycling
• Low-resistance cross trainer
• Low-intensity water aerobics
• Double-step aerobics

Aqua exercises use the water’s buoyancy to put less pressure on the pelvic floor, making them safer for people with prolapse. [2] Movements like jumping jacks, which can be hard on the pelvic floor when performed on land, are safer in water if done at a certain speed.

Using equipment like dumbbells and noodles while exercising in water can also increase muscular strength, endurance, and cardiovascular conditioning. Buoyancy belts, on the other hand, can create downward pressure on the pelvic floor, especially when worn for a long period, so it’s best to avoid wearing them. Consult a pelvic health physiotherapist to help you tailor a water-based exercise routine that suits your needs.

What Exercises to Avoid When You Have Prolapse?

Extra care is essential when exercising with prolapse, especially during the initial phases of treatment, to avoid putting excessive pressure on the pelvic floor. Here are some exercises to avoid for people with a prolapse condition:

Jumping jacks, running, or high-impact aerobics can place significant pressure on your pelvic floor. It’s best to avoid these activities initially or modify them to a lower-impact version if you have a pelvic organ prolapse.

Sit-ups, crunches, and double-leg lifts increase intra-abdominal pressure, which can further strain weakened pelvic muscles and worsen prolapse symptoms. Your physiotherapist will modify these exercises and tailor them to where you're at in your recovery journey.

Lifting heavy weights or objects can strain and further weaken your pelvic floor. If lifting is necessary, use proper lifting techniques, such as bending the knees and hips while keeping the back straight to reduce the strain on your pelvis.

Other Preventative Measures to Take with a Prolapse

Apart from doing regular exercises for prolapse, there are lifestyle changes that can help manage your symptoms more effectively.

Studies show that wearing support garments can further boost the effectiveness of pelvic floor exercises and alleviate symptoms of prolapse. [3] These compression support garments are specially designed to activate pelvic floor muscles, effectively minimising the pressure felt from prolapse. Wearing support shorts or leggings is particularly useful when you’re on your feet for long periods or engaging in exercises for prolapse.

The diuretic properties of the caffeine can stimulate the bladder muscles, which can increase the urine the body produces. This can put extra pressure on the bladder, worsening symptoms of urinary incontinence and prolapse. [4] It’s best to limit your caffeine intake and opt for decaffeinated drinks or water. If you do consume caffeine, try to monitor how your body responds and adjust accordingly.

A high body mass index (BMI) is one of the key factors that contribute to developing pelvic organ prolapse. [5] When you’re carrying excess body weight, especially in the abdomen, the intra-abdominal pressure can put stress on your pelvic floor, eventually causing it to weaken. Maintain a healthy weight by following a balanced diet and staying physically active. If your goal is to lose weight, do it by making gradual and sustained changes. Avoid extreme diets or high-impact exercises that could strain your pelvic floor. Consult your pelvic health specialist for more personalised advice.

Constipation is both a symptom and a contributing factor to pelvic organ prolapse. Chronic constipation can weaken the rectal walls and lead to the rectum filling with hard stools, potentially resulting in a rectocele. In cases of existing prolapse, constipation places additional strain on the pelvic floor, which can cause discomfort and make bowel movements more challenging. To prevent constipation, increase your fibre intake and limit foods that may contribute to it, such as dairy, red meat, and highly processed foods.

When to Talk to a Doctor or Pelvic Health Specialist

If you have mild prolapse, you might not notice any symptoms. However, if you experience the following, talk to your doctor immediately:

• A noticeable bulge or feeling of heaviness in your vagina
• Urine leakage
• Difficulty urinating or passing stools
• Unusual discharge or bleeding
• Frequent urinary tract or vaginal infection

Prompt diagnosis is crucial to prevent additional pelvic organs from being affected. Your doctor may recommend a pelvic examination, along with imaging tests, to confirm the diagnosis and develop an appropriate treatment plan.

Take Gentle Steps Toward Improving Your Pelvic Health

Starting to exercise with prolapse can feel intimidating, especially when you're also recovering from pregnancy. If it feels overwhelming, remember that even small, gentle movements can make a big difference, and progress doesn’t need to be quick to be effective.

Begin at your own pace, and don’t hesitate to seek support if needed. Regular pelvic floor exercises for prolapse, paired with adequate rest, can significantly enhance your overall well-being. Wearing pelvic floor support garments can provide added comfort and stability as you exercise. With consistency and self-care, you can gradually strengthen your pelvic health and regain confidence in your body, one step at a time.

FAQs

1. Can you do Kegels with a uterine and or bladder prolapse?

Yes. In fact, doing Kegels can treat mild to moderate cases of uterine and bladder prolapse as they can help strengthen pelvic floor muscles. However, it’s best to consult with a healthcare provider or pelvic floor specialist to ensure you’re doing the exercises correctly and safely.

2. What worsens a bladder prolapse?

Lifting heavy objects, straining during bowel movements, and doing high-impact activities initially, can further strain your pelvic floor muscles. Carrying excess body weight, especially in the abdomen, can also stress and weaken your pelvic floor, making the condition worse.

3. How do you empty your bladder with a prolapse?

To completely empty your bladder, you can do the following techniques: [6] [7] 

• Sit on the toilet with your feet and knees apart. Do not crouch or hover over the seat, as this can prevent your bladder from fully emptying.
• Lean slightly forward with your forearms or hands on your knees. You can try rocking back and forth on the toilet to help get the urine out.
• Try to fully relax the muscles around your bladder to make it easier for the urine to pass.
• After urinating, you may wait for a few minutes and then try to urinate again.

For personalised techniques tailored to your condition, consult with your doctor or healthcare provider.

4. Is sitting bad for bladder prolapse?

Sitting for prolonged periods may strain your core and pelvic muscles, which can potentially worsen bladder prolapse. Take regular breaks to stand, walk around, and do gentle stretches to relieve pressure from your pelvic floor muscles.

5. How do I know if my bladder or uterine prolapse is severe?

You may notice a visible bulge in your vaginal area if the prolapse becomes severe. Other symptoms may also include:

• Frequent urinary tract infections
• Urinary incontinence or leaking
• Loss of bladder control that results in frequent urge to pass urine
• Pressure or heaviness in the vaginal area
• Pain in the lower abdomen, pelvis, lower back, or vagina

6. Can I push my bladder prolapse back up?

No. Pushing back a bladder prolapse is not a long-term solution and may not always be safe. Speak with your doctor for proper management and discuss long-term treatment options.

7. Will walking make the prolapse worse?

Walking is generally considered a safe and low-impact activity. However, it’s important to take regular breaks to avoid potentially straining your pelvic floor. Wear a compression garment (link) while exercising. Listen to your body and take rests or reduce the length of your walks if you experience any discomfort.

8. Does running make the prolapse worse?

Running can worsen prolapse symptoms due to the repetitive jarring and pressure placed on the pelvic floor. Consider switching to low-impact activities like walking until your specialist gives you the all-clear to commence running.

References:

• https://ncbi.nlm.nih.gov/books/NBK525762/
• https://www.pelvicfloorfirst.org.au/pages/pelvic-floor-friendly-exercise-for-aqua-.html
• https://www.ics.org/Abstracts/Publish/349/000429.pdf
• https://www.uab.edu/news/health/item/262-caffeine-intake-linked-to-urinary-incontinence
• https://pubmed.ncbi.nlm.nih.gov/28700456/
• https://www.yourpelvicfloor.org/conditions/non-surgical-approaches-to-managing-bladder-problems/
• https://www.kentcht.nhs.uk/leaflet/tips-to-help-with-bladder-emptying/