Avoiding prolapse when you are working out
When you think of injuries from working out, the pelvic organs and floor muscles might not be at the top of your list. But in fact, the pelvic floor is like any other muscle and can be placed under strain.
Lisa, from Western Australia, was 39 and had been active her entire life: growing up on a farm, hiking, swimming, running after her two boys. She had never entered a conventional gym but wanted to tone up and do something different, so she joined a small gym for a six-week weight training challenge.
She was loving the new way of exercising and felt confident that the personal trainer was taking the time to teach technique and individually monitoring the small number of participants in the course – all mums.
Lisa kept at her weight training, which included extremely heavy squats, and after the course had completed she kept going to the gym three times a week. It was a real shock when about five months later, she noticed a bulge after having sex. As it often happens, ‘Doctor Google’ was the first port of call and Lisa started “freaking out” a bit. She headed to the GP and then a gynaecologist, where she was told she had bladder, uterine and rectal prolapses.
What is pelvic organ prolapse?
The pelvic organs include the bladder, uterus (womb), large bowel and rectum (back passage). These organs are held in place by support tissues called ‘fascia’ and ‘ligaments’. The pelvic floor muscles support your pelvic organs from below.
Without strong support, pelvic organs may bulge down into the vagina. This is called prolapse.
She was told the weight training could have contributed to the prolapse because of the downward pressure on the pelvic floor. Lisa also had the risk factor of childbirth, which is the main cause of prolapse. As her two kids were into their teens, prolapse wasn’t something that crossed her mind.
Her training regime dangerously increased in load. By the end of the six-week course, she had accelerated to squatting 100kg.
She felt like many others do, that ‘heavier equals stronger’. But upon reflection, she would’ve approached weight training with a different attitude.
“It’s not about much weight you’re squatting, it’s about going out there and giving it a go,” Lisa said.
“I wish I took more time to know what my body was doing on the inside, rather than what I was doing for it on the outside.”
Marietta Mehanni, fitness professional and Pelvic Floor First Ambassador, said taking it slowly is vital when exercising.
“When you first start any form of training, technique is more important than load. This is regardless of whether you have pelvic floor issues or not. Load then needs to be added gradually over a period of time. Listening to the body after each training session ensures a safe and gradual improvement in strength,” Marietta said.
Lisa had diligently followed her trainer’s instructions, which focused on breathing and the core but never the pelvic floor.
“I naturally thought the core was the same as the pelvic floor. It never entered my mind that it was different,” Lisa said.
Marietta said properly explaining and protecting the pelvic floor in a training context is important but can be difficult.
“Simply using the word ‘core’ is not enough for most people as individuals have a tendency to brace their abdominal muscles, which then usually leads to downward pressure on the pelvic floor. Commonly used words are lift, or drawing in and upwards, but there is no way to tell externally by looking at the person whether they are performing the pelvic floor activation correctly,”
“The gold standard is that the individual is aware that they have lifted their pelvic floor prior to performing the exercise. The only definitive way to know at this point is to have a pelvic floor physio perform an examination to check if the pelvic floor is engaging appropriately and then applying this knowledge with other exercises,” Marietta said.
Q. How should I speak to my personal trainer/instructor about making sure exercises are modified for the pelvic floor?
A. Some personal trainers and instructors are knowledgeable about exercise and the pelvic floor and others are not comfortable or familiar with the information. Ask specific questions like: “Do you teach pelvic floor safe options?”, “Have you done any pelvic floor and exercise specific training and where?”. You could also ask if they modify exercises for other clients re pelvic floor. A big red flag would be if they responded with a “no”. This would suggest that they are not experts in this area and it would be appropriate for you to seek another trainer.
– Marietta Mehanni
It took experiencing prolapses for Lisa to see a continence physiotherapist. She wasn’t aware of such a specialty before. She’s found it invaluable and even said the physiotherapy eased her existing back pain.
Strong pelvic floor muscles are vital for prolapse prevention and exercising them can help if you already have a low-grade prolapse. There are also many approaches available to treat prolapse once it has happened, including good bladder and bowel habits, pessaries, and various surgical approaches.
Nearly a year on from her prolapse diagnosis, Lisa is on a waiting list for a hysterectomy and vaginal approach surgery.
Prolapse has taken a toll on many parts of her life, including both physical and emotional. It has made her sex life different and she struggles using tampons, as well as suffering from an overactive bladder that doesn’t empty properly. She’s had to give up running, which she loved, and swapped it for long, low impact walks on the beach.
For more information on prolapse and its signs, causes and treatment, visit www.bit.ly/ProlapseBrochure or phone the free and confidential National Continence Helpline on 1800 33 00 66.
The Pelvic Floor First website pelvicfloorfirst.org.au has information on how to do pelvic floor muscle exercises and tips on modifying fitness exercises to suit those at risk of, or experiencing, pelvic dysfunction.