Hiking with prolapse is possible (wahoo!!!), and it’s an AWESOME alternative to high-impact exercise (such as running) for women who want to get their heart rate up without overly taxing their pelvic floor. The ups and downs and uneven terrain of a hiking trail is a great way to amp up your workout WITHOUT repetitive pounding.

That being said, there are some aspects of hiking that can aggravate your condition if you’re not careful. The following are my top tips for hiking with prolapse. Note that this article is intended for women with mild to moderate prolapse. If your prolapse is severe (to the opening of — or protruding outside of — your vagina), please consult your healthcare provider.

Before I get started, here’s a little soapbox: PROLAPSE IS NOT A DEATH SENTENCE. Yes, it’s a condition that needs some careful attention and precautions, and you should be evaluated by a women’s health physical therapist to determine your SPECIFIC, individual needs. However, a diagnosis of prolapse doesn’t mean that you’re destined to a sedentary future. You can ABSOLUTELY exercise; in fact, it’s imperative to exercise (within safe limits) in order to maintain — and even improve — the strength and resilience of your pelvic floor and core muscles. I have had several clients prevent progression of — and even REVERSE — prolapse naturally, using a combination of exercise, improved body mechanics, and better posture/alignment.

Okay. Onto my tips for hiking with prolapse:

1) If you’re using a backpack or daypack, choose one that fits appropriately and — ideally — has chest and hip straps/belts.

This will help distribute the weight of the pack EVENLY. If the weight isn’t distributed evenly (i.e. if it’s dangling off your back as seen in the picture at left) it will throw you out of alignment, compromising your posture. In the picture at left, notice how my shoulders and neck are FORWARD to help offset the dangly-ness of my pack. The forward shoulders and neck actually impact my pelvic floor, because the “hunchy-ness” up top translates to increased intra-abdominal pressure down below. This translates to increased DOWNWARD PRESSURE on my pelvic organs.

Hiking with prolapse: wear a daypack with chest and hip straps to help evenly distribute weight! #womenshealth | FemFusion Fitness

The blue pack is a better fitting backpack with a chest strap AND a hip belt to help evenly distribute the weight. You don’t want the belts to “squeeze” you, but they should be snug and feel supportive. Make sure the hip belt isn’t fastened too high (it needs to be below the waist/bellybutton, not AT the waist/bellybutton) so that it doesn’t pinch off your  middle. Again, the idea is to evenly distribute the weight so nothing is dangling and throwing off your posture.

When it comes to loading your pack, please remember that prolapse is a medical condition. Any extra weight you carry will be transferred to your pelvic floor (and will increase the impact of each step you take) and could aggravate your condition… So pack carefully, and pack light. Maybe your backpack carries extra clothes and toilet paper for the trail, and your partner’s pack carries the water, snacks, and heavier items. Packing light doesn’t mean you’re a wimp; it just means you’re working SMARTER and caring for your body.

2) Speaking of posture, hike tall and proud with your bum un-tucked and your lower ribs gently pulled in.

Incorporating ideal posture into every day activities such as sitting, standing, walking, and HIKING (!) will retrain your pelvic floor and core muscles to fire in their optimum position (for optimum function).

When you’re hiking up a hill, rather than dogging your way up the incline with a hunch-back (like the backpack picture on the left), keep your back straight and strong, and your posture tall! Breathe steadily, exhaling as you propel yourself upward, and get your arms into it. You might even consider using trekking poles if you’re walking a very steep trail.

Furthermore, don’t jut your chin forward!

Many women naturally (and unintentionally) jut their head and chin forward, especially when going uphill. When you jut your chin forward it causes a breakdown in your posture: your pelvis rotates back, downward pressure increases on your pelvic organs, and your core muscles are no longer in a good position for firing and support. Physical Therapist Sarah Duvall gives a fantastic explanation of this key tip in the following video.

Remember: instead of hunchy, head-down hill walking (like the far-left backpack picture above), and instead of chin-jutting hill walking (like Sarah describes in the video), do the RIGHT THING for your core and pelvic floor — pull your chin back and your lower ribs in.

3) Proper breathing is key.

Breath holding during resistance exercise can also contribute to prolapse, and hiking up hills is ABSOLUTELY a form of resistance exercise (What’s resisting you? Gravity!) Breathing evenly and steadily throughout your hike and especially considering your breath pattern when hiking uphill and/or stepping UP (i.e. onto a root or a rock) is essential. Remember this mantra that I learned from my friend Jenny Burrell of Burrell Eduction: “EXHALE ON EXERTION.” Performing an exhale as you do the heavy lifting (i.e. lifting of yourself) relieves abdominal pressure and causes a gentle lift of the pelvic floor.

4) Take a break and elevate your pelvis.

You’re hiking… It’s hard work! Take a break. Women with prolapse often feel a gradual increase in symptoms as the day progresses, such as an aching in the pelvis or low back. If you start feeling that, DON’T PUSH IT. Take off your pack, and lie down as pictured. Elevating your bottom allows the pelvic organs to return to their natural positions and the pelvic floor to return to a higher resting position; this will take a load off of you AND your pelvic floor! While you’re in this resting position, take the opportunity to connect with your pelvic floor muscles. Breathe deeply into your belly, and feel your pelvic floor gently descend with each inhale, and lift with each exhale.

Hiking with prolapse: rest with your pelvis elevated when you're able... #womenshealth | FemFusion Fitness

Click here to read about the “pelvic drop” for pelvic floor muscle relaxation. Lying in this supported bridge position is a great time to practice the pelvic drop!

5) Before you go, prepare your pelvic floor.

Kegels are great, but they’re not the be-all/end-all pelvic floor exercise, ESPECIALLY if you’re going to be clambering up and down hills… You need to do some functional training of your pelvic floor AND get your glutes in tip-top condition.

How do you “functionally train” the pelvic floor? They key is to break down the activity (i.e. hiking) into individual components and then create exercises that gradually progress from the basics on up to the full challenge of the sport. To start, connect with your pelvic floor via breathing, and then integrate it into progressively challenging activities that mimic hiking. This quick video provides an idea of how to gradually progresses to greater and greater functional challenges. Be sure to repeat the progression on BOTH SIDES!

You can also get ALL of your core muscles into the action via hip circles. The Circle Solution is a great place to learn a variety of multi-planar movements that activate your entire core in a way that’s SAFE and FUN.

Like I said earlier, pelvic organ prolapse is not a death sentence, and it doesn’t meant that you’re doomed to a future of sitting in an easy chair.

YOU CAN GET BACK OUT ON THE TRAILS… You CAN go hiking with prolapse!*

Prolapse can often be managed conservatively, without surgery, especially if its addressed in its early stages. Don’t ignore it or assume there are no alternative solutions; seek the care of a women’s health physical therapist, safely train your pelvic floor and core, watch your posture (don’t hunch! un-tuck your butt!), and exhale on exertion.

Until next time… Happy trails! For more women’s health info, be sure to join my Women’s Health Interest Group when you subscribe to my newsletter HERE.

Hiking and prolapse... How to cope! #womenshealth | FemFusion Fitness

*This blog post and all of the advice/information on www.femfusionfitness.com is informational only and not intended to be a substitute for individualized medical diagnosis and treatment. Please talk to your healthcare provider to find out what’s appropriate for your body and your personal needs.