Ask Bri: What to do if you have prolapse

What to do if you have prolapse | FemFusion Fitness #womenshealth #pelvicfloor

Pelvic organ prolapse (when one or more of your pelvic organ/s descend due to loss of support) is extremely common. Unfortunately, it’s also under-discussed! When prolapse is discovered, women often feel betrayed by their bodies, betrayed by their healthcare providers for not diagnosing them sooner (or for not educating them about the condition or the risks in the first place), and frustrated because they don’t know where to start.

Today, I’m going to share my take on what to do if you have (or think you have) prolapse. I’m also going to discuss POSTURE. Why? Because posture and prolapse are intimately connected. Postural dysfunction not only contributes to the development of prolapse, it can also aggravate prolapse. On the other hand, great posture can help prevent the progression of prolapse. It’s definitely something worth understanding and noticing!

What to do if you have prolapse:

Step One: Get Checked!

If you think you have prolapse, then schedule a consultation with your gynecologist or with a women’s health physical therapist. Here’s a link to a women’s health PT locator to help you find a provider in your area. Your provider will give you a solid diagnosis (including exactly how far advanced your prolapse is), and can provide you PERSONALIZED recommendations re: the next best steps.

But while you’re waiting for your appointment… Move on to step TWO!

Step Two: Assess Your Posture

This requires some self-analysis. Go to a full-length mirror, march in place a few times, and then stand normally. How do you typically hold your body? Are your feet turned out? Are your shoulders hunchy? Does your head poke forward? Do you just your hips forward and “hang” on the front of your hip ligaments? DOES YOUR TUMMY POOCH OUT? Be honest!

It’s super important to take stock of how you normally stand, sit, and move… And then to CORRECT it if  you notice something’s off. Recently, I received the following question from a FemFusion friend:

Since my bladder prolapse, my lower tummy seems to poke out. I don’t know why this happens — maybe it’s just more comfortable.  Should I be trying to correct this?  Should I be always pulling up on my transversus abdominis (TA) to pull it in… Or is that not good either? 

If your lower belly pooches, don’t just “suck in” your tummy and call it good… Instead, align yourself correctly from the bottom up. The key is to focus on your whole-body posture rather than just pulling in your TA. From the bottom up, be sure that:

  • your feet are planted firmly on the ground and pointing FORWARD (not out)
  • your pelvis is shifted back over your heels (not forward over the balls of your feet)
  • your pelvis is NEUTRAL (bum not tucked under, and not a super-strong arch in your low back either)
  • your lower ribs are gently pulled in and not flaring outward or popping forward
  • and your chin is gently pulled in so that your ears are in line with your shoulders (go to the mirror and check it out!)

This will keep all of your muscles in their optimal position for firing and supporting you without you having to “pull in” any single muscle/muscle group excessively. When you excessively contract a particular muscle it can throw you off-balance, increase intra-abdominal pressure (which can increase prolapse), and make your muscles fatigued and possibly painful.

The video below from my friend Tasha Mulligan at Hab-it does a GREAT JOB explaining proper posture and alignment, and why it’s important for pelvic health.

So remember, check your posture and pay special attention to your pelvic alignment! Posterior tilt (i.e. bum tucked under) places excess downward pressure on your pelvic organs AND they’ll be more apt to “slide on down” through the pelvic outlet. Anterior tilt (i.e. a “swayback” look) can provide a bony “stop” for downward progression of your pelvic organs; however, it can lead to the poochy tummy look, overstretched abdominal muscles, spinal instability, and low back pain.

Correct posture:

  • properly engages the pelvic floor muscles
  • promotes deep abdominal muscle activity
  • improves breathing

YOU NEED TO FOCUS ON YOUR POSTURE!

Step Three: Safe Exercises

Sometimes women with prolapse unintentionally TENSE their muscles all day long (in order to keep everything “in”). This can lead to muscle fatigue and pelvic floor muscle dysfunction. The last thing these women need to be doing is hundreds of kegels each day to strengthen their pelvic floor… So check yourself before you wreck yourself! It’s possible that kegels are an appropriate exercise for you, but it’s also possible that they are NOT. You might need to learn how to RELAX the pelvic floor muscles before you can effectively strengthen them.

This is where seeing a qualified women’s health (pelvic floor) specialist comes in; she (or he) can help you determine your personal needs when it comes to pelvic floor strength and coordination training. Every woman will be different. However, you can do some initial exploratory work on your own, in order to get a feel for where you think you are.

Prop your hips up on some pillows and try a kegel exercise. Check in with yourself; is your pelvic floor truly weak and under-responsive, or is it actually TENSE and overly active?

Either way, it’s important to know. Check yourself, bank that knowledge, and then instead of relying on kegels alone to self-treat your prolapse, try the two exercises I demonstrate in this video (after the kegel check): the Ball Squeeze with hips propped, and the Butterfly Bridge. They are safe strengtheners for most women with prolapse, regardless of their resting pelvic floor tension.

Please note that with prolapse, you might see a fluctuation in symptoms. This fluctuation can be due to your daily activities (i.e. a bigger bulge on days you did more lifting or were more physically active), whether or not you’re constipated, and it can also be related to your menstrual cycle. The uterus changes position throughout your cycle, so that can contribute to the changes.

It is ABSOLUTELY possible to prevent progression of prolapse, and some women are able to reduce it and/or manage their symptoms without surgery or use of a pessary. The keys are to identify it early, seek treatment, and to modify lifestyle factors such as exercise, body mechanics, and posture.

So… To sum it up, WHAT TO DO IF YOU HAVE PROLAPSE:

  • See a doctor or a women’s health physical therapist who can assess your individual needs.
  • Know that kegels are only part of the recovery/treatment plan, and may not be appropriate for every person right away.
  • Understand that posture/alignment is key. Check yourself RIGHT NOW, and then make a plan to check in on your posture 2-3 times throughout the day to get an honest assessment of how you really sit, stand, and live your life. It might be contributing to your prolapse (and might need to be corrected).
  • Give yourself rest breaks where you lie on your back with your hips propped up on pillows (supported bridge).
  • Start with the following exercises that are safe for most women with prolapse: Ball Squeeze with hips propped, and the Butterfly Bridge. See this video.
  • Last but not least, exhale with exertion (when lifting, for example).

More great prolapse info:

Love and LIGHT to you! Yours in good health, 

Dr. Bri, PT, DPT - FemFusion Fitness

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