As some of you are aware, a little while back I conducted a survey of women who had been diagnosed with pelvic organ prolapse. I was thrilled to receive over ONE HUNDRED responses in just a few shorts days! Many of the participants came via a wonderful Facebook group called POP Fitness. This group was founded by Haley Shevener (pictured), a fitness professional that, quite frankly was sick of all the negativity surrounding exercise and pelvic organ prolapse. Instead of all the “don’t do anything” messaging, she wanted to create a safe place where women could actually discuss movement and exercise while living with pelvic organ prolapse.
I digress… (but seriously, if you have POP check out the group – it’s pretty amazing)
I completely acknowledge that the information gathered in this survey cannot be extrapolated to all women. Women joining this FB group are likely to be those that are symptomatic with their prolapse and actively seeking information and support, rather than women who had asymptomatic POP. I did not seek out the demographical details either, but I do believe that the majority of the group are between the ages of 25-40- with more participants who enjoy movement and exercise than those that don’t.
So yes…I know that I can’t publish this information in a journal.
BUT… I believe that the information gathered is extremely valuable. For one thing, I asked a lot of open-ended questions, enabling women to answer in their OWN VOICES. I did not put words into their mouths and as I am not their personal physiotherapist, they were able to be completely truthful without worrying about hurting my fragile ego.
One question that I asked was:
How much improvement have you had in your symptoms?
I found it reassuring that so many women had at least SOME improvement in symptoms, although almost 20% reported no change at all.
I really wanted to know what helped women most in terms of dealing with their symptoms, so the following question was
What strategies have you been given (or you’ve figured out for yourself) that you have found the most useful for relieving or avoiding symptoms associated with your POP?
As you can imagine, the answers to this question were varied. I dug into the responses and collated the information to come up with a list of the 10 most frequent responses. I have listed them and briefly quoted some of the participants, but will go into more detail about these strategies in future posts.
I hope that these answers are helpful, but feel free to add your own tips in the comments section below.
Pelvic floor muscle strengthening
This was the most frequent answer that was found within the survey. Of course the way in which women performed their strengthening exercises was variable – some women were given an individual program from their pelvic health physiotherapist, whereas others used online programs such as Dr Sarah Duvall’s Pelvic Floor Perfect.
It makes sense that many women found pelvic floor strengthening exercises to be of benefit as we know that strengthening the musculature of the pelvic floor can give a lot more support to the internal organs and relieve tension on the ligaments. Many women also commented that they utilised pelvic floor contractions during specific exercises or activities of daily living (such as lifting up their baby or a pram).
If you want to learn HOW to do pelvic floor muscle exercises, seek out a local pelvic health physical therapist, who can make sure that you are not bearing down during these contractions. We will discuss pelvic floor strengthening in more detail in future blogs.
Closely following pelvic floor muscle strengthening was changing breathing strategies. Again, the responses were somewhat varied but included tips such as:
- exhaling on the challenging part of the exercise
- Julie Wiebe’s Pelvic Floor Piston course and breathing strategy (“Blow before you go”)
- relaxing the abdomen when breathing
- avoiding holding the breath during exercise
The diaphragm (our major breathing muscle) and pelvic floor muscles seem to work in synch, with inhalation being associated with a slight eccentric lowering of the pelvic floor and exhalation with an active lift of the pelvic floor muscles. It makes sense that we should try to coordinate these actions – and in many women this is a successful strategy for managing intra-abdominal pressure – but keep in mind that different breathing strategies may be required for different tasks…so don’t be rigid in your approach! We will talk more about intra-abdominal pressure and breathing in future posts.
3. Bowel Management
Unsurprisingly, managing the bowels and avoiding constipation came up very high on the list. For some clients, this meant using stool softeners and laxatives, whereas for other women dietary changes were successful.
Many women mentioned splinting to be a useful strategy when emptying the bowels. In the case of posterior wall prolapse (rectocele), inserting a finger into the vagina and putting pressure on the prolapse (ie literally pushing it back where it should be) can assist in emptying the bowels more effectively. Here in Australia, many women use a product called a Femmeze (instead of the finger!) which can make life a little easier.
Other strategies for effective bowel management included:
- using a footstool or Squatty Potty
- relaxing the pelvic floor muscles
- breathing into the side of the abdomen
- avoiding straining
Many women reported that their symptoms improved when changing their posture or alignment during specific activities. Some women noted that changing their alignment helped them manage their intra-abdominal pressure during exercise. Others stated that they felt better activation and awareness of certain parts of their pelvic floor when adapting their posture (eg the front of the pelvic floor when using a slight forward lean posture).
One woman noted that changing positions and postures regularly helped her manage her symptoms. Another noted that if she tucked her bum under, she felt worse.
There is no perfect answer when it comes to posture and alignment, so it is important to try different positions and see what works best for you. We often talk about stacking the rib cage over the pelvic floor, or the sternum over the pubic bone. Ultimately end range positions of the pelvis (ie extremely rotated forward or backward) seem to produce a poorer contraction of the pelvic floor in comparison with the more neutral positions of the pelvis.
5. Use of a pessary
Many women noted that using a pessary reduced their symptoms and enabled them to return to higher level exercises and sports. Some women stated that they only used their pessary for activities such as running, whereas others used their pessary throughout the day. Most women did not specify what type of pessary was used, but rings and sponges were mentioned.
In most countries, gynaecologists or pelvic health physical therapists fit pessaries. Although traditionally pessaries have been recommended for the more elderly population, they have been recognised more in recent years as being a highly effective tool for the young, active population with pelvic organ prolapse. It is important that pessaries are professionally fitted and that the vaginal tissues are regularly checked. Often women will be prescribed topical oestrogen at the same time.
6. Low impact exercise
It was wonderful to read so many statements about how exercise and movement helped women feel better symptomatically. Some were specific in the types of activities that they did (such as walking or Pilates), whereas others were more broad in their description.
Regardless, it would seem that the benefits of exercise were substantial, including improved mental health, quality of life and overall fitness.
I was happy to see that so many women acknowledged the role of rest in their recovery. You have to understand that this is not a group of women who like to do nothing. They would probably not choose to spend their days lying down on the couch… (well, maybe occasionally, but who doesn’t?!).
Many women stated in the survey that they just HAD to listen to their body and rest.
In terms of how they chose to rest, it included things like:
- lying down towards the end of the day
- sitting down for regular rests if on her feet for long periods
- lying on her back with hips supported on cushions
- lying down in the middle of the day
It seemed to be particularly important for women in the earlier postpartum period….so make sure that you take up all the offers for cooking and cleaning from your friends and relatives!!
8. Relaxation of the pelvic floor muscles
Contrary to #1, there were a lot of women who stated that they had overactive pelvic floor muscles and actually felt a heck of a lot better learning how to RELAX them. Many of these women would have gained this knowledge from having an internal examination with their pelvic health physical therapist, and would have learnt strategies for “downtraining” these muscles.
For some women, overactive pelvic floor muscles present as painful sexual intercourse, difficulty insertion tampons or problems with bladder and bowel function. Some women in the survey mentioned that they felt that what they believed were the symptoms associated with the prolapse actually felt better by relaxing their pelvic floor muscles.
9. Strengthening other muscle groups (eg glutes)
As someone who is super passionate about exercise (and teaches it for a living), I was stoked to see strength training make the list! Many women reported that they felt BETTER by getting stronger. Some were specific in the muscle groups that they targeted (eg abdominals or glutes) whereas others were more general or stated that they felt better by “lifting weights”.
Although performing strengthening exercises was mentioned multiple times, it should be noted that a number of women also stated that they felt better by “not lifting heavy weights”. As with any exercise program, the intensity should be based on the woman’s individual circumstances, but it does seem that many women cope well with light to moderate strength training.
10. Relaxation/meditation/positive mindset
It would appear that many women get symptomatic relief through the use of meditation and specific relaxation techniques.
“Less stress helps”
“Meditation – mental connection to my pelvic floor and self care routines have helped massively. Stress will exacerbate symptoms for me”
“Staying as low stress about everything as possible ”
I do feel that the way in which the diagnosis is made may have a significant impact on the way in which a woman approaches her recovery. If she has been given a more positive prognosis and some strategies that may help her in her journey, then she may be more likely to approach the diagnosis with a positive mindset.
Some clients with POP require more professional attention in this regard, and if you do feel that the diagnosis of POP has hit you hard, please do get a referral from your GP to a psychologist or other mental health practitioner. You are not alone if you feel depressed, angry, frustrated, devastated by learning that you have pelvic organ prolapse.
In fact, I made up a video on some of the responses that women had to receiving their diagnosis.
The results from this survey of over 100 women with pelvic organ prolapse show that there are many strategies that women can utilise to help reduce symptoms. The variety in answers shows that there is not one true solution and that an individualised approach is key. However, the frequency with which some of the answers came up (in particular pelvic floor strengthening, breathing strategies and bowel management) lead me to think that these should be at minimum mentioned to women upon diagnosis.
I recommend that all women with symptomatic POP reach out to the pelvic health physical therapy community and learned what strategies will best help you. And don’t be afraid to reach out to a few health professionals – it certainly seems to be the case that many women need assistance from physios, gynaecologists, fitness professionals, dieticians and/ore psychologists in their journey.
(NB re Affiliate links. I do have a couple of affiliate links within this article. Please note that I do make a small commission if you purchase via the links. However, I did NOT add them to the article for this purpose, they were genuinely listed within the survey responses)