The thought of our vaginas falling outside of our body is absolutely terrifying, and when most people think about prolapse, this may be the image that first comes to mind. But for the vast majority of people living with prolapse, this is not their experience and never will be. In reality, many people may have a prolapse and not even know it. Other people may have a prolapse and only feel it while going for a run or after being on their feet all day or when sitting on the toilet or just when they place their hand at their vulva during a shower. There are a variety of prolapses and an even larger variety of prolapse symptoms, ranging from heaviness or pressure in the vagina, bulging towards and even beyond the vaginal opening, to occasional sensations of wearing a tampon when you aren't.
Whatever your experience, it's important to understand that a prolapse is not a dangerous or emergency situation — and having symptoms now does not necessarily mean that your condition will absolutely worsen over time. Still, if you are experiencing pelvic symptoms, whether pain, pressure or incontinence, it is important to reach out to your medical provider. Your doctor can help you understand what's happening in your body and let you know if pelvic floor physical therapy for prolapse is right for you.
If you have a prolapse and your symptoms are limiting your activity or impacting your quality of life, then it is the time to take control over your body and address your prolapse. Here are 8 exercises and strategies that will help reduce your symptoms and improve your function immediately.
#1 Strengthen your pelvic floor.
One of the many tasks of the pelvic floor is to elevate and support your pelvic organs. Build up coordination and awareness of your pelvic floor by practicing kegels in a variety of positions: kneeling, sitting, standing, while walking, etc. As you become more in tune with your pelvic floor, begin to strengthen and increase your endurance by practicing to engage them during a variety of tasks and exercises, especially those tasks that may increase your prolapse symptoms. Get started with the seated kegel below.
How to do a seated kegel:
- Sit in a chair with feet flat on the floor and hip distance apart.
- Inhale deeply, allowing air to fill the bottom of your lungs. Feel your lower abdomen, your low back and your pelvic floor gently stretch outwards with your breath.
- As you exhale, contract your pelvic floor muscles in a kegel, feeling your pelvic floor lift up and in and your belly button move towards your spine.
- Relax your pelvic floor during the next inhale.
If any of your pelvic symptoms increase with doing kegels, stop and reach out to a pelvic floor physical therapist for a program that is tailored to fit your needs.
#2 Relax your pelvic floor.
Muscles need to be able to operate in their full range of motion in order to maintain their strength and function. If the muscles of your pelvic floor become too tight, often by chronically contracting (imagine clenching your jaw or holding tension in your shoulders, but in your pelvis), this can lead to weakness and can limit how well your pelvic floor can support your pelvic organs. Diaphragmatic breathing is a great strategy to keep your pelvic floor operating normally.
How to breathe with your diaphragm:
- Lie flat on your back in a comfortable position.
- Place your hands beneath your ribs or on your belly.
- Inhale, feeling your abdomen expand outward and into your hands, pelvis and back as your lungs fill with air.
Tip: With each inhale, imagine your pelvic floor lengthening like the bottom of a balloon as it inflates with air.
- Exhale, allowing your belly to gently recoil back towards your spine.
Begin by lying down but you can do this in any position. Try to do any time you feel increased stress or pelvic discomfort to reduce tension being held in your pelvic floor.
#3 Fight gravity.
Overnight, our pelvic organs are resting within the pelvis, away from the vaginal opening and the pelvic floor. Following hours of sleep, for many people, a prolapse is completely symptom-free. But gravity is not our friend. As the day goes on, gravity slowly and gently tugs at our bodies, our breasts may hang a little lower, our belly may look a little fuller, and our pelvic organs are no exception. As gravity brings our pelvic organs lower in our pelvis, this can cause pressure, heaviness or bulging symptoms to increase. One strategy to combat the effects of gravity is to take periodic breaks throughout the day and give our pelvis a break by simply lying down or by inverting your pelvis in a supported bridge pose for a little while.
How to do a supportive bridge:
- Lie on your back with your arms at your side and both knees bent, feet flat on the ground, hip distance apart.
- Draw your belly in towards your spine to engage your core before the movement.
- Keep your core engaged as you squeeze your glutes and push into your feet, lifting your hips off the floor.
- Place a yoga block, pillows, or bolster under your hips to support you in this bridge position.
- Take deep diaphragmatic breaths as you relax your body into this pose.
- To exit this pose, engage your core and squeeze your glutes to lift your hips into the air and off of the support. Remove the support from beneath you, so you can lower your body back to the floor.
Be sure to consider your whole body in this pose, if pain increases in your neck or back, try to reposition with better pillow support. If you continue to have pain, discontinue this exercise.
#4 Jump with a soft landing.
When we jump, run or even step off a tall curb, with each landing, our body needs to absorb this shock. If you are experiencing prolapse symptoms, it is important not to have your pelvis bear the brunt of this impact. Instead, practice landing quietly. Actually listen to the sound your foot makes on the ground. Now make it quieter by allowing your knees, hips and ankles to all bend, slowly and with control, upon hitting the ground. Try practicing with a jump squat.
How to do a jump squat:
- Stand with your feet hip distance apart.
- Pull your belly button in towards your spine to activate your core.
- Keeping your core engaged, push your hips back and bend your knees as though lowering into a chair.
Tip: Try to keep your knees directly above your ankles and feel your weight shift into your heels.
- As you straighten your legs, squeeze your glutes and push through your toes to jump into the air.
- Land softly, lowering back into a squat.
In changing how you land, you may find your hips, thighs, and calves all need to work harder during the exercise. If you experience any leg pain, reach out to a physical therapist to determine if your body may require additional strength conditioning in order to participate in this exercise.
#5 Avoid straining.
Managing the pressure within your pelvis is especially important when living with a prolapse. Straining to perform an exercise, lift a heavy object, or pass a bowel movement will all likely exacerbate your symptoms. Develop a practice of exhaling with exertion in order to allow pressure to release up and out rather than concentrating that same pressure down towards your pelvic organs. This TRA activation exercise will help.
How to activate your TRA:
Stand with your feet hip distance apart and your hands placed on your lower belly.
- Inhale and feel your belly expand, filling your cradled hands.
- Exhale and pull your belly up and in towards your spine and away from your hands to activate your Transverse Abdominal muscle.
Tip: Practice keeping your core engaged while breathing normally.
Note: As you build up your pelvic floor muscle coordination, practicing to activate your pelvic floor in anticipation of increased intra-abdominal pressure (IAP) as with lifting a toddler or pushing a heavy cart, can help further support your pelvic organs and reduce symptoms in spite of increasing IAP..
#6 Try splinting.
When pushing or straining to have a bowel movement, we are intentionally increasing the pressure in our abdomen and pelvis. This pressure is used to push stool out of our body. But when our pelvic organs are less supported, we may need to push harder or longer in order to actually pass a bowel movement. One strategy to better support our organs and promote smoother and faster emptying is splinting.
Fold a few squares of toilet paper and hold them on the pad of your fingers on one hand. Place this tissue against the lower portion of your vulva and your perineum, the area between the vaginal and anal openings, applying firm but gentle pressure with the pads of your finger. Continue to hold this pressure for the duration of the bowel movement.
Note that some people find it helpful to wash their hands and insert one finger or thumb into their vaginal canal for even more targeted support in the direction of the rectum as they pass a bowel movement. Keep in mind, no splinting techniques should be painful. If you experience pain with bowel movements, reach out to your medical provider.
#7 Kegel under pressure.
Sneezes, coughs, and laughing will all lead to sudden, often unexpected, pressure increase in your abdomen and pelvis. This may lead to bladder leaks for some, and for others it can lead to prolapse symptom exacerbation. You can help support your pelvic organs when these moments occur by contracting your pelvic floor (aka doing a kegel) and holding it as you cough, sneeze, laugh, jump.
Practice doing a kegel when you cough:
- Stand with your feet hip distance apart.
- Inhale and fill your belly with air, keeping your pelvic floor relaxed as you feel your belly expand outward.
- Contract your pelvic floor muscles in a kegel as you exhale, feeling your belly draw in towards your spine.
- Continue to hold the kegel and cough once. Try not to lose the strength of your kegel for the duration of the cough.
- Relax your pelvic floor.
This exercise should be challenging but not impossible. If your fake cough feels too intense to compete with, start with a smaller, less intense cough and then gradually progress until you feel strong enough for the real deal.
#8 Brace yourself.
If the ligaments of your knee are strained, injured or weakened, you may wear a knee brace while running or playing soccer without a second thought. A pessary is a brace for the ligaments surrounding your vaginal canal. It is a tool that is inserted within the vagina like a tampon and remains in place to prevent your pelvic organs from leaning into your vaginal canal and towards your vaginal opening. You may only need a pessary when participating in your sport or exercise, others may choose to wear a pessary if they are planning to be on their feet all day or just insert it when symptoms arise, and some people will wear a pessary all the time. There is no right or wrong way to use a pessary, its purpose is to support you when you need it. Speak with your provider to determine if you may be a good candidate for a pessary.
There are many types, shapes and sizes of pessaries so if you try one on and don't like it, keep working with your medical provider until you find the fit that is right for you.
Prolapse may affect as many as 65% of people with vaginal anatomy. If you are experiencing prolapse symptoms, reach out to your provider to determine what strategies and options may be available to you to help reduce your symptoms and improve your quality of life. A pelvic floor physical therapist who works to address your pelvic floor function and prolapse symptoms may be a great addition to your healthcare team.