Pelvic Organ Prolapse (POP) is a diagnosis women can get postpartum and after childbirth. Statistically, 50% of women are at risk for POP after pregnancy, but you can develop POP prior to pregnancy. I ended up having a little pelvic organ prolapse during my "training for half marathon" days, which then worsened postpartum (with each of my pregnancies). Know this though, having prolapse does not mean you have to stop exercising. I certainly have not and I am pregnant with my third! :)
Prolapse can tend to be a scary word, so let's go over what it is. Pelvic Organ Prolapse (we will discuss female anatomy) is when the pelvic organs are pushing against weakened pelvic floor muscles that are not functioning to support the organs within the pelvis (bladder, uterus, rectum, urethra) and women can begin to feel pressure in vagina (sometimes women feel like an old tampon is coming out) from the organs starting to come down into the vagina.
3 Most Common Types of POP:
1: Cystocele: bladder prolapse. Women may complain of feeling pressure in vaginal canal. Sometimes the pressure is felt when the rectum is filling with stool and pushing in on cystocele. Other times it is felt after lifting or carrying weight (same with all 3 types), such as babywearing.
2. Uterine: The uterus can lower post pregnancy and delivery. Sometimes it is difficult to keep a tampon in due to a lower uterus or some women find intercourse uncomfortable because their partner may be hitting their cervix during deep penetration. Do keep in mind, the uterus does move during our cycles (higher and lower) and this is why some women may feel this during their days 14-21 of their cycle (different for everyone).
3. Rectocele: Rectum prolapse: Some women may complain of feeling a bulge in vagina when the rectum is full of stool. Some women have to "splint" or insert their fingers vaginally to push back on the rectum to void during a bowel movement.
Prolapses are measured by grades of 0-4. "0" meaning no degree of prolapse and "4" meaning the prolapse is bulging outside of the vaginal opening. Your doctor can give you your grade of pelvic organ prolapse in their office. I like to look at my patients' prolapase in the clinic in a few different positions and let the patients see what they are feeling in their vaginal canal. Remember, 50% or more of women can have some kind of degree of POP after baby and some can be asymptomatic and manageable. Some POPs cause more issues so it's important to seek proper postpartum exercises and the help of a pelvic floor physical therapist to assess what exercises would benefit you and help you get back to certain exercises that interest you.
With being early postpartum, and/ or if you are experiencing "feeling of pressure in your pelvis" or "pressure down there", it is important to avoid certain activities and exercises:
- Avoid standing for prolonged periods of time: this could be household work, baby wearing through the grocery store, carrying toddler, lifting heavy weight (moving furniture) etc
- Avoid wide leg squats and lifting from a deep squat, especially while holding your breath may increase your prolapse
- Avoid abdominal exercises: such as crunches, sit ups, planks and push ups (not saying avoid forever)
- Avoid running, jumping, HITT workouts, plyometrics and burpees etc ( I like to avoid these until 4-6 months postpartum AT LEAST to help the pelvic floor muscles heal properly after delivery).
What you can do while exercising in early postpartum:
- Pay attention to what you are feeling in your vagina while exercising and afterwards. Increased bulging and pressure are bad. If you feel this, you may have increased your exercise time or intensity too soon.
- Focus on your posture and alignment while exercising. Remember to keep ribs stacked over pelvis.
- Watch your breathing with exercises. EXHALE during exertion and avoid holding your breath with exercises.
- Focus on core and pelvic floor strengthening and retraining to get the muscles on the right tract to support you and your organs again
- Do exercises in different positions: lying on your back, back and hips elevated, sidelying, sitting, standing (avoid too much of this one due to gravity)
I like to suggest to new moms to seek the help and guidance of a pelvic floor physical therapist before getting back into running or plyometric exercises to avoid POP and other pelvic floor dysfunctions in the future (especially if they are having signs of pelvic floor dysfunction: urinary incontinence, pelvic pain, feeling of pressure, diastasis recti, low back pain, hip pain etc). .