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Pelvic Organ Prolapse and Exercise Part 2

The Barn KT9’s 3-part guide to understanding what pelvic organ prolapse is, where to start in managing symptoms, and how to continue exercising with prolapse written by our Instructor Tori.

Pelvic Organ Prolapse: What to do?

A new bulging sensation often sends women into Kegel-mode; “If I keep squeezing, then maybe it will go away!” But there are so many other, more effective, options so let’s explore those here. 

Pelvic Floor Physiotherapy: PFPT’s specialise in the assessment, treatment, and rehabilitation of the pelvic floor. They approach this by using:

  • Pelvic floor exercises (kegels)

  • Manual therapy (external and internal exam, if comfortable)

  • Biofeedback

  • Lifestyle/Behavioural modification

  • Scar therapy, whether from a c-section or episiotomy, can help reduce pulling, numbness and/or pain which will all have an impact on the pelvic floor. 

  • Assessment and treatment of core stability, posture, pressure management strategies, and movement tendencies concerning pelvic health

Even just one session can give you such valuable information regarding what your pelvic floor needs and how to progress forward with exercise. 

Women’s Health Osteopath: WH Osteopaths take a more holistic approach when treating POP and look at the human body as a whole, rather than lots of separate parts. For POP clients, treatment would include:

  • Manual therapy to improve connection and optimize the movement of the muscles, fascia, and ligaments of the pelvis.

  • Support with breathing to improve ribcage mobility and the coordination between the diaphragm and pelvic floor. 

  • Treating pain elsewhere in the body so the whole body feels safe and can function together as a unit. 

  • Scar therapy, whether from a c-section or episiotomy, can help reduce pulling, numbness and/or pain which will all have an impact on the pelvic floor. 

  • Visceral Osteopathy treats pelvic viscera/organs. An example that would be beneficial for someone with POP would be treating the bladder and/or rectum, which would improve the organ's ability to move properly and take pressure off of the prolapse.

Pre & Postnatal Exercise Specialists: A pelvic organ prolapse diagnosis can often steer people away from strength training, however, it may just be how someone is strength training that is causing more problems than good. Strength training with POP needs to be more intentional and more tailored for the individual. We start by stripping basic movement patterns back and marrying them with supportive breathing mechanics, pressure management strategies, and awareness of one's alignment. Once this foundation is built, we can then progressively add in more load and challenging movements until a new threshold for activity is reached. At the Barn KT9, you are always in the hands of a personal trainer who understands the relationship between strength training and pelvic health. Beyond our scope of practice, we have knowledgeable physiotherapists, osteopaths, and other health professionals whom we liaise with to help support our clients in their strength journeys. Scroll to the end of the blog to see our recommended women's health professionals.

Pressure Management: The core is a canister with the diaphragm sitting on top, pelvic floor on the bottom, abdominal muscles in the front and spinal extensors in back. These muscles all work as a team to create stability and to manage what is called Intra Abdominal Pressure. Without management, increases in that pressure will want to travel the path of least resistance, and for someone with pelvic organ prolapse, that usually means towards the pelvic floor. This can not only increase symptoms but can worsen the degree of POP. Tuning into your breathing, tension, and positioning tendencies is a must to move forward with exercising with POP. This is a huge part of pelvic floor physiotherapy and is the foundation of the postnatal fitness classes and Postnatal UpLift Beginning Courses held at The Barn KT9.

Toileting habits: When using the toilet with pelvic organ prolapse, things like the ability to relax the pelvic floor and good pressure management strategies are essential. If you find that you have to strain or are unable to fully empty, then things like pelvic tilts, elevating your feet on a step, diaphragmatic breathing, and including fibre-rich foods in your diet can be helpful tools. 

Pessary: The sports bra for your pelvic floor. It is designed to provide structural support to the walls of the pelvic floor to help with pressure management and improve symptoms. When fitted correctly by a pelvic floor physiotherapist, you should not feel anything. It’s there to ease your mind and allow you to go about your day, and exercise, without your symptoms holding you back. It can be used for extra support during activities where you feel symptomatic or can be used long-term. 

Prehab in Pregnancy: The ability to generate a good contraction of the pelvic floor is important, however, the ability to fully release that tension and relax the muscles is key. In pregnancy, those muscles must relax to allow movement of the pelvis and to help avoid injury during a vaginal delivery. Finding exercises that allow an increase in mobility of the hips, lengthening of the glutes and pelvic floor, and down training of the nervous system will be extremely helpful in preparing for birth and postnatal rehab. It’s also extremely beneficial to have thorough conversations with the birthing professionals who will be supporting you (midwives, OBGYN’s, doulas etc) about your birth options and preferences regarding pelvic health. 

Time: As with all things, time is a healer in itself. Postnatally, it takes time for the tissues of the pelvic floor to heal. For some it takes a few months to feel back to “their normal” and for others, it may take a couple of years. Understanding your pelvic organ prolapse and your pattern of symptoms [ie. When do you feel best? Does that change throughout the day? Or throughout your cycle? What is your threshold of activity?] takes time. Especially post-birth, there are so many factors at play that can impact your ability to focus on these things - such as looking after a newborn and your emotional well-being - that it may take time for your own POP rehab to become a priority. 

Mindset: Dr Google is not helpful when it comes to finding the right headspace after a pelvic organ prolapse diagnosis. Surrounding yourself with positive POP stories from like-minded individuals will help you feel less alone. Fear can also lead to an increased level of tension, or guarding, of your pelvic floor, which can worsen symptoms. To strengthen a muscle, we must be able to lengthen a muscle, and we cannot lengthen a muscle that is constantly being contracted. Slowing down, learning to release tension, and becoming intentional with movement will only benefit you in the long run. 

Surgery: For those with a grade 3 or 4 prolapse, surgery is an option. However, it would always be advised to seek multiple opinions and explore all rehab options first. 

So, as stated before, what works for one, may not work for another, so it’s important not to get hung up on what others are doing. Healing your prolapse is subjective to you and this takes time, effort, and usually a combination of support from the list above. Our bodies change and while one may be without symptoms for some time, things like pregnancy, changes in breastfeeding patterns, perimenopause, and menopause may cause changes again. Think of your symptoms as a way of communication between your body and your brain. Your brain wants to do A but your body (& prolapse) is saying “don’t forget about us” or “let’s try something different”. Finding the right tools to keep you feeling aware of your symptoms, positive, and empowered is the winning combination. 

So, what to do?

Don't be afraid to speak to one of our Instructors before class if you have any concerns, we're all welcoming and can help you to adjust your workout accordingly.

Chat to an Osteopath, here at The Barn KT9 we recommend Laura Tilson Osteopathy.

Chat to a Women's Health Physio, we recommend:

Read Part 3: How to Exercise with Prolapse (to be uploaded soon)

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