You're managing pelvic organ prolapse and you want to go (back) to the gym. While some may feel that these statements are at odds, we are huge supporters of women returning to the gym post diagnosis.
For many, the gym is not just a place of physical strength, but a community, as well. The psychological ramifications of a POP diagnosis can be particularly challenging for those who sought social support from the environment of the gym (or a workout class, or run club, etc.). While we are huge advocates of flexing one's "adaptability muscle" and finding new ways to thrive, we also find that many with POP are placed on restrictions that don't honor their true capabilities, or are too fearful to even consider returning to their previously loved activities. On the other end of the spectrum are women who have been told to "just do what you want!" and "come back when you want surgery!" They've been "cleared" to run, jump, and lift without proper assessment or appropriate guidelines.
Let's do better!
Here are five considerations to think about before you hit the gym with POP!
1. See a Pelvic Floor Physical Therapist (Physio)
In a perfect world, laundry would do itself, "work" would be scrolling baby animal videos on Instagram, and each woman would have access to excellent care through a pelvic floor physical therapist qualified to help manage POP and athleticism. We're certainly not living this utopian dream, but we can take steps in the right direction!
If you have access to pelvic floor physical therapy, we highly recommend taking advantage of it. A PFPT is uniquely qualified to provide internal examinations which provides valuable information on the function of the pelvic floor. They can work with you to identify your strengths and areas that might benefit from greater attention. They can provide feedback on your tendencies (are you engaging too much? Too little? Is your pelvic floor coordinating with the rest of your system well?) and prescribe interventions to improve the response of your pelvic floor. Pelvic floor PTs can work with you to get you from where you are to where you want to be!
2. Nail the Prerequisites
Movements exist on a spectrum - before you overhead squat a barbell, let's make sure you can squat your body weight first. Before you run, let's get you performing well on one leg without the impact.
Many with POP have "always done" a certain type of exercise and aren't quite sure where to go, now that their needs are different. Often, they move away from their desired activity entirely instead of simply taking a few steps back to work their way back up.
There are several ways to identify an appropriate starting point for you. When possible, in-person help from a qualified exercise or rehab professional is ideal. But if you're not able to access that care, you might consider online support, as well.
One tool you might consider is our online program, POP UP: An Uplifting Guide. Not only do we cover basic exercise science fundamentals that teach you how to consider the movements you want to do, we include a 12-week foundations exercise program that considers every movement pattern and part of your body and prepares you to return to more vigorous activity (and, by the way, once you're done, we have a more challenging 12-week program, too!).
Online coaching can also be a fantastic option. You might consider looking for a coach in your area here: http://www.briannabattles.com/professional-network/
With a basic understanding of how to progress and regress exercise, and an awareness of your strengths and not-yet-strengths, you can better scale movement to work for you while still participating in familiar programming, classes, and movements!
3. Dial in Your Strategy
It's not just what you do, but how you do it!
You can squat a barbell in a way that is supportive of your pelvic floor, or you could squat a barbell of the same weight in a way that taxes your pelvic floor beyond its functional threshold. Understanding your pressure management and the ways in which you're able to modulate it (breath, positioning, tension being a few) can make movement more (or less) accessible for you and the status of your pelvic floor.
POP UP: An Uplifting Guide includes modules dedicated to discussing and implementing strategies aimed at dialing in strategy to find ways to move that work for you!
With a strategy that works for where you are right now, you have more movement options available to you!
4. Establish a Baseline Symptom Profile
If you are typically not symptomatic of POP, then you'll typically find it much easier to ascertain whether a movement is provoking symptoms for you. With a few exceptions, most feel best performing exercise that keeps them below their symptom threshold (the point at which symptoms become present). This becomes, to some extent, a process of educated trial and error. If you are progressing appropriately (not going from 0-100 overnight), you likely have quite a bit of room to play around to see if movements are working for you.
But what should you do if you aren't ever free of symptoms?
It can be frustrating for some to hear that they should only exercise in a way that doesn't provoke symptoms when they always have symptoms. In this case, we recommend establishing a baseline symptom profile: an assessment of what your typical symptoms are that you can then use as your "baseline". We want to try to stay within a range that feels appropriate to you (you might still experience symptoms, but they are at a level that is familiar and manageable).
In order to do this well, a level of honesty is required: be honest with yourself about the symptoms you have, how bothersome they are, and the activities that seem to be related to the exacerbation of them.
It's also worth mentioning that an aggravation of symptoms is not always indicative that the physical presentation of your POP has changed. POP symptoms are poorly correlated to grade, and it's best to consider them as feedback versus proof that your POP is suddenly worse.
It's also important to note common situations when an uptick of symptoms might occur: during menstruation, ovulation, after getting little sleep, in times of stress, etc.
We always want to stress that only you can make the call on what is most important, meaningful, and relevant in your journey of POP management. Do we wish everyone to be able to enjoy their preferred activities symptom-free? Absolutely! Is that always possible? No, not always. There might be times when you choose to partake in activities that seek to provoke symptoms and you decide that it's worth it to you to continue that activity at this time. Your body, your business.
5. Pessaries: The Sports Bra For Your Vagina
Sometimes, an activity continues to exceed one's symptom threshold, even with the most functioning pelvic floor and best implementation of progressive overload. For those people, a pessary can be an excellent tool.
Pessaries are (typically) silicone devices that are inserted into the vagina to support the pelvic floor. They come in all different shapes and sizes and are typically obtained through a urogynecologist. Many choose to use their pessary only for activity (or certain types of activity) and some prefer to use them full-time.
While pessaries aren't a magic device that suddenly means all exercise is totally fine (progressive overload principles still apply!), they can be the tool that makes activity accessible, and can provide a confidence boost for many.
Perhaps most importantly, we want you to know this:
A return to the gym with POP is possible, and in many cases, preferable.
We want you to feel strong. We want you to be strong (in ways that work for you). The benefits of exercise are immense and difficult to state without dedicating another 10 paragraphs. And those paragraphs aren't necessary, anyway: you know exercise is helpful. You know you want to do it, and you want to do it in a way that is meaningful to you.
And we believe you can.
If you need help navigating a return to the gym with confidence, we can help you!
We'd be thrilled to support you. Consider accessing 20+ hours of evidence-guided support here.
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