Prolapse and Exercise

I am not too worried when patients use Dr. Google to find out more about their conditions. I encourage it in most situations. It means that the patients are engaged and they find out that they are not alone. The only exception to this is a Google image search for Pelvic Organ Prolapse (POP).  Not because I don’t want people to find out, but the pictures on the internet are pretty confronting.

For those of you who don’t already know a POP is when one of the pelvic organs- most commonly either the bladder, bowel or uterus- moves from its original position. This can mean that they start moving down into the vaginal cavity. Please note that the bladder and bowel do not come through the vaginal wall but pushes onto it. This condition is quite common and it is estimated that 60% of women over 60 have a degree of prolapse, and there is even evidence to suggest that approximately 15% of women under 25 also have one.

The cause of prolapse is living. The moment human beings stand upright gravity starts pushing down on those organs and the ligaments that hold them in place. Other events that can cause extra pressure on the pelvic organs is constipation, pregnancy and delivery and the menopause. More recently women have become more active and with the current focus on obesity are encouraged to exercise throughout their whole lives. What effect could this have on the pelvic floor and the POP?

After having a quick look through the evidence the only conclusion I can draw is that there is not much that has been published recently. The only relevant research i.e. within the last 10 years and looking at the difference between strenuous exercise (in this case CrossFit) and non-strenuous exercise (walking) was only performed on women that had not had any children. Another piece of research looked at whether there was a difference in middle-aged women who had completed strenuous exercise in their youth compared to those who hadn’t.

To be truthful Physiotherapy research can be a little hit and miss. There are challenges about reducing the placebo effect. The research on the women completing the CrossFit vs Walking trial showed that any activity including walking can cause a significant (in research this means a definite change) descent of the pelvic organs to into the vaginal cavity. The research on the affect of strenuous exercise in their youth implied that there could be an effect on POP in later life. In the CrossFit trial it was shown that despite the fact that women were overall stronger in the CrossFit group their was no difference between the strength of the pelvic floor between them and the non-strenuous group. This could indicate that if they are working at higher intensities they could experience more symptoms such as incontinence and discomfort later in life. To confirm this there should be more research.

It would be common sense to assume that the more pressure and exercise you would put your organs through the more support they can provide to your organs. Completing high impact activity, which is any exercise with both feet off of the floor at same time, exerts more downward pressure. The Pelvic Floor is the muscle that can counteract that downward pressure and prevent more damage. I am not wanting to discourage people from participating in sport. If it makes you feel good and you are having no problems then carry on. To help prevent issues in the future, do regular pelvic floor exercises and avoid constipation and do not use Google image search!

If you have any further questions or want to make sure that you are doing your pelvic floor exercises correctly visit me (Isobel Weaks) at Wellington Sports Med or Willis Street Physiotherapy.

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