Pelvic Organ Prolapse, or POP, can often be a devastating diagnosis. This is especially true for active women, because once you Google it, you find all sorts of ‘you can’t do xyz anymore’ and that can feel really limiting. Some of the suggestions don’t even make sense. For many women, symptoms appear after childbirth, and being told that you should have excellent lifting mechanics EVERY time you pick up your baby, or that you should never baby wear is just terrible advice because it’s not possible to adhere to. It is important for any woman to feel confident in her body so that she can take care of all of her daily tasks AND thrive. For some women, thriving includes working out at higher intensities. This workout was designed for those women, and I will detail below why I have chosen each of these movements for women experiencing POP. If you want to get straight to the workout instructions, scroll down! It’s a challenging one with or without POP!

This is not a ‘beginner’ workout to start immediately after a POP diagnosis. I always recommend that one follows up with a pelvic health professional to optimize pelvic health, breathing, and body mechanics, ensuring that you start with the basics before progressing to more intense workouts. If you start seeing a physical therapist who gives you a list of ‘never do this agains', it’s time to have a discussion. Your job in going to physical therapy for pelvic organ prolapse is to tell your therapist what activities you would like to do, and it is your therapist's job to optimize your mechanics, posture, and anatomy to get you on your way to achieving those goals. It is also important for you to be educated about POP. If you and your therapist have worked through understanding the potential risks and benefits of higher intensity exercise for your specific case and you wish to continue at higher intensities, you should be working together to achieve that goal.

We know from research that BMI, or body mass index, is an important and modifiable factor in POP. A higher BMI means likely more intraabdominal pressure on the pelvic organs, and more mass for the pelvis and pelvic muscles and ligaments to support. Working out (and healthy eating) can help to lower BMI, thus reducing stress to POP. Higher intensity exercise has not been found to be a risk factor for POP. This should be taken with the caveat that heavy occupational work HAS been associated with prolapse. But there is a huge difference in working out for an hour and working for 8. Typically people are more focused on form with working out, and are lifting things that are designed to be lifted. Work can involve all different shapes, weights, and repetition of objects needing to be lifted. So more research needs to be done on what type of occupations are most risky for prolapse. Another reason to consider exercising at your highest tolerated intensity (which would be a level that is below an intensity that would aggravate symptoms) is that a specific focus on strengthening should also carry over into pelvic floor strengthening. Again, this is important to check if you’re doing it correctly and have ensured this is happening. A strong pelvic floor works in favor of prolapse by helping to support the pelvic organs and structures. And your pelvic floor does not function in isolation. A strong hip girdle and core help to balance all forces through your trunk to avoid excess strain on any one area.

Lastly, you may consider the use of something like the V2 Supporter during workouts (or as needed) to provide a gentle support to the pelvic floor (think much less than a weight belt). You may also try something like VMagic, which is a nice vulvar area moisturizer if you have any issues with chafing-this could be more common early postpartum or in menopause because of the reduction in natural tissue lubrication. Both items are pictured below, the supporter is appropriate outside of pregnancy despite the pictures!

Hopefully I have provided some encouragement here for women who would like to do some higher intensity exercising. And with that, let’s get to the workout. Here’s why I have chosen each move specifically for POP:

• Kettlebell swings: the American style of KB swings reaching all the way overhead gives you an opportunity to slow the movement down versus a Russian kettlebell swing, which is to shoulder height. This helps to give time to ensure that your form is good. Plus, it allows you to coordinate with your breath (exhaling on the powerful swing up, inhaling on lower) until you feel confident managing your intraabdominal pressure (more on that here) and don’t need to focus so much on the breath coordination. To improve ease with these, drop the weight; to make them more challenging increase the weight and speed as your pressure management allows.

• Squat taps: Here you are moving through a small but challenging range. You should be focusing on posture and form, and ensure that at no point you are bearing down while breath holding. You should be able to feel a good burn in the buttocks, and keep a small arch in the low back to keep the trunk long and reduce pressure on the internal organs! To make this harder, go deeper or add more weight. To make them easier, don’t go so low and drop the weight.

• Pushups: This is a gravity-eliminated position for your pelvic floor. Again, you should be going slower and breathing on the push up, inhaling on the down until you are confident in your pressure management. A good indicator for this is paying attention to any pressure or fatigue in the pelvic floor. Once you are not aggravating anything with any part of the workout, it is fine to speed up and reduce or eliminate the breathing coordination. These can be made easier on knees and harder on a decline (feet on a bench, hands on the ground).

• Side Plank Walks: a stable pelvic floor starts with a stable pelvis. If you had any pelvic girdle pain with pregnancy, you may still have some stability issues. Side planks are an excellent way to help provide pelvic stability, and this moving variation allows a significant amount more work to go to the adductors. I have found clinically that hip adductors (groin muscles) tend to be easily forgotten but significant in assisting pelvic stability. This can be made more challenging by putting the hand on the ground, or easier by starting at tabletop height.

To determine if your prolapse will react to any of these movements I recommend doing the lightest intensity variations of each move. This is especially important if you have not been exercising at higher intensity regularly. If you are concerned that the workout may be too intense and increase symptoms, break it down and do one of the moves per day to check that none specifically worsens symptoms. Once you can complete each move without aggravation of you POP, start combining movements until you can determine if you can tolerate the entire grouping or some of its components. Do ehat you can and progress slowly toward the rest!

The POP Workout

4-5 Rounds

20 American Kettlebell Swings

10 Squat Taps (one rep is 3 taps each foot on both legs)

20 Pushups

10 Side Plank Walks each side (2 steps forward, 2 steps back is one)

Enjoy!! Comment below on how it worked for you, and any specific challenges you have had with working out with pelvic organ prolapse!