If impact gives us symptoms, is it bad for our pelvic floor? Should we abstain from impact work all together?

In a word, no! If you experience pelvic health symptoms during impact activity, it’s just a sign that your pelvic floor muscles need some attention for a little while to improve the ability to manage the pressure. In fact, abstaining from all impact doesn’t actually help at all – what we need to do, instead, is find the level of impact that we can just about manage without symptoms and  then gradually progress from there whilst also doing daily pelvic floor squeezes (remember we have loads of information on how to do these in our Essentials resource). This is the quickest and safest path to long-term, symptom free impact.

Will high impact exercise make my prolapse worse?

Usually not, if you are mindful of the way in which your body is moving. We cover all you need to know to exercise safely with a prolapse in this guide and accompanying Umi Live but remember we always advocate seeing a pelvic health physio too if possible for an individualised assessment. The basics to remember are to use strategies that manage shock absorption well without creating excess pressure or tension and to increase your impact slowly and gradually based on how your symptoms feel. Remember that progress is not always linear (and that’s OK!) and, the sensation of a bulge in the vagina is a valid measure of prolapse so if you’re not feeling anything then everything is good. On the flipside, though, if you have the sensation of a bulge in the vagina it does not necessarily mean that things have got worse - sometimes, if we are too vigilant or obsessive in checking in with our symptoms and feelings, this can actually lead us to feeling a prolapse more. If in doubt, always seek an assessment.

What if my prolapse feels worse when/after trying impact again?

Firstly do not panic and try not to catastrophise. We appreciate that this is more easily said than done. Take some deep breaths. Remind yourself that pelvic floor symptoms happen to exercising and non-exercising people and will very likely improve within a few hours or days. You won't have done any irreversible damage and remember you are using your prolapse symptoms as your yardstick for where your body’s tolerance is at for impact. So, if you feel symptoms during or after adding some impact back in then this is the time to pause briefly and reflect on what you did. When your symptoms have settled again and you next exercise, what can you do differently? This might mean adjusting your strategy (more on this coming up) for example taking some reps off, or exercising for a shorter time, or maybe it will be a combination of the two - this really will be individual to you. Check out our section below on where to start adding impact back in again for a simple scale of impact movements that you can also use to modify your next session depending on where you’re at and how the prolapse is feeling.

Should I wear a pessary when doing high impact exercise?

A pessary is like a sports bra for the vagina and can be really useful for some women with prolapse. A pessary is worth considering if you feel as though your symptoms are really restricting what you’re able to do exercise wise or if you’re not progressing as quickly as you would like. In most cases your GP will be able to point you in the direction of your nearest pessary clinic. Some pelvic health physiotherapists are also trained to fit pessaries.

How can including impact exercise in my regime benefit my prolapse?

Recent research has shown us that there is significant reflexive or involuntary activity of the pelvic floor muscles during high impact exercise, which at times exceeds the amount of contraction which could be achieved during a voluntary pelvic floor squeeze. We should note that this research did not test those with prolapse, but if the principle is transferable, it suggests that high impact exercise, rather than something to be avoided, could actually be beneficial for those with POP.

Strategy: What can I do straight away to reduce prolapse symptoms with impact?

There are three crucial things that have been proven to decrease excessive pressure/increase pelvic floor functioning during high impact movements:

1. Relax your tummy muscles – the more we can relax our tummy when exercising the better. That includes you too pilates! Our body will automatically activate our tummy muscles to the required amount during exercise, consciously over-activating or clenching them is detrimental. If you have a tendency to hold your tummy in, maybe because you feel self-conscious of it (as unfortunately many women do), wear a looser top or high waisted bottoms while exercising. This might be helpful in allowing you to break the tummy-sucking habit.

2. Keep breathing – to lessen pressure we need to be breathing in and out throughout exercise. At no point should we be holding our breath or bracing. As the diaphragm links to the pelvic floor, maintaining diaphragmatic breathing whilst exercising also allows the pelvic floor to be flexible and therefore able to work at its most efficient. Be aware of this, in particular, during demanding activities which really leave you out of puff! Do your symptoms correlate with those activities? If so, turn the focus to your breath next time and see if it helps; this might mean scaling back the intensity a little temporarily. Remember to aim your breath into the bottom of your ribcage as opposed to lots of shallow breaths.

3. Relax the pelvic floor muscles – it has been shown that normal support within the pelvic floor is flexible and not rigid. Despite many women instinctively holding in their pelvic floor through fear of or experiencing prolapse symptoms, clenching the pelvic floor during exercise actually makes us more likely to have them. It’s recently been shown in high impact movements that the pelvic floor moves down and up with each heel strike/impact so it’s crucial that the pelvic floor is able to move. If you think you have any excess tension in the pelvic floor or pelvic area, make sure you check out our Umi Guide and Umi Live on this.

Is there anything else I can do?

Along with implementing the strategy suggestions already mentioned above:

• Keep your BMI below 30. Although the use of BMI as a marker of overall health is controversial, the research supports that a BMI over 30 is detrimental to the function of our pelvic floor. The more we weigh, the more pressure will be created meaning the pelvic floor muscles have to work harder to meet the demand.

• Try exercising on a softer surface e.g. on an exercise mat/gym floor as opposed to bare concrete, and get stretching your calves, especially if your ankles are a bit stiff! These two things help with your body’s ability for shock absorption.

• Start doing daily pelvic floor squeezes (not forgetting to fully let go in between each one) as soon as possible. Check back to module 3 in Essentials for the full lowdown on how to do your squeezes, how to check if you’re doing them correctly, what position to do them in and how many you need to do (start with at least 8 reps, three times per day and build up to being able to hold for 10 seconds in standing). Work towards doing the squeezes in functional positions that mimic your exercise choice, for example split stance or staggered stance.

Where do I even start trying to incorporate impact again?

Work out using the scale below where you can get to without feeling any prolapse symptoms and start there before moving up on to the next level. (It might take anything from 1-6 weeks before moving onto the next level depending on your baseline). You can make each level more challenging by adding more reps, height and/or speed or make each level easier by reducing reps, height and speed. There is a level for everyone so just start, remembering our tips above, and you’ll be getting better before you know it!

1. Horizontal impact eg jump one or two legs out/in when in a plank position +/- elevated hands

2. Stamping/stomping eg standing upright and literally stamping like an angry toddler

3. Landing from a heel raise from your tip toes

4. Hopping on one leg

5. Jumping with two legs

6. Running (first uphill, then flat, then downhill)

7. Skipping with a rope

(Be sure to check out the accompanying Umi Live for some video demonstrations of these)

Also, think in terms of the activities you want to do. For example, if you want to do box jumps, follow 1-5 above, and from there you could start by jumping down from a small box, then a taller box, then up to a small box, increasing the reps and height gradually.

Running specific considerations

Once you are at the stage of being able to add running into your exercise routine again, here are some running specific considerations for the pelvic floor that we couldn’t not mention:

• Lean. Leaning forward more when we run helps to reduce excessive forces through the body and therefore pelvic floor. This also helps to encourage our feet to land underneath our body rather than out in front of us which also really helps with reducing excess pressure.

• Rotation. Ensuring that our arms are an active part of our running technique is actually crucial for our pelvic floor! By ensuring that our ribcage is rotating and allowing our arms to swing and drive (a normal part of optimal running technique) it helps our tummy muscles to let go and for our breathing to be more efficient. All of these things again help to reduce excess downward pressure.

• Uphill vs downhill. Very simply, running downhill puts a lot more pressure and forces through the body than running uphill. This means that you will be more likely to be able to feel any prolapse symptoms when running downhill as opposed to running uphill. So if you are starting back running again, try to avoid downhill running for the first little while if at all possible.

• And lastly, look out for Run by Umi which will be launching in the near future and is jam packed with running specific considerations for a healthy and optimal pelvic floor now and into the future!

It feels as though I only have prolapse symptoms at certain times of the month, does the menstrual cycle affect things?

Yes it can. Naturally our hormones fluctuate and they can have effects on muscle physiology - mainly flexibility and endurance. This is not a detrimental thing or anything to be avoided, but it might help you to understand your body more. It’s still really important to adhere to the advice above, as then once your pelvic floor is able to perform better, you may not notice hormonal fluctuations by means of prolapse symptoms. If you think this applies to you, like we recommend all women do anyway in Essentials, be sure to track your cycle and log your prolapse symptoms to gain better understanding.