Restore Your Core The Intersection of Prolapse & Weightlifting: What Athletes Should Know

The Intersection of Prolapse & Weightlifting: What Athletes Should Know

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The Intersection of Prolapse & Weightlifting: What Athletes Should Know

By Lauren Ohayon 01/25/2024

4 Min Read

For athletes, especially weightlifters, managing pelvic organ prolapse can be challenging. There are risks to consider before participating in your sport, including the possibility of making your prolapse worse. Gaining an understanding of the forces at play can help you make more informed decisions about your training and long-term pelvic health, especially when weight lifting with prolapse.

Prolapse and its prevalence in athletes

Pelvic organ prolapse is a condition in which one or more of the organs contained in the pelvis have moved out of place. Most people experiencing prolapse will also experience other symptoms of pelvic floor dysfunction, such as back pain, constipation, or leakage. The symptoms are also accompanied by uncomfortable sensations such as heaviness, a felt or visible bulge, or the feeling of something stuck or falling out of the body.

The question pelvic health professionals are often asked is: Can lifting weights cause prolapse? The prevalence of pelvic organ prolapse in athletes has not been studied in nearly as much detail as urinary incontinence, which is highly studied among both the general population and people who engage in high-intensity exercise. However, a recent literature review (2023) provides some insight into whether the increased loads of athletic pursuits such as weight lifting correlate with a higher incidence of pelvic organ prolapse: the numbers are roughly the same as in the general population, with a few notable details. 

  1. The highest risk factor for pelvic organ prolapse is vaginal birth. Very few other activities can match the intensity of the load placed on the pelvic floor during a vaginal birth.
  2. The highest number of pelvic organ prolapse cases occurred among female Olympic weightlifters and powerlifters.
  3. Strenuous exercise in general, performed without awareness of pelvic floor muscles or appropriate strategies for managing intra-abdominal pressure, can increase the risk of pelvic floor dysfunction, including stress incontinence and pelvic organ prolapse.
weight lifting with prolapse

Can lifting weights cause prolapse? The answer is no, not by itself. But doing so without paying attention to how your pelvic floor muscles react to your training can increase your symptoms if you do have a prolapse. The good news is that you can train yourself to manage the pressure better. 

It’s important to understand how prolapses come about in order to manage your symptoms and discomfort. Learning how to manage intra-abdominal pressure is key to successfully lifting weights with prolapse. We’ll dive into the why and the how throughout this article.

Understanding Prolapse: Basics for Athletes

Prolapse types and symptoms

There are five primary types of pelvic organ prolapse:

  • Bladder prolapse- Cystocele
  • Rectum prolapse- Rectocele
  • Uterine Prolapse 
  • Vaginal Vault Prolapse
  • Small Intestine Prolapse- Enterocele

Symptoms you may experience:

  • A heavy pulling or dragging sensation in the pelvic floor
  • Pain or discomfort during intercourse
  • Difficulty with urination, including incomplete bladder emptying or urine leakage
  • Constipation
  • Back pain
  • Visible or palpable bulge 

It is difficult to say unequivocally that there is only one cause of prolapse; rather, it is a combination of conditions, often including a lack of tone in some of the muscles of the pelvic floor, that allows for one or more of the organs nestled in the pelvic bowl to “slip” or “drop” down. The feeling of heaviness, the sense that something’s not in the right place, or like something is falling out of your body, is incredibly disconcerting, and leads many people to stop exercising completely for fear of making it worse. The mental health toll of feeling like your body is broken can make the healing process even harder, especially if you’re used to having your sport as a mental health support.

While slowing down and learning new strategies for moving may be necessary for some period of time, you absolutely can get back to moving. The treatments for prolapse include both physical therapy and surgical options. The general recommendation is to focus on exercise-based solutions first, and if after a year you are seeing no progress, to explore other options. Prolapse is an injury, and it takes time to heal, just like a sprained ankle or broken wrist.

Weightlifting and Its Impact on Prolapse

Weightlifting, when performed with good form, is not inherently harmful to the pelvic floor. And while there are more weightlifters with pelvic floor issues (especially urinary incontinence), that doesn’t mean that choosing to lift weights means that you are going to give yourself pelvic floor dysfunction. Strength training is an important component of any physical fitness program, and teaching your body to manage a variety of loads is essential for all bodies, regardless of whether you’re an athlete.

However, precisely because weightlifting increases the maximum loads you’re moving with your body, there are some special considerations when it comes to your pelvic floor and weightlifting. 

Let’s look at a squat as an example of how the ways that lifting weights with prolapse can be complicated. Squat variations are great whole-body exercises–we include them in Restore Your Core® because they are so effective at teaching the body how to coordinate the muscles of the leg, back, and core. In a weightlifting context, there are some specific aspects of the squat that can be challenging for folks with prolapse.

The Intersection of Prolapse & Weightlifting

A well-executed squat requires the use of the muscles of the legs, particularly, the quads, gluteal muscles, and hips; it also requires a certain amount of hip, ankle, and knee mobility. The erector spinal muscles help maintain the position of your spine, while the muscles of the core and pelvic floor work to stabilize the trunk as you come in and out of the squat. The depth of the squat may vary depending on the requirements of your sport, but the essential movement pattern is the same. 

Intra-abdominal pressure

What doesn’t get nearly as much attention when you’re learning how to squat is how to manage the intra-abdominal pressure that comes from putting in effort to perform the lift. Think about how you might bear down to have a bowel movement when constipated. We often will do the exact same thing while working with a heavy load in the gym. 

Here’s how intra-abdominal pressure works: Imagine the whole core system (including the pelvic floor and diaphragm) as a balloon, and picture squeezing the top of the balloon like you’re holding your breath. The bottom of the balloon pushes out and down. When we have excess tension in the upper body, or in the pelvic floor, that pressure increases beyond what is necessary.

A movement like a squat already takes a good deal of coordination, and if there are other compensation patterns popping up as you lift (e.g., your knees want to knock in, or you need to turn your feet out wide to get depth in the squat), you may find that you’re displacing more of the load onto the pelvic floor than you should.

All this does not mean that you should stop lifting weights because you have pelvic organ prolapse! What it does mean is that you need to learn techniques for offloading the pelvic floor and better distributing the effort among all the muscle groups involved in any given exercise. In order to do so, you may need to back off of the loads you’re working with until you find a less symptomatic baseline.

Safe Weightlifting Practices with Existing Prolapse

Some guidelines for weight lifting with prolapse include:

  • Learn how to breathe in a way that reduces intra-abdominal pressure
  • Use your symptoms as a guide for how much effort is too much
  • Reduce the amount of load you’re working with until you’ve trained your pelvic floor to withstand higher loads
  • Work with a professional to find optimal techniques–some of these may be as simple as changing your stance, while others may require learning to recruit some muscles differently. 

Side note: One methodology for diagnosing prolapse includes using the valsalva maneuver–which is also a popular breath control technique for lifting heavy weights– that particular maneuver is used to help discern the maximum depth of the prolapse. So use caution if you’ve been trained to use a Valsalva/breath-holding technique. Ideally, you would consult with a professional trained in working with athletes with pelvic floor disorders in order to find a suitable solution for your particular body.

Modifications and adaptations in weight lifting routines

In addition to working with lighter loads, another way to reduce pressure on your pelvic floor when lifting weights is to change the angles involved. To come back to our squat example, you may find that a shallower squat enables you to work with a heavier load with fewer symptoms because you’re not compensating for a lack of range of motion at the joint with increased pressure. 

Pelvic floor strengthening exercises

If you’re lifting weights with prolapse, you should consult with a physical therapist who specializes in pelvic health in athletic populations in order to determine what aspects of pelvic floor work you need to do. While pelvic organ prolapse is often a result of laxity in the tissues of the pelvic floor, folks who are highly athletic frequently have a pelvic floor that is actually too tense. Getting assessed to see what’s going on in your pelvic floor will make planning to strengthen your pelvic floor much easier. A solid program that continues to incorporate aspects of weight training with pelvic rehab exercises (such as Restore Your Core®) is ideal.

Preventing Prolapse: Tips for Weightlifters

Again, pelvic organ prolapse is not necessarily caused by weight lifting alone. However, it is helpful to consider ways to prevent pelvic organ prolapse as a weightlifter if you have no existing history of prolapse. The most common risk factor for pelvic organ prolapse is birth. So if you plan to get pregnant, and you are an athlete or a weightlifter, you will want to do some prehab work during your pregnancy and as part of your postpartum recovery

Incorporating pelvic floor health into training routines

The other thing you can do to prevent prolapse is learn good strategies for preventing excessive intra-abdominal pressure throughout your daily life as well as in the gym. You can incorporate pelvic floor health into your training routines by adding warm-ups or cool downs that focus on core engagement, breath training, and pelvic floor strengthening and stretching. 

A whole body program like Restore Your Core® can be useful as a routine to work into your week, but just adding a few minutes a day of mindful movement can help make your pelvic floor more reflexive and responsive, even to the big loads you’re lifting. 

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You don’t have to live in

fear, pain or discomfort

Get back the confidence + lifestyle you love.

Role of diet and lifestyle in preventing prolapse

Constipation is another risk factor for pelvic organ prolapse because of the downward pressure on the pelvic floor when you are straining to have a bowel movement. So eat plenty of fiber and drink water to keep your digestion moving smoothly.

Key takeaways  

You can lift weights, and you can be an athlete even with pelvic organ prolapse. Even if your particular prolapse requires surgery, having a good grasp of the forces at play will help you recover better. 

When to consult with a professional: It’s quite likely that if you’ve been diagnosed with pelvic organ prolapse you have a medical team. Keep them informed of the kind of training you’re doing, and let them know right away if you have a sudden increase in symptoms, new symptoms, or any other discomfort that seems out of the ordinary. Knowing your body is key. While making progress in your training is possible, it may go more slowly than you’re used to. Aim for progress, not perfection. Doing a core and pelvic floor rehab program such as RYC® can help you learn strategies to better manage your prolapse, learn the correct form for listing so as not to add additional pressure to your pelvic floor, and move towards healing your prolapse. 

If you suspect you may have a pelvic organ prolapse and would like to know if it is being caused or exacerbated by weight lifting we recommend seeing a pelvic floor specialist either online (you can book an assessment with an RYC® teacher here), or in person.

FAQ 

1. Can weightlifting actually cause prolapse?

Heavy lifting with improper form may contribute to the development or exacerbation of pelvic organ prolapse (POP) in some individuals, though it is not usually the only contributing factor. Weak pelvic floor muscles and other risk factors, such as vaginal birth, may also play a role in POP in athletes.

2.  What are the early signs of prolapse in athletes?

Early signs of pelvic organ prolapse may include a feeling of pressure or fullness in the pelvic region, discomfort during physical activity, and changes in urinary or bowel habits. Athletes experiencing such symptoms should seek medical evaluation.

3. How does prolapse affect long-term athletic performance?

Pelvic organ prolapse can impact athletic performance by causing discomfort, pain, or limitations in movement. Athletes may need to modify their training routines to manage symptoms and prevent further strain on the pelvic floor.

4. Are there specific weightlifting exercises to avoid if you have prolapse?

People with prolapse may need to avoid certain weightlifting exercises that put excessive pressure on the pelvic floor. Consult with a healthcare provider or a pelvic health specialist for personalized advice.

5. When should athletes with prolapse symptoms consult a healthcare provider?

Athletes experiencing symptoms of pelvic organ prolapse, such as pressure, discomfort, or changes in bowel or urinary habits, should seek prompt medical attention.

6. Can prolapse be completely cured, allowing for a return to full weight lifting activities?

It really depends on your particular body. A complete return to your sport may not always be possible, but targeted exercises, along with a solid plan from your healthcare providers, may help you return to weightlifting, even with prolapse. A rehab program such as RYC® can help you learn supportive core and pelvic floor strategies to alleviate your symptoms and (in time) take part in your favorite activities without intensifying your prolapse.