Last time, we took a deep dive into pelvic organ prolapse (POP) and its various forms, symptoms, and causes. Today, we are going to discuss some of the tips and tricks you can try if you are dealing with POP. We really believe that knowledge is power and the key to advocating for yourself, but we ALSO believe that knowing what to do and when can be hard to discover, and it’s even harder to know if what you’re doing is what is best for you. This post is divided into four sections: bowel movements, workouts, posture, and external supports, and we are going to elaborate and explain as best we can each of these sections and why they’re important.
**DISCLAIMER** These tips and tricks are general things to try if you are dealing with a pelvic organ prolapse, but everything is not one-size-fits-all. If you attempt any of these tips/tricks and feel like your symptoms worsen, please discontinue whatever you are doing, and seek out pelvic floor physical therapy. It is possible there are underlying tissue pathologies or movement impairments that need to be addressed with a physical therapist to understand what is going on with YOUR body and YOUR prolapse. Not every prolapse is the same, and while there are definitely commonalities (discussed here: https://www.empowerpelvichealth.com/post/pelvic-organ-prolapse-what-it-is-what-are-the-symptoms-and-what-you-can-do), treating your prolapse may look slightly different to treating someone else’s and those differences can make all the difference.
To discuss bowel movements, I believe we first need to discuss stool. A great tool to discuss and assess the quality of your stool is the Bristol Stool Chart. This chart shows the various types of stool. You should do your best to stay within a 3 or 4 on the chart, and if you are going in either direction, addressing what could be affecting your stool is an important step for you. Bowel movements directly tie in with pressure management and increased load to your pelvic floor and thus your prolapse. All of the tips and tricks that follow should benefit you in some way shape or form, but if you are still struggling and straining during a bowel movement due to the poor quality of your stool, you are doing yourself a disservice.
Now, stool is only part of the bowel movement equation, another variable is your potty posture; it can also make or break your bowel movements. Good potty posture is where you prop your feet up onto a squatty potty, stacked books, or stool (the height can vary) and you lean slightly forward and rest your elbows on your thighs. Keep your back straight and lean forward at the hips; do not hunch your back to rest on your legs. This posture best allows you to have a straining-free bowel movement and allows for your pelvic floor to relax and your rectum to be better aligned to allow your stool to pass.
So, we have two variables, now for the third and final: bowel mechanics. More specifically, breathing and sounds. Straining during a bowel movement is going to create too much intra-abdominal pressure for you and your prolapse. Creating appropriate pressure to aid you during a bowel movement is not impossible. After getting into good potty posture start by taking some good, belly-breaths and releasing them normally. When you feel like you need to start "pushing" or bearing down, one great way to create pressure is by taking a deep, belly-breath and keeping your belly “hard” and slowly releasing your breath as if through a straw. This is going to create good, appropriate intra-abdominal pressure. Other strategies would be to start the same, with a good, belly-breath, and then release your breath with a shhhhhhhhhhhh or a khhhhhhhhhhh. This will create a bit more intra-abdominal pressure, but still an appropriate amount. The main thing you want to avoid is bearing down inappropriately and straining to pass stool.
We've provided a video of Brittany Sudbrook, PT, MPT, FAAOMPT getting into good potty posture and practicing some bowel sounds as an example for you. She will also discuss in a separate video a way to tell if you are bearing down appropriately.
Working out and exercising is so good for you! But a lot of women can experience heaviness and pressure post-workout, and this can happen for a multitude of reasons. One reason is the time of the day; the best time to workout if you are experiencing a pelvic organ prolapse is the morning. If you have been on your feet all day, you’ve been up and about all day, or been not managing pressure well all day, and then you add exercise to the end of the day, you are more likely to experience this heaviness and pressure because gravity has been working against you all day.
Another reason you can feel post-workout heaviness is going straight from exercise to more activity with no break. You have been lifting, running, jumping, even walking and then continue with your activities without letting your pelvic floor recover from gravity, increased pressure, and stress/load. A great thing to do after your workout is to take a couple minutes and relax in a position that is going to take stress and gravity off your pelvic floor.
Two great positions to be in post-workout are wide-leg child’s pose (see above) or 9090 (see right).
Spend a couple of minutes in either of these positions and take some good diaphragmatic breaths while in the position.
Lastly, focusing on pressure during exercise is going to be important. A technique called “blow before you go” can help you to maintain good pressure while lifting/exercising. What you want to do is match your exhale with your effort. Say you are doing a squat, you’ll take a nice deep breath as you go down and then as you come out of your squat, you will exhale that breath while moving up. You are matching your exhale with the effort of the exercise. This process is going to help reduce the amount of intra-abdominal pressure and stress you are putting on your pelvic floor.
Posture is such a key tool in managing pressure, and poor posture can create increased pressure and symptoms like urinary urgency, and pelvic heaviness and pressure. Below is a video on how to get into a good posture that is going to help take some of that increased pressure off your pelvic floor. The main points are shifting your weight to be balanced over your whole foot, floating your ribcage over your pelvis, making sure your hips are in line with your ankles, and unclenching your glutes.
Another factor with posture and increased pressure is gripping your abdominals. A lot of us were told to suck it in when we were younger and still do to this day. Gripping your abdominals is keeping your system and container (group of bodily structures that relate to pressure) in a constant state of tension. You need to release your abdominals and let them relax. Allow your system to exist with a good, appropriate amount of pressure.
Here is Brittany explaining the common posture we see in pregnant and postpartum mommas and how to get into good posture for protecting your pelvic floor:
Somethings to try if you are experiencing prolapse are not necessarily solutions but support you while you seek solutions; a pessary is one of these things. This is a disk like device that is inserted into the vagina that acts as an internal support. A urogynecologist should be able to "fit" you for a pessary. It can be an effective tool to use during pelvic floor physical therapy to manually “hold up” the vaginal walls while we work on strengthening and addressing specific muscle imbalances or movement impairments.
Another supportive structure is a type of girdle. This device, unlike the pessary, is entirely external. It looks like a pair of underwear and is worn as external compression to help alleviate some of the feelings of looseness associated with pelvic organ prolapse. This girdle is like the pessary in that it is not a long-term solution, but merely a supportive device to use while addressing symptoms.
Lastly, another external supportive device is a type of compression short for pelvic organ prolapse. Think of something kind of like a bike short but with increased support in the section of the shorts that goes between the legs. These are also entirely external and can be used in tandem with pelvic floor physical therapy while a patient works on addressing symptoms and building strength.
We hope that these tips and tricks are helpful to you and have provided you with some insight into things you can try if you are dealing with pelvic organ prolapse. Please know, we recommend that if you think you may have POP, reach out to a board-certified urogynecologist or a pelvic floor physical therapist. These tips and tricks are generalized, and the best option is always going to be addressing symptoms with your body in mind after having done a thorough assessment of your pelvic floor muscles and entire musculoskeletal system. As always, we hope you learned something new and are always here if you have questions, want to learn more about pelvic floor physical therapy, or are ready to schedule an appointment. Use the button below to contact our Patient Care Coordinator directly. She would love to speak with you!